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AMA considers whether to pay for donation of organs

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7353.1541 (Published 29 June 2002) Cite this as: BMJ 2002;324:1541
  1. Deborah Josefson
  1. Nebraska

    In a major and contentious policy shift, the American Medical Association (AMA) has voted to encourage studies that would determine whether financial incentives could increase the pool of cadaveric organ donors.

    The association's House of Delegates endorsed such studies after furious debate at their an-nual meeting in Chicago, Illinois.

    The issue was originally considered at a meeting in December 2001, when the association's council for ethical and judicial affairs ruled that financial incentives to encourage organ donation were not intrinsically unethical and warranted further study.

    However, when a vote was called, the House deemed the issue too controversial to be dealt with at that time and opted for reconsideration at their annual meeting in June 2002.

    At this latest meeting a reference committee initially opposed endorsing such studies, but ultimately the resolution was passed.

    Currently, US federal law prohibits the sale of organs and any “valuable consideration” for organs under the provisions of the 1984 National Organ Transplant Act. The act recognises only altruism as a motivator for organ donation.

    However, altruism alone has not increased the number of organ donors, and organs are in critically short supply. Nearly 80000 people are on transplant waiting lists, and an estimated 15000 people on those list die while waiting for an organ, according to the United Network for Organ Sharing, the non-profit making agency that maintains transplant waiting lists in the United States. Last year 6100 people died waiting for an organ.

    Momentum has therefore been building to study whether financial incentives would increase the pool of organ donors. Among strategies to be considered are small payments of $300-$1000 (£200-£670; €310-€1032)—which could deflect the funeral cost of a relative—and preferential consideration for organ donation when a member of someone's family member has donated an organ.

    Proponents of incentives point out that payment for blood and blood products as well as eggs and sperm are already routine and that it is more unethical to let people on transplant waiting lists die than to study whether monetary enticements could ameliorate the situation.

    Those opposed to such measures generally contend that payment represents the slippery ethical slope of organ trafficking.


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