Intended for healthcare professionals

Rapid response to:

Analysis And Comment Controversy

Payment for living organ donation should be legalised

BMJ 2006; 333 doi: (Published 05 October 2006) Cite this as: BMJ 2006;333:746

Rapid Response:

Who will pay?

This was a very interesting article. My first question to the author
would be - who would pay the cost of reimbursing the donor?

Who would then decide on the level of reimbursment? A flat fee
reimbursment may overcompensate some who do not incur much cost in
relation to travel etc, and may undercompensate others. This does not
seem at all fair.

If there was no flat fee, who would decide when to cap - or even if
to cap the payment. This may lead to a system of auctioning of organs -
with those who had the most money being able to attract the organs.

It is naive to believe that paying for organs will help prevent
exploitation of those at risk. I frequently get calls from people wishing
to take part in clinical trials, not because of wishing to advance medical
knowledge, but because they really need money. This is unethical and a
previous author raised the point that, rather than using existing
practices to justify something that seems slightly distasteful, perhaps we
should be reexamining our current practices.

More money needs to be spent on education, prevention and early
detection and treatment of chronic organ disease. The education also
needs to be directed to the general public about voluntary organ donation
and the process needs to become more transparent. Why is there not a
"living organ donation register" in the same way there is a bone marrow,
or blood donation register? Lets try appealing to people's altruism
before we try bribing them.

Ultimately, I propose that if cash for organs is to be made legal, it
should be conducted in the same method that reimbursement for bone marrow
donation is. The donor has their travel and accomodation costs paid for,
and small compensation for loss of earnings. They lose nothing except an
organ, and they gain nothing except the satisfaction of knowing they have
saved a life - far more valuable than a new pair of shoes.

Competing interests:
None declared

Competing interests: No competing interests

14 October 2006
Emma L Grabinski MB ChB
Research Associate
Univeristy of Michigan, Ann Arbor, MI, 48105