Conference considers compensating organ donors

Conference considers compensating organ donors

May 16, 2003

Could financial rewards for organ donors--dead or alive--eliminate the suffering and death caused by the long wait for kidney or liver transplants? A team of transplant physicians, medical ethicists and economists will consider that question, and others, at a two-day conference to be held at the University of Chicago's Gleacher Center, 450 N. Cityfront Plaza, on May 16 and 17.

There are currently more than 54,000 people in the United States waiting for kidney transplants, where the median wait for an organ exceeds three years. The 17,000 people waiting for liver transplants can expect to wait more than two years. Many of those waiting will die before they get a transplant. In 2001, 2,918 people died waiting for a kidney and 1,978 died waiting for a kidney.

The keynote speaker, Gary Becker, a Nobel Prize-winning economist from the University of Chicago, will argue that monetary incentives offered to living donors could increase the supply of organs for transplant "sufficiently to eliminate the long queues in the organ market" without significantly raising the total cost of a transplant.

Until now, discussion of paying for organs has focused almost entirely on cadaver donors. But Becker argues that there are not enough potential cadaver donors to meet the demand. Currently, only Iran allows payment of living donors.

Such payments, however, could dramatically increase the number of donors, argues Becker, who has worked with economics department colleague Julio Elias to predict the effects of reimbursing organ donors. They estimate that if a kidney were priced at about $15,000, that would attract enough donors to close the gap between supply and demand. Because donating part of a liver involves greater risk and discomfort, the price of a liver would be about twice as high, around $32,000.

At those rates, kidney transplants would increase by almost one-third, from 13,000 (in 2000) to more than 17,000 per year. Liver transplants would increase by 60 percent, from 5,000 (in 2000) to 8,000 per year.

"This is a provocative and thoughtful but controversial proposal," said David Cronin, a transplant surgeon at the University of Chicago and the co-organizer of the conference. "The technical aspects of transplantation have improved year by year, but we still have a bottleneck caused by the shortage of donors. This is exactly the sort of thinking that we need to move transplantation forward, and the sort of idea this international conference was designed to consider."

Other speakers will consider the ethical, legal and policy issues of paying organ donors and issues of organ allocation.

"Though there already is a market for bodily parts, gametes, tissues, corneas, etc., it's not clear how ready people are to agree with the selling and buying of organs," added Kristina Orfali, sociologist and ethicist at the MacLean Center for Clinical Medical Ethics at the University of Chicago and co- organizer of the conference. "Ethical, legal, cultural and even religious barriers will have to be overcome before such a major adjustment can be accepted."

The conference was sponsored by the Biological Sciences Division, the departments of surgery and economics, the MacLean Center, and the Irving B. Harris Graduate School of Public Policy Studies at the University of Chicago, and by the France Chicago Center. Fujisawa Healthcare, Inc., supplied additional support.

Program: Friday, May 16
3:45 p.m. Welcome by James L. Madara

4:00 p.m. Session 1: Moderator: Mark Siegler
Financial Compensation and Organ Donation: Can We Boost the Organ Supply?
Speaker: Gary S. Becker, "Financial Incentives for Live Organ Donation"
Respondent: Francis L. Delmonico
Discussion Panel: Christoph Broelsch, Leonard Morse, and James Schulak

Saturday, May 17
9 a.m. Session 2: Moderators: Kristina Orfali and David Cronin
Financial Compensation and Organ Donation: Ethical, Legal and Policy Issues
Ben Mitchell, "How Much for a Liver? Transplantation and Ownership of the Human Body"

9:20 a.m. Philip J. Held and Friedrick K. Port, "The Impact of the Organ Shortage Beyond the Immediate Loss of Life: Social, Medical, and Economic Costs"

9:40 a.m. Eric Cohen, "Arguments For and Against Financial Incentives in Organ Donation"

10:45 a.m. Jeffrey Punch, "Saving Lives: Making a Case to Test Financial Incentives to Increase the Cadaveric Donor Supply"

11:05 a.m. Robert Sells, "Thoughts from Munich 2002: Some New Bioethical Agreements on Old Contentious Issues"

11:25 a.m. Discussion Panel: Nancy L. Ascher, Dolph Chianchiano, and Robert Metzger

2 p.m. Session 3: Moderator: J. Michael Millis, "Organ Allocation: Policy Issues"

2:15 p.m. David O. Meltzer, "From IOM to MELD: Is Liver Allocation Improving?"

2:35 p.m. Christian Hiesse, "The Allocation for Kidneys in France: A Legal-Based System for Equitable Access to Transplants"

2:55 pm. Discussion Panel: Sadek Beloucif, Maryvonne Hourmant, and J. Richard Thistlethwaite

4:00 p.m. Concluding Remarks by David Cronin