organ shortage

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State Pushes For More Organ Donors Fall Flat (So Maybe Pay Big Bucks?)

In this 2011 photo, people fill out forms in which they can register as an organ and tissue donor, as they apply for a California drivers license at a DMV office in Los Angeles. (Nick Ut/AP)

In this 2011 photo, people fill out forms in which they can register as an organ and tissue donor, as they apply for a California drivers license at a DMV office in Los Angeles. (Nick Ut/AP)

For the nearly 80,000 Americans who are on waiting lists for organ transplants, this is probably not news: Though all 50 states have been trying to encourage people to sign on as donors for years, all those efforts have barely made a dent in the organ shortage.

That’s the central finding of a new paper just out in the journal JAMA Internal Medicine, and it prompts a provocative commentary in the same issue — Time To Test Incentives to Increase Organ Donation — co-written by Yale’s Dr. Sally Satel. An excerpt:

“We believe it is time for disruptive innovation. By this concept, we mean compensating donors, not simply seeking to soften the financial ramification of donation. It is time to test incentives, to reward people who are willing to save the life of a stranger through donation. … Our current transplant system is inadequate for the task of boosting the volume of organs needed for life-saving transplantation. Altruism is not enough. Pilot trials of incentives are needed.”

Food for thought: The commentary suggests not a free market and lump sums of cash for organs, but a government- or charity-run system of “in-kind reward,” like, say, a tuition voucher for about $50,000, or payments covering funeral expenses. Readers, what do you think?

I spoke with the lead author of the article that documented the failure of current policies to make a dent in the organ shortage: Dr. Paula Chatterjee, a clinical fellow in Internal Medicine at Brigham and Women’s Hospital. Our conversation, lightly edited:

How would you sum up what you found?

We know that thousands of patients die every year because of shortages in organ supply, and finding ways to address this public health issue is critical. States have passed a variety of strategies over the past few years, but we didn’t know if any of these strategies have been successful. What we found is that for the most part, these strategies have had almost no effect on increasing organ transplants and donations over the last few decades.

Basically, what we can say is that in states that adopted these strategies versus those that did not, the rates of donation and transplantation were essentially the same. The only strategy we found that may have had a very modest effect is the creation of revenue pools — which is basically a way for a state to put aside a pool of money, whether it’s from voluntary contributions or state-dedicated funds, to promote organ donations in whatever way the state feels would be helpful. And even that policy alone had a pretty modest effect.

Is it just that it’s too big of an ‘ask’ for policies that nibble around the edges? Continue reading