Incentives, please
Mar 23,2007 00:00 by The San Diego Union-Tribune

For years, the U.S. government has done strikingly little clear thinking about organ donation and how to encourage it. Transplant surgery has become routine, but few healthy organs are available. Yet this deadly supply problem is considered a taboo public policy issue, primarily because of fears that giving incentives to people to donate organs will spawn a ghoulish black market and prompt the destitute to risk their health to pay the rent. Fortunately, we're finally seeing some progress. The House of Representatives recently approved a measure that legalizes paired kidney donations. Many people with failing kidneys have family members or friends willing to donate a kidney, but their organs are a bad match because of conflicting blood or tissue type. Setting up a kidney exchange program - in which willing donors can be paired up with suitable recipients in a reciprocal arrangement - is a highly promising approach that could significantly reduce the 4,000 or so Americans who die each year waiting on a new kidney.

Unfortunately, such deals have been interpreted as running afoul of the flat federal ban on people benefiting from donating an organ. This is crazy, so we're heartened that the Senate seems strongly inclined to pass the House bill and promote this clever approach. In anticipation of that day, a database of California residents with failing kidneys and willing but incompatible donors should be established right away.

Still, this is only a very modest start. The U.S. kidney waiting list has more than doubled in the past decade - there are more than 15,000 on California's list alone - and this trend is sure to continue in coming years as baby boomers age. Other organ waiting lists are also long, thanks to a widespread reluctance by Americans to agree to donate their organs upon death.

It's time to address these problems with basic incentives. Their power has been documented in, of all places, Iran. Under a 19-year-old government program, individuals who can safely donate a kidney are paid up to $4,000 and provided with after-surgery care and health insurance. Since 1999, Iran has been the only nation on Earth without a kidney-transplant waiting list.

Without going to such a crude arrangement, it is easy to see how the United States could achieve similar results. Why not give a substantial tax credit or prefunded health savings accounts to individuals who can - without endangering their own well-being - donate a kidney? Why not give individuals who agree to organ donation upon death an estate-tax credit or contributions to their children's or grandchildren's educational savings accounts? Relying on altruism hasn't worked. It's time we started giving people a more compelling reason to help their fellow man.


Reprinted from The San Diego Union-Tribune.