The Ethics of Organ Transplants: The Current Debate

A. L. Caplan, C. T. Van Buren,
and N. L. Tilney

The transplant community is currently awash in a sea of proposals calling for the creation of financial incentives in the United States as a solution to the shortage of cadaver organs and tissues. ^1,2,3,4,5,6 Although the plans vary in detail, all imply that monetary incentives will increase donation. African Americans are a particular target of financial compensation schemes as they are underrepresented in the overall pool of cadaver donors relative to their numbers in the general population. ⁷ Because they and other minorities may be in low income categories, financial incentives are sometimes touted as likely to be attractive. ^8,9 Advocates of paying for organs often argue that since some poor persons face the potential burden of uncovered medical expenses, funeral costs, or both, the prospect of compensation might encourage them to agree to organ or tissue donation, should the situation ever arise. ¹⁰ Those favoring reforms to make it legal to pay for cadaver body parts sometimes support the morality of such policies by noting that since other parties involved in transplantation, from procurement organizations to surgeons, make money from the procedure, it should not be illegal for donor families also to be compensated.^8,11

We believe that existing law and public policy should not be modified to permit compensation. A national policy, regional efforts, or pilot projects which permit payment, either direct or indirect, for cadaver organs may further reduce already marginal numbers of donors and may very likely be deleterious for those currently awaiting transplants. There are important ethical and pragmatic reasons for not changing the present policy.

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