How to Best Incentivize Organ Donations?

(Polka Dot)

Organ donation is a familiar topic around here. Back in December, we discussed whether there should be a legal market for organs in a podcast episode called “You Say Repugnant, I Say… Lets Do it!” A few weeks ago, we blogged about whether the idea of a legal organ market is losing its stigma. So we were immediately intrigued by news that emerged earlier this month from China, about a 17-year-old boy who had sold his kidney for $3,392 to buy a new iPad 2. From the BBC:

The 17-year-old, identified only as Little Zheng, told a local TV station he had arranged the sale of the kidney over the internet. The story only came to light after the teenager’s mother became suspicious. The case highlights China’s black market in organ trafficking. A scarcity of organ donors has led to a flourishing trade.

The story turned out to be perfect fodder for Michele Goodwin, who has embarked on a three-part series on organ transplantation over at the Chronicle of Higher Education. Goodwin argues that the organ transplant market is far too restrictive, and makes the case for creating better incentives for organ donors in order to undercut the black market. From her first installment:

Some might read the take away from Little Zheng’s story as a warning against incentives for organs, but that would be short-sided and incomplete. Don’t get me wrong, black markets in organs are illegal and brokers should be prosecuted to the fullest extent of the law for coercing, exploiting, and otherwise harming organ suppliers. But, keep in mind, organ demand outpaces supply, and the will to live is strong—Darwinian you might say.

Organ supply is a problem in China and the United States. In the United States, there are 111,519 patients waiting for organs. About 7,000 people who could benefit from an organ transplant will die in 2011. Most of those who will die are patients on the transplant wait list. The  patients who will hang on this year might wait six or seven years before a suitable organ becomes available. For an increasing number of patients that length of wait-time is a death sentence. For those patients, the black market is a logical solution.

In her second installment, Goodwin sketches out the restrictions that surround the organ transplant market:

The National Organ Transplant Act (NOTA) has been problematic for some years. Under the Justice Department’s enforcement of NOTA, there was the prohibition of organ swaps, meaning a husband and wife who didn’t match couldn’t swap with neighbors who did match.

Violation of NOTA can result in a felony conviction, with a five-year prison term and $50,000 fine.

She then lays out a few ideas on how to provide better incentives to donors:

Jake Linford, a young professor at Florida State University Law School, advocates for scholarships for kidney donations. According to his plan, give a kidney and get a full scholarship. No loans or owing the banks with that proposal. Other incentive-based proposals include burial benefits for families who donate their deceased relatives’ organs, tax deductions, mortgage forgiveness, and free medical coverage for life. These all have merit and are worth considering by states and the federal government—now, not later.

If we want people to step up to the plate to be organ donors in a healthy, transparent system, let’s give them something.  If police officers, fire fighters, and military men and women receive acknowledgments, including incentives for saving lives, why not show that same kindness to potential organ donors? It’s a much better and safer solution than black markets.


What's the best way to incentivize people to donate their organs?

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  1. Chad says:

    I learned about one interesting solution to the problem of organ donation from a fellow student at Princeton whose senior thesis was solving a network problem of organ exchange. If I remember correctly, for organs that one can donate without dying, often a willing donator is not a match for the donatee. What her model did was match up donations across the country, so that if I wanted to donate to my wife, but didn’t match, and another person was in the same situation, I would essentially donate to his wife, and he to mine (both matches). When this network is much larger than two families (i.e. the whole USA), the number of organs that could be donated is much larger than the current number that are. There are obviously a lot of kinks to work out, but this system could be implemented if the rules disallowing the selling of organs (effectively prohibiting the trading of organs) were altered. Ah Optimization.

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    • Bree says:

      Donations like that have happened in MN. I think I read that the most “complex” multi-donation was eight different organs?

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  2. nitin d says:

    Hidden due to low comment rating. Click here to see.

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  3. Mark M says:

    The problem with any opt-in system is that organ donation isn’t as straightforward as one imagines it might be. The process isn’t simply saying yes and it is done.

    I was recently widowed and donated my late wife’s organs. This meant that in the middle of the worst day of my life I had to sit there and answer an hour’s worth of fairly personal questions about her life. They also kept her on life-support for about 36 hours after she was pronounced dead, prolonging that agony. She was then wheeled off to surgery at an hour that was convenient for them denying me any control of a crushing moment.

    The local organization made efforts to honor her donation, but that really just means reliving that horror again. A name on a wall is no substitute for my wife.

    I am not sure that I would do it again if I was in the same situation again. I can’t possibly imagine that there is some amount of money that would change this opinion.

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  4. Tim Nelligan says:

    Hey, how about treating them like human-being, instead of tins-o-beans, or batteries, and ALLOWING the human beings to HELP each-other? No? Ok. @tnteacherTim

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  5. mannyv says:

    Who pays? Everyone makes money off the organ donation process except the donor. That’s patently unfair. Take Tim’s idea and go further: donors (or the estate) of the organ in question receive a percentage of the donor’s income stream. That sort of financial uncertainty would torpedo the idea.

    Really, the problem is that the only stakeholder that isn’t represented in the process is the deceased/donor. Everyone else wants to keep the system as-is: recipients get free organs (via insurance) and the various entities (doctors, storage/transport companies, harvesters) in the supply chain benefit from free raw materials (ie: organs).

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    • ThatMattGuy says:

      Great point! If it’s unethical for me to gain even “a cup of orange juice” from giving up a kidney to someone, why is it ethical for everyone on the surgical team to gain financially from it?

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  6. Dave Undis says:

    The best way currently-legal way to incentivize people to donate their organs is to allocated organs first to registered organ donors. Few people would refuse to donate their organs if they knew it meant going to the back of the transplant waiting list should they ever be unlucky enough to need a transplant.

    Anyone who wants to donate their organs to other organ donors can join LifeSharers. Membership is free at or by calling 1-888-ORGAN88. There is no age limit, and no one is excluded to to any pre-existing medical condition. Anyone who joins LifeSharers will get preferred access to the organs of other members, currently numbering almost 15,000.

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  7. Carolina says:

    I think the idea of the incentives would work best if there were several ones that people could choose from (ie. a scholarship OR help with mortgage).. Although a scholarship would be appealing to many, it wouldn’t be very effective as it doesn’t apply to everyone (whereas tax breaks and health care subsidies does).

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    • Enter your name says:

      Tax breaks don’t appeal to low-income people. A lot of blue-collar families pay almost nothing in federal income taxes.

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  8. SC doc says:

    As a health care professional, I take offense to the fact that you would suggest this.

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