Common Questions and Our Answers to Them

Q1. What are the arguments for using a death benefit to encourage families to donate the organs from their deceased loved ones?
Q2. What are the arguments against such a death benefit?
Q3: Won't family members be utterly disgusted and/or deeply insulted by any attempt to offer them money for their deceased loved one's organs?
Q4: Doesn't a death benefit put a price on the human body, which many people find offends their sense of human dignity?
Q5. Don’t opponents of financial incentives also say they won’t work?
Q6: Doesn't the National Kidney Foundation vehemently oppose any sort of monetary compensation for donating organs?
Q7: Why $5,000?

Q1. What are the arguments for using a death benefit to encourage families to donate the organs from their deceased loved ones?

A. Supporters say it will save thousands of lives a year and shorten transplant waiting times for tens of thousands of Americans, greatly improving the recipients' quality of life.

Q2. What are the arguments against such a death benefit?

A. Opponents say it starts us down a slippery slope, that today it might be a death benefit for the act of donating, but tomorrow it'll be payment for the organs themselves, the day after that it'll be payment to living donors, and after that it'll be traders buying and selling human organs like hog futures on a commodities market.  We say that's preposterous.   We think a standard $5,000 death benefit will be adequate to double or even triple the supply, and that this will end the shortage, along with any need to have living people risking their lives as living donors. The people waiting and dying for organs aren't concerned about any "slippery slope." As far as they're concerned, our organ transplant system has already fallen off the cliff.

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Q3:  Won't family members be utterly disgusted and/or deeply insulted by any attempt to offer them money for their deceased loved one's organs?

A:  Yes, and so would we if we were approached in such a crude way. That is why we were careful to spell out the exact language that we'd like to see used, so that the family will understand that they're not being offered payment for their loved one's organs, but a societal thank-you gift as a token of appreciation for their life-giving act of community service.  And they can always donate the gift to their loved one's favorite charity.   Why would that be offensive?

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Q4: Doesn't a death benefit put a price on the human body, which many people find offensive?

A:  No,it only seems that way to those who don't fully understand the proposal.  Once people realize it's a standard amount, rather than an amount that is adjusted according to the actual value of the organs, and once they realize it can be refused or donated to a favorite charity, they are much more accepting [read the thoughts of one such person here].  Most people have no problem with death benefits being paid to servicemen killed in the line of duty, and don't regard the latter as a vulgar attempt to "buy off" the family.  It's a thank-you gift for a life-giving act of community service - a token of appreciation.  But even if some people still find it offensive, what is more important – the lives of the people dying on the transplant waiting list, or the feelings of the people who oppose even trying financial incentives?  You decide.

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Q5. Don’t opponents of financial incentives also say they won’t work?

A. Yes, they sometimes say that. But the available evidence suggests otherwise.   Economist David Kaserman of Auburn University and his colleagues conducted a survey, and found that even modest amounts of monetary compensation ($500-$1000) could greatly increase the rate of donation (see Adams, Barnett, and Kaserman, Contemporary Economic Policy, 17: 147-155 (1999)).  In the real world, Spain in the late 1990s found that compensating families for donating the organs of their deceased loved ones greatly increased the supply.  But here in the U.S., financial incentives have never been tried. We want to give them a try, for the sake of the people dying while waiting for transplant operations.

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Q6: Doesn't the National Kidney Foundation vehemently oppose any sort of monetary compensation for donating organs?

A: Yes, they do.  But the American Medical Association, The United Network for Organ Sharing, and the American Society of Transplant Surgeons have all conducted vigorous internal debates about the ethics of financial compensation, and all have officially concluded that some types of compensation can be done in an ethically sound manner, and have advocated pilot studies, as have the American Association of Kidney Patients and the Florida Medical Association.   But as to the NKF, we simply disagree with them, vehemently.  Here are some of the things they say, and our responses.

They say "Payments would be very easy to start...but impossible to stop."
We say our government could stop payments any time our elected officials so chose.  And if such payments do become impossible to stop, it'll be for one reason: because they are saving lives!

They say "Money is an insult to donor families."
We say a thank-you gift for community service is perfectly acceptable, and that refusing to even test the effectiveness of such compensation is a grievous insult to the thousands of Americans who suffer and die each year while waiting for organs that never come.

They say "There is no way to do this and maintain our values as a society."
We ask, "What values are they trying to maintain that are more important than the more than 6,000 lives that could be saved every year, not to mention the vast improvement in the quality of life of the tens of thousands who could get a kidney and get off dialysis?"

They say "The voluntary system we have, free of coercion or commercialization, is the only ethical way medicine can be practiced in the United States."
We say there is nothing ethical in letting people die if a monetary thank-you gift could save their lives.  Besides, the current system is not free of coercion, as family members often feel pressured into making a living donation to a relative.  If we could end the shortage by doubling or tripling the rate of cadaveric donation, we could eliminate the circumstances leading to this type of family-imposed coercion.

They say "We must be able to say to our patients and the public, we don't pay for organs, period. We must have a voluntary system so that all families who made a decision to save someone's life can proudly say, we 'donated' organs."
We think families would be even prouder to say, "We donated our loved one's organs, and on top of that we donated our $5,000 death benefit to our loved one's favorite charity."

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Q7: Why $5,000?

A: Five thousand dollars is enough to convey to families how deeply important the decision to donate is, and not so much as to make anyone jump up and down as though they'd won a lottery, i.e, it's not so much that it'd be viewed as an amount that people couldn't refuse.  We view it not as coercive in that sense, but as a substantial reward that will encourage people to do the right thing.  And, the fact that it is a round sum emphasizes that it's a gift, like something one might get from a rich relative upon getting married, and not tied to anything from life's more mundane economic realm.