Studying Financial Incentives for Cadaveric Organ Donation

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Physicians’ ethical obligations to contribute to the health of the public and to support access to medical care extend to participating in efforts to increase the supply of organs for transplantation. However, offering financial incentives for donation raises ethical concerns about potential coercion, the voluntariness of decisions to donate, and possible adverse consequences, including reducing the rate of altruistic organ donation and unduly encouraging perception of the human body as a source of profit.

These concerns merit further study to determine whether, overall, the benefits of financial incentives for organ donation outweigh their potential harms. It would be appropriate to carry out pilot studies among limited populations to investigate the effects of such financial incentives for the purpose of examining and possibly revising current policies in the light of scientific evidence.

Physicians who develop or participate in pilot studies of financial incentives to increase donation of cadaveric organs should ensure that the study:

Is strictly limited to circumstances of voluntary cadaveric donation with an explicit prohibition of the selling of organs.
Is scientifically well designed and clearly defines measurable outcomes and time frames in a written protocol.
Has been developed in consultation with the population among whom it is to be carried out.
Has been reviewed and approved by an appropriate oversight body, such as an institutional review board, and is carried out in keeping with guidelines for ethical research.
Offers incentives of only modest value and at the lowest level that can reasonably be expected to increase organ donation.

AMA Principles of Medical Ethics: I, III, V, VII, VIII, IX

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Opinion 1.1.1

Patient-Physician Relationships

At the heart of medicine lie relationships founded in a “covenant of trust” between patient and physician in which physicians commit themselves to responding to the needs and promoting the welfare of patients.

Opinion 2.1.1

Informed Consent

Informed consent to medical treatment is fundamental in both ethics and law. Patients have the right to receive information and ask questions about recommended treatments so that they can make well-considered decisions about care.

Opinion 6.1.1

Transplantation of Organs from Living Donors

Donation of nonvital organs and tissue from living donors can increase the supply of organs available for transplantation, to the benefit of patients with end-stage organ failure. Enabling individuals to donate nonvital organs is in keeping with the goals of treating illness and relieving suffering so long as the benefits to both donor and recipient outweigh the risks to both.

Opinion 6.1.4

Presumed Consent & Mandated Choice for Organs from Deceased Donors

Donations under presumed consent (or mandated choice) would be ethically appropriate only if it could be determined that individuals were aware of the presumption that they were willing to donate organs and if effective and easily accessible mechanisms for documenting and honoring refusals to donate had been established.

Opinion 6.2.2

Directed Donation of Organs for Transplantation

Donation of needed organs to specified recipients has long been permitted in organ transplantation. Directed organ donation policies that produce a net gain of organs for transplantation and do not unreasonably disadvantage other transplant candidates are ethically acceptable.