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AMA Split Over Proposed Payments for Transplant Organs

Organization to vote on whether to study compensation plan

MONDAY, Dec. 3, 2001 (HealthDayNews) -- Would organs for transplants be more plentiful if they were sold as well as donated? The American Medical Association (AMA) may soon find out.

The nation's largest doctors' group is considering a plan to study whether compensating the families of dead organ donors would help ease the burden on the country's strapped transplant system.

The proposal from an AMA committee would apply only to organs harvested from cadaveric transplants, not grafts taken from living donors. Also, it would not alter the current system of allocating organs through a waiting list to the neediest patients. Congress outlawed compensation for organ donors in 1984, though the practice is legal in other countries.

Dr. Frank Riddick, Jr., chairman of the AMA's council on ethical and judicial affairs, says the proposal has met with mixed and often emotional reaction from physicians in the 290,000-member organization. Many feel compensation would coerce poor people to donate to the advantage of the rich.

The measure will be voted on by the AMA's 550 delegates tomorrow or Wednesday at a delegates' meeting in San Francisco. But Riddick says the proposal is simply an attempt to learn if a "a non-coercive system and one that's not predatory" will lead to more donor organs. "We will never know, unless we do the pilot studies to find out," he says.

Last year, doctors transplanted just under 6,000 cadaveric organs, about 27 percent of the total number of transplants, according to the United Network for Organ Sharing. On the other hand, approximately 5,600 people died while waiting for donor organs, and the list of those needing grafts rose to more than 79,300 by the end of 2000, the group says.

Donor system experts estimate that one in three Americans is willing to give up organs upon death. And only one in every three medically eligible donors donates.

"We're burying organs and people are dying," says Brian Broznick, president and chief executive officer of the Center for Organ Recovery and Education (CORE) in Pittsburgh. CORE, one of 59 organ-gathering groups in the nation, operates in a state that does about 400 transplants each year, says Broznick.

He supports some form of compensation for donors. "I think we've got to find something new. Altruism simply is not working," he says.

The Pennsylvania legislature in 1994 passed an initiative allowing motorists to contribute $1 to a trust fund for the families of organ donors to help with hospital expenses or burial costs. But state health officials froze that money -- now as much as $180,000 -- after concluding that the payments would have violated the federal compensation ban.

Broznick says, however, that the state will begin disbursing the trust fund next year to pay hospitals for overnight stays, meals and other incidental expenses incurred by families of organ donors.

The fund will chiefly benefit living donors who travel for their surgery, he says, because relatives of cadaveric donors typically go home after the decision to permit transplantation. "We would have much rather seen the burial expense benefit," he adds.

Jonathan Moreno, a bioethicist at the University of Virginia in Charlottesville, says compensation for organs is almost certainly occurring already in the United States as financial arrangements slip through the screening systems in place to prevent them.

"We don't know what takes place outside the consulting room. There's a serious effort to make sure there's an altruistic intent," he adds, but notes that it's impossible to fully police the system.

Moreno believes allowing compensation for organs would be a mistake, not only because of the "gray market" that would arise but because it's not clear whether such a move would benefit those who need transplants. At least one economist, he says, has argued that opening a market for organs in this country would deplete, rather than expand, the number of available grafts.

Emanuel Thorne, the Brooklyn College economist who proposed that hypothesis, says it's possible that opening a market in organs would discourage donors guided solely by altruism.

"The assumption that a market will increase supply must assume that the donations will continue or that the incentive of the market is so profound that" it overwhelms the retreat of altruists, he says. "There's no evidence of that," he adds.

Thorne also believes the current system hasn't done enough to encourage charitable organ gifts, which he feels explains the dearth of organs. "It's just a matter of effort, it's not a question of a fixed supply of altruists," he says.

Moreno says the debate over compensation is "a distraction" from other avenues of increasing the pool of organs, including stem cell research and xenotransplantation (the use of animal tissues).

But Broznick argues that a compensation scheme, carefully applied, could save lives. And he says those who question its ethics should consider that sperm, egg and plasma donors are already being paid for their services.

"If we're doing those things, what's wrong with paying for organs?" he says.

What To Do

For more on the organ supply in this country, try the United Network for Organ Sharing or the Coalition on Donation.

You can also try the Center for Organ Recovery & Education.

SOURCES: Interviews with Frank Riddick, Jr., chair, American Medical Association council on ethical and judicial affairs; Brian Broznick, president and CEO, Center for Organ Recovery and Education, Pittsburgh; Emanuel Thorne, Ph.D., assistant professor of economics, Brooklyn College, Brooklyn, N.Y.; Jonathan D. Moreno, Ph.D., director, Center for Biomedical Ethics, University of Virginia, Charlottesville, and senior research scholar, Kennedy Institute of Ethics at Georgetown University, Washington, D.C.; American Medical Association
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