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 In addition to removal of financial barriers, they would also like
to see careful consideration and testing of potential financial
incentives for organ donation.
But any changes in current practice must be able to pass tests of
both efficacy and ethics, says the 38-member Incentives Workshop
Group, comprised of representatives of the American Society of
Transplantation and the American Society of Transplant Surgeons.
The group published its recommendations in a paper in the American
Journal of Transplantation.
“Every person in the chain of an organ donation, except one,
profits,” said Daniel Salomon, an author of the paper and the
medical director of the kidney and pancreas transplant program at
Scripps Health in San Diego.
That “one” who doesn’t profit is the donor. According to the
American Journal of Nephrology, living donors incur out-of-pocket
expenses averaging $5,000. While a recipient’s insurance covers the
donor’s medical expenses, it won't cover transportation, lodging,
childcare and lost wages.
And families of deceased donors may face higher hospital and funeral
costs resulting from donation.
“Donor costs should be incorporated into the cost of the
transplant,” said Tom Mone, CEO of OneLegacy, the nation’s largest
organ procurement organization. “The donor should bear no economic
detriment.”
The workshop group maintains that upfront cost coverage would result
in drastic and long-term savings among insurers by facilitating
organ donation.
“From every single patient that stays on dialysis, the payer is
losing $60,000 a year if they are not transplanted,” Salomon said.
According to the U.S. Organ Procurement and Transplantation Network,
more than 123,000 Americans await organ transplants. Roughly 4,000
die each year.
But according to the United Network for Organ Sharing, the number of
living kidney donors in the U.S. has been declining. In 2014, they
numbered 5,817.
While there’s agreement that financial barriers prevent too many
potential donors from proceeding with the surgery, incentives are a
murky territory. The 1984 National Organ Transplant Act made donor
compensation illegal. But other incentives may be effective without
interfering with inherent altruism, the authors say. For families of
deceased donors, for example, coverage of extra funeral costs could
be considered.
Offering incentives to living donors, however, “is so ethically
charged,” said Elisa Gordon, a Northwestern University medical
anthropologist and working group member. “We don’t know if that
would result in exploitation or undue inducement.”
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“We have a responsibility to living donors,” Salomon said. “But, we
basically take their kidney and say goodbye.” He maintains that
donors should receive lifetime health coverage, while other working
group members have suggested coverage for a certain time.
Some people fear that such offers may go too far, however. Any harm
attributable to living donation, including medical costs and lost
wages, should be mitigated, said Mildred Solomon, CEO of The
Hastings Center and a Clinical Professor of Anesthesia at Harvard
Medical School. But lifetime care constitutes a “perverse incentive”
in the U.S., she believes.
“We are the only developed country in the world that doesn’t see
healthcare as a universal right,” Solomon said. “What a statement it
would be about our society if people decided to give an organ so
they could get health insurance.”
Working group members say a balance should be struck between
burdensome donation costs and compensation, and this balance can be
identified in careful consideration of other incentives- but not
cash.
“The conversations have been too polarized,” said University of
Nebraska Medical Center transplant surgeon Alan Langnas, a paper
co-author. “When you have those two arguments, nothing happens.”
Salomon said he anticipates dialogue with the Centers for Medicare
and Medicaid Services, private insurers and donors who themselves
have experienced roadblocks.
“We need to initiate discussions with a broad group of stakeholders
in this country, starting with the patients, families and payers,”
Salomon said.
SOURCE: http://bit.ly/1abgQVQ
American Journal of Transplantation, online March 31, 2015.
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