Should the families of organ donors be compensated?

0:01Stacey Vanek Smith:NPR.

0:11Stacey Vanek Smith:Kurt Sweat remembers one of the first times he watched a surgeon remove the heart from a deceased patient. I'm very queasy with blood and there's obviously a lot of blood. There's obviously a very bad stench in the operating room, things like that, that kind of you don't expect.

0:26Cardiff Garcia:It was 2021, and at the time, Kurt was a grad student at Stanford studying economics, although most of the people in the operating room did not know that.

0:36Stacey Vanek Smith:Someone mentioned I'm a student, and they assume I'm a med student or something. I remember they asked me to tie knots on the gown, and I don't know how to do that. So, you know, I was just like, you know, I'm the wrong kind of student. Afterwards, Kurt tagged along with the transplant team as they transported the heart from this operating room in New Mexico to an OR in California. There, another patient was waiting. Knowing that this person's heart was going to a young boy at the pediatric hospital at Stanford, I mean, it was just amazing. It's been a few years since Kurt first witnessed how organ donation can save a life.

1:15Stacey Vanek Smith:And the experience stuck with him because in his own nerdy econ brain way, Kurt wants to help save lives, too. This is The Indicator from Planet Money. I'm Adrian Ma.

1:28Cardiff Garcia:And I'm Waylon Wong. Today on the show, Kurt and his colleague Alex Chan get into the economics of organ donation. And they argue why the government should financially compensate donors and their families.

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2:53Stacey Vanek Smith:Whenever you have a demand for something and a limited supply, you've got a market. And when it comes to the market for human organs, Harvard economist Alex Chan says the stakes are brutally clear. With more than 100 ,000 people on the National Organ Transplant waiting list, the consequences of market inefficiency are the difference between life and death. So the level of inefficiency is also staggering, right? In this market, more than 5 ,000 people every year die waiting for organs. They're waiting for kidneys, livers, hearts, and lungs. The government spends billions of dollars a year on healthcare for people on the waiting list.

3:30Stacey Vanek Smith:For example, in recent years, it's spent between$30 to$45 billion a year on dialysis and other treatments for people dealing with chronic kidney disease. That accounts for actually a huge part of our national budget. through Medicare and other sources. So this is not just a life and death decision, but also a decision that is a huge amount of implication on our fiscal stability as a country.

3:53Cardiff Garcia:Recently, Alex and his colleague Kurt Sweat came up with a proposal they say could help increase the number of organ donations, would save lives, and save the government money in the process.

4:04Stacey Vanek Smith:And here's their idea in a nutshell. When a person dies in the hospital, their organs might be donated if they're a registered organ donor or the family gives consent. In either situation, Kurt says the government should reimburse donors' families for their funeral expenses. But that's not all. Other things that might be covered are things like support for the donor family. Think travel and hotel rooms for a family that want to be near their loved one throughout the donation process. The amount of compensation might be capped at$6 ,000 to$8 ,000, the typical cost of funeral services. And by offering this incentive to everybody, Alex and Kurt believe more families would consent to their loved ones' organs being donated, and more people would choose to become registered donors in the first place.

4:49Stacey Vanek Smith:And the result, they estimate, would be a 9 % to 35 % increase in the number of organ donations each year.

4:57Cardiff Garcia:Wow. I mean, that's a really big range, obviously, but even the low end of the range, 9%, seems very significant to me. And as a result, they say thousands more lives would be saved. And the government would save money as there would be fewer people on the wait list in need of expensive, long-term medical treatment. So on paper, seems like a pretty good idea, right?

5:18Stacey Vanek Smith:Right. Except for a few potentially glaring issues. The first being that under the current law, this whole proposal is illegal.

5:27Cardiff Garcia:Oh, minor detail. Minor detail.

5:30Stacey Vanek Smith:And the backstory to why is actually pretty interesting. The story sort of goes that there was someone who wanted to go to other countries and pay people to donate one of their kidneys. Because kidneys, you have two. So you could do a living donation. They wanted to basically go pay people elsewhere to do that and then bring the kidneys back to the United States.

5:51Cardiff Garcia:This is like getting into urban legend territory for me.

5:54Stacey Vanek Smith:Right?

5:55Cardiff Garcia:Yeah. And when we first heard this, we had a hard time believing it. But indeed, in 1983, a Virginia doctor named H. Barry Jacobs formed a company called International Kidney Exchange. According to an article in The Washington Post, he talked about sourcing organs from, quote, U.S. citizens and third world indigents.

6:16Stacey Vanek Smith:This is a great way to make money. I go somewhere, I get the kidneys cheap, I bring them back to the U.S., I transplant them, and I charge a bunch of money. And everyone thought, that's just, that's terrible, that's icky.

6:27Cardiff Garcia:It is terrible.

6:29Stacey Vanek Smith:Yeah, I think I understand the ick factor is pretty strong here.

6:35Cardiff Garcia:Off the charts, yeah. Shortly after this, Congress passed the National Organ Transplant Act, which, among other things, outlawed the exchange of any human organs for, quote, valuable consideration. And on the one hand, this obviously makes sense. Like, imagine if the market for organs revolved around wealthy people paying for the organs of poor people. That would be incredibly dystopian, like an episode of Black Mirror.

7:00Stacey Vanek Smith:Absolutely. On the other hand, though, what Alex and Kurt are proposing here is far from that. And Alex argues that tweaking the law to allow compensation for donation has some existing precedent. Like, after all, he points out that people can get paid for donating blood plasma. And a person who donates their whole body to medical research is actually allowed to have their funeral costs covered. It's like an interesting dilemma, right? Like whole body you could pay, the blood plasma you could pay, but sort of somewhere in between the organs, not okay.

7:32Cardiff Garcia:But let's put aside the legal issues for a moment and talk about another potential issue with their proposal. The ethics. Is it even right to offer this sort of incentive to people in exchange for their decision to donate? Here is how Alex sees it.

7:48Stacey Vanek Smith:People worry that financial incentives will corrupt sort of this gift of life that is a pristine thing, the whole transplant process. But if you think about the process more holistically, right, a lot of players already have incentives. He says the transplant surgeon is paid to do the surgery. The organizations that procure organs are paid for that work. But the donors and their families? They are the true heroes of the story. They are the folks who actually are left out of the system where incentives are embedded.

8:17Cardiff Garcia:He says allowing them to be compensated for funerals, hotel, and travel costs, that would actually make the system more fair, particularly for people who might struggle to afford those things.

8:29Stacey Vanek Smith:When you're well off, you can afford to hang out in the hospital nearby and you could skip work. Where if you are a family of donors who are less well-resourced, now you are not allowed to be there with your loved ones, even though you have both made a heroic decision. So after hearing Alex and Kurt make their case, we wanted to get a sort of second opinion from someone who works with people who've actually made that heroic decision. And so we reached out to Shelly Snyder. Shelly is an executive director for Donate Life Kentucky Trust, which is a nonprofit that provides education and financial support to donors and their families.

9:03Stacey Vanek Smith:Financial strain is very real for families. I think we also have to consider, though, that any policy would need really clear guardrails and separation from the decision to donate in order to protect that public trust. She says people are often making this decision at an emotionally vulnerable time, and she doesn't want them to feel like their decision is being influenced by money.

9:30Cardiff Garcia:One way of avoiding this might be through raising public awareness, running ad campaigns, letting people know that compensation for donation is a thing long before they ever have to actually make the decision. Another might be making sure that people responsible for discussing donation with families are separate from those who would handle reimbursements. In the end, Shelley says, it should be about honoring people's generosity.

9:55Stacey Vanek Smith:The people who say yes to donation are doing it because they want to save another human's life. And that always needs to remain at the forefront of the reason for making that decision to donate their organs as a registered donor or to donate their loved one's organs. And that's what organ donation has always been built on.

10:23Stacey Vanek Smith:This episode was produced by Angel Carreras and engineered by Kweisi Lee. It was fact-checked by Sierra Juarez. Cake & Cannon is our editor and the Indicators production of NPR.

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