Ethics and Medico-legal

By Dr Elizabeth Feeney

Australia has a low rate of organ donation with approximately 1700 people on organ transplant waiting lists. Most will wait between six months and four years to receive a transplant and many will die before an organ becomes available.[i]

Australia’s system of organ donation is based on altruism, where individuals undertake a free and informed choice to donate their organs. Direct payment for organs is illegal.ⁱ

While the majority of Australia’s donated organs come from deceased individuals, living donors make an important contribution to the supply of organs for transplant. Living donation may include tissues, whole organs such as kidneys, and parts of organs such as livers.[ii] In Australia, over a third of donated kidneys for transplant come from living donors.ⁱⁱ

Living organ donors place their own health at risk for the benefit of others. For those willing to become living donors, it’s important they are treated with respect and fairness.

Which brings us to the question – should we reimburse living donors for expenses associated with donation?

In response to a recent article in the British Medical Journal proposing regulated paid provision of living donor kidneys in the United Kingdom[iii], Medical Director of Kidney Health Australia, Mr Tim Mathew, reiterated a call for the Government to consider reimbursing live kidney donors for reasonable and verifiable expenses associated with donation.[iv] While some medical expenses may be covered through the public health system, other donation-related expenses, such as lost income, may not. For some, this poses a barrier to donation.

Many would consider offering financial incentives to living donors ethically unacceptable as it may take unfair advantage of economically challenged or otherwise vulnerable people (and even contribute to organ trafficking). 

But reimbursement for living organ donation could be undertaken in a way to simply recover expenses related to the donation itself, including lost wages. In this way, living donors do not ‘profit’ from donation, but do not incur any significant expenses that may otherwise impede their ability to donate.

This is the critical question. Does reimbursement constitute a financial incentive to donate organs? Some will say ‘no’ - reimbursement of certain associated expenses removes a barrier to donation but is not an incentive to donate. Others will say ‘yes’ – removing a disincentive to donate (the associated expenses to the donor) constitutes an incentive to donate.

What do you think?

[i] Australian Government. Organ and Tissue Authority. Facts and Statistics. http://www.donatelife.gov.au/Discover/Facts-and-Statistics.html (accessed 5th September 2011).

[ii] National Health and Medical Research Council. Organ and Tissue Donation by Living Donors. Guidelines for Ethical Practice for Health Professionals. Australian Government 2007.

[iii] Rabbitt Roff, Sue. We should consider paying kidney donors. BMJ 2011;343:d4867.

[iv] Medew J. Doctors urge compensation on kidney transplant. The Age. 4 August 2011.