New Hope On Organ Donation

This week Senator Specter introduces the Organ Donation Clarification Act of 2008, a bill that would allow states to compensate donors for offering a kidney transplant.

That's good news for the 657 former patients of the Life Care Dialysis Center on West 61st Street, closed down last week by the Department of Health over unsanitary conditions and fears of hepatitis, as well as for the other 76,000 Americans waiting for a kidney donation.

Arlen Specter's simple bill is just three pages, yet it could be a life-saver for sufferers of kidney disease. It faces little opposition, and could pass when Congress returns in November or next year. It is supported by medical groups such as the American Society of Transplantation and the American Association of Kidney patients.

Here's how Mr. Specter's bill would work.

People have two kidneys, but can manage with one. Healthy people can donate a kidney to people who need one. Usually it happens within families, occasionally between strangers.

Transplantation lets people with kidney disease be cured by receiving a kidney from live or recently-deceased donors. But there aren't enough donated organs available, hence the lengthy kidney waiting list, filled with people whose lives and possibly careers are disrupted by having to go to a dialysis center three times a week for four hours each time.

The waiting time on the kidney list has grown from a year in 1983 to between five and 10 years. Patients on the list are more likely to die, or to become too sick to be eligible, than to receive a donated kidney.

While waiting for a kidney, patients survive through dialysis, an expensive process paid for by Medicare at an annual cost to taxpayers of $70,000 a year. Patients are on dialysis for an average of five years, and visit clinics such as the 61st Street Life Care Dialysis Center to have their blood cleaned of impurities.

The bill would save the government money, because increased kidney donation, even with compensation to donors, would lower costs to taxpayers. It's estimated that a $100,000 kidney transplant could save Medicare over $220,000 a patient.

So why aren't more Americans kidney donors? The National Organ Transplant Act of 1984 specifically prohibited organ donors from receiving any compensation, under penalty of a possible $50,000 fine and up to five years in prison.

Mr. Specter's bill would raise the fine for commercial sale of organs to $250,000 but, according to the bill's summary, it would "increase the supply of donated organs by clarifying the legality of both government incentives that honor the gift of life and payments associated with the screening, pretransplantation care, and follow-up care expenses incurred by living organ donors." Both states and charities would be allowed to pay these expenses.

By prohibiting commercial organ sale at the same time as permitting government incentives, Congress wants to make absolutely sure that poor people do not feel tempted to sell organs because of financial need.

In fact, Mr. Specter's bill could shrink the market for organs in foreign countries. Americans who can afford the trip can travel abroad to acquire organs they pay for in places such as China, but this is an expensive process, and many patients have moral qualms about the possible coercive origins of the donated organ.

A resident scholar at the American Enterprise Institute, Sally Satel, a recipient of a donated kidney, who has a new book, "When Altruism Isn't Enough — The Case for Compensating Kidney Donors," has done path-breaking work in persuading legislators that some compensation should be allowed.

In a telephone interview, she said, "The bill simply liberates states to be creative in figuring out the most effective way to motivate people to donate. It allows states to reward individuals who would like to save the life of a stranger."

A kidney specialist at Beth Israel Medical Center in Manhattan, Richard Amerling, agrees. "Transplantation provides the best quality of life and survival. Arguments against compensation such as exploitation of the poor, 'commoditization' of the body, and the loss of altruism, are all extremely weak, especially in the face of high mortality on the waiting list."

However, a physician and a resident scholar at AEI, Leon Kass, disagrees. "Giving modest financial incentives to increase kidney supplies from living donors will hardly meet the need," he said. "It should thus be seen as a first step toward overt buying and selling of human body parts. Do we want to move toward a world in which the poor are induced to sell and the young and healthy can think of their kidney as a banked resource to pay for college or buy a new car?"

As states sort out these issues, there are a variety of ways that they could permit compensation, such as funeral expenses, payments to an IRA, tuition or tax credits, or health insurance. One potential benefit to encourage donations would be to put donors and their families at the top of the list to receive kidney donations from others, should a future need arise.

The Organ Donation Clarification Act could give new hope to thousands of kidney disease patients. If handled correctly, no other congressional bill has as much potential to save lives.

Ms. Furchtgott-Roth, former chief economist at the U.S. Department of Labor, is a senior fellow at the Hudson Institute.