“I’m actually not against compensating people for donating their organs,” says Sigrid Fry-Revere, director of Bioethics Studies at the Cato Institute, a Washington D.C.- based policy institute. “Particularly since we have a shortage and seven people are dying every day waiting for organs. Why not compensate someone with health insurance for life? It’s a little scary to offer cash or immediate gratification, because it’s a decision that someone needs to carefully consider. Compensation would make the risk more worthwhile and hopefully encourage more donations.”

For the time being, any type of compensation for organ donation is clearly illegal. However, a gray area is emerging that questions the difference between valuable consideration and reimbursable expenses. All medical expenses of organ donors are fully covered by the recipient’s insurance, but many other costs are not.

Says Lindower, “Travel to and from the hospital or time off from work for the surgery or the recovery—donors are using all their own time and money for that. And after the surgery, they may need pain medication which they usually pay for out of their own pocket, as well.”

Incentives
Federal employees are given 30 days of paid medical leave when they donate an organ. Seven states offer employees some type of leave for being an organ donor and 11 states allow living donors to deduct up to $10,000 on their state tax returns for donationrelated expenses.

Some private companies have paid leave policies, but most living organ donors willingly sacrifice what they must to save the life of a loved one. Medical experts and ethicists question why.

“If you’re making all these restrictions because you’re afraid people will make the wrong decision, that’s a legitimate fear,” says Fry-Revere. “But people are dying. Wouldn’t you rather risk a few people making a bad decision and help people live?”

Federal legislation
According to the National Kidney Foundation’s Council of Nephrology Social Workers, 25% of potential donors are hesitant to donate because of the financial burden they may incur. A similar percentage of living donors regretted their decision because of the economic consequences.

Passed in 2004, the Organ Donation and Recovery Improvement Act (H.R. 3926) was a major breakthrough in addressing these concerns. It established a federal grant program to assist living donors with travel and other nonmedical expenses.

Despite high hopes that this would encourage more living donations, funding for this act has been authorized but not yet appropriated.

Until the act is appropriated, living donors will have to rely on what their state may offer because as Lindower says, “It’s against the law to pay donors, and it’s kind of a gray line. The exchange of any money needs to come from the government.”

Groups such as the National Kidney Foundation and the American Society of Transplant Surgeons are sounding a call for people to contact their representatives in Washington in support of putting real money behind the good intentions of the act.

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