Nguyen Hoang Long, 16

School: St. Joseph’s Institution

Topic: Should we incentivise organ donation to increase supply?

Award: Special Mention, Open Category, 2022

How to solve organ shortage: A look into an incentive-based approach to organ donation

The innovation of organ transplantation is one of the greatest milestones in mankind’s medical progress. Organ transplant, a medical procedure in which an organ is transferred from the donor’s body to that of the recipient to replace a diseased organ, has helped save over 120,000 lives worldwide each year. Thanks to it, the quality of life has improved for many, and the numerous lives which were suffering from organ failure and were thought to be impossible to help before have been saved.

However, organ transplant is faced with a scarcity of organs given from donors. Countries around the world are troubled by the sheer gap between the never-ending list of transplant recipients and the scanty number of organs available. To illustrate this shortage, in the United States alone, more than 90,000 patients are waiting for kidney transplants every year, yet the number of transplants performed annually is just 20,000. This has led to the consideration of incentives for organ donation, which might contribute to an increase in the supply of organs. The incentives could potentially solve the public health problem as they appeal to more people, and provide reciprocity and community recognition that donors deserve. Thus organ donation should be incentivised to increase the pool of organs at hand.

How can organ donation be incentivised? There are two main types of incentives: financial and non-financial. Aside from direct payments, financial incentives can come in the form of reducing taxes or reimbursing certain living expenses such as healthcare, travel, education, funeral costs (for postmortem donation). Non-monetary compensation can include giving the benefactor preferential access to donated organs and giving them community recognition. Organ donors will have a choice to either accept or decline their compensation.

First of all, organ donation should be incentivised as it is likely to prompt more people to donate than waiting for altruistic donation. Altruism, the selfless concern for the well-being of others, has long been the core principle of organ donation. Although selflessness in organ donation is commendable, relying solely on altruistic donation may be insufficient in closing the tremendous gap between the demand and supply of accessible organs. It is evident that the altruism-based system of donation has been in effect for decades. Unfortunately, not many people are willing to risk their health and lives to save and improve others’ out of pure altruism. On the other hand, having some inducements may appeal to more donors and encourage them to make a donation. In fact, according to a poll conducted by the United Network for Organ Sharing (UNOS) Ad Hoc Donations Committee, 52% of the surveyed population favoured some kind of compensation for organ donors. Generally, people will feel more motivated to take action if there are benefits to be enjoyed in return. Similar to how incentive programs at work motivate employees and boost their productivity, inducements to organ donation can greatly encourage more potential donors to make life-saving contributions. This is not to say that the selfless will of donors to sacrifice part of themselves for the sake of others is unnecessary. Altruism should be combined with incentives to effectively encourage self-sacrificing individuals to donate their organs for others to live on.

Secondly, inducements for organ donation should be introduced because it is an ideal method of providing reciprocity for the donor. Organ donors play an important role in the transplantation process, yet they usually are the only ones who do not receive any tangible benefits. People who make living donations may have limited resources, especially after the transplant they may be further burdened with the cost of treatment. An incentive-based system of procurement of organs could alleviate their financial situation by offering to fund their medical bills and other expenses. This is highlighted in the case of Susan Sutton. After her death, the twenty-eight-year-old woman’s family decided to allow her heart, liver, corneas, even her bones and skin, to be removed for granting others a second chance to live. Despite these charitable gifts of life, she did not have a proper burial, as her family was not compensated justly and was not able to afford the expenses for her funeral. They had no choice but to bury her in an unmarked grave. Is this fair for her and her family to not receive any help in this matter? Incentives might have offered them more support and covered these types of costs for them to say goodbyes to their loved ones properly. Therefore, not only would incentivising organ donation aid the donors’ lives, but it would also do justice for them.

Thirdly, being more than a token of appreciation, incentives can give worthy community recognition of the organ donors’ sacrifices. Some inducements can take the form of recognition, like an award or a news article. Oftentimes, people like to be recognised. This means being acknowledged for their contribution can appeal to the emotion of many, thereby compelling more people to make organ donations. Additionally, it is simply unjust to let their selfless sacrifices go unnoticed. Moreover, the reason for community recognition is to bring attention to their exemplary acts of kindness, which gives donors a voice in their respective communities and society. Their stories can reach and touch the hearts of many, making them more aware of organ donation and may even encourage people to donate their anatomical gifts.

An objection to incentivising organ donation is the concern about whether it will affect the sincerity of the donor. Some people fear that the introduction of money for a donated organ may result in the loss of genuinity of donors as there could be people who are motivated by the gains more than their compassion. Opponents of incentivising organ donation also claim that individuals that sincerely want to donate to help others might have second thoughts. The incentive-based scheme for organ donation may backfire because some altruistic donors felt it undermines their sense of right and wrong.

Contrary to what the opposing argument says, people who donate their organs with truly altruistic motives would not be affected whether there are incentives or not. As altruism is the selfless care for other people, altruistic donors want to contribute their body parts for the sole purpose of saving a fellow human being. Their reason to help others should not be impeded by the incentives that come with their generosity, since their donation will still eventually save someone. Thus, they will help save a life regardless of the benefits given for their charitable actions. Consequently, their selfless, sincere intentions will seem inauthentic when they avert from doing good to others. After all, their goal is unfulfilled when there are unfortunate people suffering in wait for their donation. Hence, saying that they will abstain from donating just because there is a reward that makes their motives seen as impure contradicts the fact that they donate out of the willingness to help the patients. Additionally, the donor is given a choice to accept or reject the incentive. They can decide to not receive the compensation if they see it as unnecessary.

Another argument against the incentive-based approach is that financial incentives may be detrimental to the people who want quick cash, especially those from a lower socioeconomic background. Monetary rewards might give the underprivileged the impression that donating organs is the only method of earning income. As a consequence, they may rush to a wrong or ill-informed decision and put themselves at risk. Furthermore, in order to increase their likelihood of being selected as a donor, they might give untrue medical information, which could harm the organ recipient and no side would benefit.

To address the problem of poor judgement of money-driven organ donors, the decision-making process of donors should not be significantly affected by the involvement of financial incentives. As mentioned above, there are various ways through which incentives can be provided. Benefits such as community recognition, preference in the list of organ transplant, coverage for education and medical costs… , though important, are unlikely to make people hasty in making decisions that concern their well-being and that of others. It is also important to note that economic decisions are part and parcel of people’s daily lives. If anything related to money leads to bad judgement, it will undermine the donors’ free choice, informed consent and bodily autonomy. There are other factors that are taken into account when donating an organ, including health risks, family, religion. With numerous considerations accumulating before signing up for organ donation, it is improbable that individuals would blindly accept removing their organs for transplantation for money alone, even those from a lower socioeconomic background.

In short, though there is controversy surrounding the incentive-based approach to organ donation, it should nevertheless be incentivised. It may prove to be more effective than the altruistic organ donation system, provide more satisfaction to the people via reciprocity and give rightful community recognition to admirable donors. Therefore, it could be an effective way to increase the supply of organs and minimise any ethical dilemma that might arise.

Disclaimer: Please note that the views and opinions expressed in the essays for the Live On Festival 2022 are those of the participants and are not endorsed by the National Organ Transplant Unit (Ministry of Health). To learn more about organ donation and organ transplantation in Singapore, please visit www.liveon.gov.sg