State to offer money for organ donation

Stipend to offset funeral costs, spur donations

Advisors to Pennsylvania’s governor are devising a plan to pay families of organ donors a $300 stipend to offset funeral costs. The idea is to encourage families to consider donation because the need for organs is much higher than the number of available organs. But the idea may not reach fruition due to potential legal hurdles. The National Organ Transplant Act of 1984, for example, prohibits the exchange of organs for payment.

Officials at the U.S. Health Resources and Services Administration in Washington, DC, concede that Pennsylvania has increased organ donation rates in the state. A recent federal rule requiring hospitals to notify organ procurement organizations of deaths was in fact modeled after a Pennsylvania law.

The program would be voluntary, says Emilie Tierney with the Pennsylvania Department of Health in Harrisburg. ’The benefit will be made available for a funeral. It will be made available to family members or to whomever is responsible for the funeral, but it’s voluntary, and the families don’t have to accept the benefit.” Funds would go directly to the funeral home and be charged against the funeral expense, Tierney adds.

Pennsylvania’s Organ Donation Advisory Committee will present its recommendations early this month, but the health department will decide whether to recommend to implement the program, she says. Funding for the program would come from an existing budget in state finances.

The plan most likely would face opposition from the federal government as well as religious groups, says Arthur Caplan, PhD, director of the University of Pennsylvania Center for Bioethics. Caplan would serve as a monitor for the program should it be enacted. Religious groups might view offering a stipend as treating the body like a commodity, he says.

He says money has never served as a motivating factor in organ donation, but in Pennsylvan ia’s case the stipend amount is so small it wouldn’t have an impact on someone’s decision, anyway. ’The main obstacles to donation are religious concerns, aesthetic concerns, and anger over perceived inequities in access to transplants for the poor and minorities,” he adds.

Plan greeted with skepticism

The organ donation stipend drew negative, skeptical reactions after it was revealed in a New York Times article published May 6. Medical practitioners and ethicists alike argue it could lead to the buying and selling of organs.

Pennsylvania’s plan ’is drawn from good intentions but is seriously misconceived,” wrote Jerome Groopman, MD, a professor of medicine at Harvard in Cambridge, MA, in an editorial published the following day in the New York Times.

Groopman suggests that, if Pennsylvania adopts the plan, families might withdraw life support from family members prematurely in order to benefit from the stipend. He also notes that other states could follow Pennsylvania’s example but offer higher stipends, creating a ’buyer’s market” for organ donations.

Caplan disagrees. ’I do not think a $300 payment toward funeral expenses will lead anyone to prematurely request withdrawal of a loved one from life support,” he says. ’Nor is it going to lead to anyone picking a state to die in that offers a subsidy for funerals.”

Donations increase overall

Pennsylvania’s efforts at increasing donations come on the heels of good news nationally. The number of organ donors increased 5.6% in 1998, according to the U.S. Department of Health and Human Services (HHS) in Washington, DC, and the United Network for Organ Sharing in Richmond, VA.

The national increase follows the launch of the Clinton administration’s donation initiative in 1997. The increase also could be attributed to the regulation requiring hospitals to report deaths to local organ procurement organizations.

Preliminary data reveal the number of cadaveric donors increasing from 5,470 in 1997 to 5,788 in 1998. The increase is attributed to 600 additional organ transplants and up to 14,000 additional tissue transplants, according to HHS.

Tax benefit suggested as better option

Creating a fixed tax benefit for which participants could check a box on their income tax forms is one incentive Groopman suggests as a more appropriate method of encouraging donation. He also suggests that states waive the driver’s license fee for people who choose to note their wishes of donating organs on their licenses.

Initially, any changes in Pennsylvania’s policy may not be well-received among hospital personnel who approach families regarding organ donation, Caplan notes.

’It is hard to introduce incentives of any sort into a system that has been based on voluntary altruism for so long. Some doctors and nurses will, in all likelihood, not raise the issue of funeral expenses. Organ procurement organization personnel will do so, however, since they are more familiar with and comfortable with the new law,” he says.