Tax incentives don’t appear to increase organ donation
Would you expect that offering state tax incentives or credits would increase organ donation? In fact, researchers found little difference in the annual number of living organ donations per 100,000 population between the 15 states that had enacted some sort of tax benefit as of 2009 and states having no such policy at that time, according to a 2012 study.1
Funds allocated as tax breaks for donors could be better used in a pool of money for donor assistance for things that might arise in the course of donation, such as unexpected expenses for transportation, childcare, utility bills, and meals away from home, argues Mary Ellen Olbrisch, PhD, professor of psychiatry and surgery and director of education and training in clinical health psychology at Virginia Commonwealth University in Richmond. Olbrisch is the designated living donor advocate for the liver transplant program at the VCU Medical Center.
“During the psychosocial evaluation of prospective organ donors, we are obligated to discuss and explore financial issues, including the possibility that the donor has been offered some financial incentive or payoff for organ donation by the recipient,” she says. “Now, donor advocates are even expected to inform donors that the buying and selling of organs is a federal crime. This is an extremely sensitive topic that has to be handled with tact and diplomacy.”
Most donors are willing to make great personal sacrifices to help the person they are helping, both in terms of putting their own health at risk and some personal expense due to time off from work, most often uncompensated, Olbrisch explains. “Most prospective donors will simply tell you there is no financial arrangement. Some will be offended that you have suggested there might be,” she adds. “On rare occasions, one learns that a vulnerable person is being manipulated with the promise of payment for an organ.”
If the parties wish to conceal financial arrangements or motivations, little can be done to uncover these. “However, I believe that for the most part if finances are a barrier, individuals do not come forward as donors, and a promised tax incentive will not be enough to bring them forward,” Olbrisch says.
People who are donating out of care, love, and compassion, however, may actually be turned off if told that as an added bonus, they will get a tax break for their donation, says Olbrisch. “Behavior that is intrinsically motivated can be decreased or devalued if externally reinforced. Donors want to see themselves as good people doing the right thing,” she explains. “If they are put in the position to see themselves as people getting a tax break, it detracts from the image of themselves as caring, loving, compassionate people.”
A tax credit would be more valuable to the donors, as they would get a dollar-for-dollar reduction in their taxes rather than getting a few cents on the dollar that a deduction in taxable income provides, argues John P. Roberts, MD, professor and chief in the Division of Transplant Services at University of California, San Francisco Medical Center. “I don’t think that there any ethical issues with these incentives. What the incentives are doing is reimbursing the donor for out-of-pocket costs occurring related to donation,” he says. “Personally, I think organ donors should be offered lifetime health insurance for donation.”
- Venkataramani AS, Martin EG, Vijayan A, et al. The impact of tax policies on living organ donations in the United States. Am J Transplant 2012;12(8):2133-2140.
- Mary Ellen Olbrisch, PhD, ABPP, Professor of Psychiatry and Surgery, Clinical Psychologist, Department of Psychiatry, Virginia Commonwealth University, Richmond. Phone: (804) 827-0053. E-mail: firstname.lastname@example.org.
- John P. Roberts, MD, Professor and Chief, Division of Transplant Services, University of California, San Francisco Medical Center. Phone: (415) 353-9321. E-mail: John.Roberts@ucsfmedctr.org.