Students could pay off debts by donating kidneys, says academic

[Karol]

Students could pay off debts by donating kidneys, says academic
Kidney donors should be paid £28,000 for their organs, according to an academic who claims the move could help students pay off their university debts.

By Martin Beckford, Health Correspondent11:31PM BST 02 Aug 2011 6 Comments

Sue Rabbitt Roff said that paying live donors would encourage more to come forward and so shorten waiting lists, as three people currently die every day because they were unable to receive a transplant.
She claimed that it would not be “such a big step” from current systems, whereby medical research subjects are paid wages and workers who lose organs receive compensation, and would avoid the black market that exists in other countries.
Dr Rabbitt Roff, a research fellow in medical sociology at Dundee University, wrote in an comment piece published online at BMJ.com: “It’s time to begin to explore how to pilot paid provision of live kidneys in the UK under strict rules of access and equity.
“We need to extend our thinking beyond opt-in and opt-out to looking at how we can make it possible for those who wish to do so to express their autonomy in the same way as current donors are encouraged to do by making available a healthy kidney for a fee that is not exploitative.”
However her call has not been backed by leading kidney charities.
Professor Neil Turner, Chairman of Kidney Research UK, said: “The decision to become a living organ donor is one which is extremely personal and should not be motivated, influenced or incentivised by the prospect of financial gain.
“Such a system would likely be open to abuse and we have yet to fully explore other alternatives - such as an opt-out approach to the organ donor register, which we would favour instead.
“The idea that you can sell one of your organs to pay off a substantial debt, such as a student loan, will undoubtedly appeal to some people. However, if money is their only motivation, they may well find that they come to regret their decision at a later date.”
Tim Statham, chief executive of the National Kidney Foundation, added: “I think payment could actually be harmful because at the moment people do this altruistically.
“If they thought they might be perceived as doing it for payment, it could actually reduce the number of donors.”
Currently less than one in three of the population is on the NHS’s organ donation register, and earlier this week the DVLA started asking all motorists who apply for driving licence if they want to sign up in order to boost numbers.
Previous attempts to set up a system of “presumed consent”, whereby individuals have to opt out of leaving their bodies to medicine, have been rejected.
Patients who suffer kidney failure face years on waiting lists as the supply of deceased donor organs has not increased but demand has risen.
About one in 10 transplanted kidneys now come from live donors, usually relatives or spouses of the patient, who give up one of their two organs.
But Dr Rabbitt Roff said more kidneys are needed, particularly as diabetes rates increase, and that regulating the market and introducing large payments would increase donations while preventing poor people being exploited.
“If the standard payment were equivalent to the average annual income in the UK, currently about £28,000, it would be an incentive across most income levels for those who wanted to do a kind deed and make enough money to, for instance, pay off university loans.”
Dr Tony Calland, Chairman of the BMA’s Medical Ethics Committee, said: “The BMA would not support payment for donating organs. We believe that one of the best ways to increase organ donation is to move to a system of presumed consent with safeguards – this would have to be supported by the public and be preceded by a high profile public awareness campaign.
“Organ donation should be altruistic and based on clinical need. Living kidney donation carries a small but significant health risk. Introducing payment could lead to donors feeling compelled to take these risks, contrary to their better judgement, because of their financial situation.”

http://www.telegraph.co.uk/health/healthnews/8677153/Students-could-pay-off-debts-by-donating-kidneys-says-academic.html

[Clark]

http://marketdesigner.blogspot.com/2011/08/debate-over-kidney-sales-in-scotland.html

Debate over kidney sales in Scotland

Here's a 4 minute interview on Radio Scotland from August 2011, on kidney sales, http://kuznets.harvard.edu/~aroth/RadioScotland.kidneymarketiview.August%202011.mp3 in which Sarah Toom talks to me about the debate there about whether payments to living kidney donors should be allowed, and other ways of increasing transplants (including kidney exchange).

The proximate cause was a proposal by Sue Rabbitt Roff, a senior research fellow at the University of Dundee, in the BMJ: "We should consider paying kidney donors." http://www.bmj.com/content/343/bmj.d4867
Her proposal calls for a tightly regulated system with a standard payment to donors of around the current average Scottish salary (at which price transplantation is still a bargain compared to dialysis).

She concludes "So it’s time to begin to explore how to pilot paid provision of live kidneys in the UK under strict rules of access and equity. We need to extend our thinking beyond opt-in and opt-out to looking at how we can make it possible for those who wish to do so to express their autonomy in the same way as current donors are encouraged to do by making available a healthy kidney for a fee that is not exploitative.

The proposal has sparked a lot of British press coverage, e.g. here, http://www.guardian.co.uk/society/2011/aug/03/kidney-sale-proposal-medical-ethics and here, http://www.thecourier.co.uk/News/article/16206/academic-suggests-people-should-be-allowed-to-sell-their-kidneys.html and here, http://www.onmedica.com/NewsArticle.aspx?id=bc5e0007-e2cd-4dd2-ac21-19116f99547d and here http://www.bbc.co.uk/news/uk-scotland-tayside-central-14379215 . In each of the articles, the other reported comments are all negative. (I can't tell if British reporters work differently than American reporters and only solicited negative views to balance the proposal being reported as the main story, or if it is harder to find pro as well as con views in the UK.)
*******

Here are links to my previous blog posts on compensation for donors, http://marketdesigner.blogspot.com/search/label/compensation%20for%20donors and to my two papers that lead to unexpected calls on this subject from radio journalists in far places.

Roth, Alvin E. "Repugnance as a Constraint on Markets", Journal of Economic Perspectives, 21:3, Summer, 2007, pp. 37-58. http://kuznets.fas.harvard.edu/~aroth/papers/Repugnance.pdf

Leider, Stephen and Alvin E. Roth, ''Kidneys for sale: Who disapproves, and why?'' American Journal of Transplantation , 10 (May), 2010, 1221-1227. http://kuznets.fas.harvard.edu/~aroth/papers/KidneySales%20repugnance%20AJT2010.pdf

[Clark]

http://www.digtriad.com/news/article/186351/176/Selling-Organs-To-Pay-For-Tuition-Stirs-Ethical-Debate

Selling Organs To Pay For Tuition Stirs Ethical Debate

 A debate is raging in the United Kingdom over the prospect of allowing students to sell organs for tuition money.

"We allow them to burden themselves with these debts" to attend college, Dined University's Sue Rabbitt Roff wrote in an article published in the British Medical Journal. "Why can't we allow them to do a very kind and generous thing but also meet their own needs?"

Roff is insisting that a ban on selling the organs be overturned.   She figures student could get around $46,000 per kidney, roughly the average annual income in the country.

Roff says anther reason she supports the plan is to increase the number of available replacement organs.  She cites the fact that three people die every day waiting for a kidney transplant.

She has her critics.  "Young people, particularly from disadvantaged backgrounds, are already being asked to take on huge debt to afford an education," Robin Parker, president of the National Union of Students in Scotland, told the Scotsman. "They shouldn't be expected to remove a body part as well."

The United States also bans the selling of organs.

"Permitting students to sell their organs to pay off school debt does not make sense," Alexandra K. Glazier, chairwoman of the ethics committee of the United Network for Organ Sharing (UNOS), told CBS News in an email. "Students should not have to lose a body part to pay for education."

Glazier said the donation of an organ represented an altruistic gift. Problem is, statistics suggest that Americans are coming up short in the altruism department.

In the U.S., there are now more than 110,000 people waiting for a heart, lung, kidney, liver, pancreas or intestine, according to UNOS. The U.S. Health and Human Services Department estimates that 18 Americans die every day while waiting for an organ that never becomes available.

[Clark]

http://www.cbsnews.com/8301-504763_162-20088302-10391704.html

Cash-for-kidneys tuition plan stirs ethics debate
By David W Freeman

Students short on cash for college should be able to cash in their kidneys. A Scottish academic raised a ruckus by making that proposition, insisting that overturning the UK's ban on organ-selling could be a twofer - letting hard-up college kids raise money to pursue their studies while easing the chronic shortage of donor organs.

"We allow them to burden themselves with these debts" to attend college, Dundee University's Sue Rabbitt Roff wrote in an article published in the British Medical Journal. "Why can't we allow them to do a very kind and generous thing but also meet their own needs?"

Roff figures collegians should get around $46,000 per kidney. That's roughly the average annual income in the UK.

There's certainly a need for more organ donors. Currently, Roff wrote, about three people die every day in the UK while awaiting kidneys. But while Roff's plan might be a hit with would-be organ recipients, some were dubbing the plan an indecent proposal.

"Young people, particularly from disadvantaged backgrounds, are already being asked to take on huge debt to afford an education," Robin Parker, president of the National Union of Students in Scotland, told the Scotsman. "They shouldn't be expected to remove a body part as well."

Dr. Calum MacKellar, director of research at the Scottish Council on Human Bioethics, told the Guardian, "To place a financial value on human beings or parts of human beings undermines the inherent dignity of the human person and the innate as well as immeasurable worth of all individuals."

That sentiment was echoed in the U.S., which shares with the U.K. and just about all other countries a ban on the selling of organs.

"Permitting students to sell their organs to pay off school debt does not make sense," Alexandra K. Glazier, chairwoman of the ethics committee of the United Network for Organ Sharing (UNOS), told CBS News in an email. "Students should not have to lose a body part to pay for education."

Glazier said the donation of an organ represented an altruistic gift. Problem is, statistics suggest that Americans are coming up short in the altruism department.

In the U.S., there are now more than 110,000 people waiting for a heart, lung, kidney, liver, pancreas or intestine, according to UNOS. The U.S. Health and Human Services Department estimates that 18 Americans die every day while waiting for an organ that never becomes available.

[Clark]

http://theconversation.edu.au/organs-for-sale-the-ethics-of-paying-living-kidney-donors-2679

Organs for sale? The ethics of paying living kidney donors

The Commonwealth Government is considering a proposal from Kidney Health Australia to reimburse living kidney donors for reasonable expenses incurred during the donation process, such as loss of income or travel expenses.

Meanwhile, senior research fellow at the University of Dundee in the United Kingdom, Sue Rabbitt Roff, has argued in the British Medical Journal that in order to raise live organ donation rates, donors should receive an average annual income.

So what are the ethical implications of paying for organs? Associate Professor Malcolm Parker, University of Queensland’s head of Medical Ethics, Law and Professional Practice explains:

Reimbursing living kidney donors for lost income is a reasonable proposal. Clearly, it’s directed towards increasing the organ donation rate to make it somewhat more attractive for living donors to at least consider this route.

The question that arises is whether payment could be construed as a coercive incentive. But if there’s a limit on the payment and it’s restricted to lost income and other associated costs, that argument becomes weak.

Payments are not unheard of in medical, psychological and pharmaceutical research trials – the reimbursements are designed to cover expenses that the participant has incurred in the process of getting to and participating in the trial.

Clearly, there’s more involved in becoming a live organ donor but similarly, I think many people support the idea of reimbursements for costs incurred, up to a limit.

Such a scheme could increase the rate of live organ donors to some extent but given the invasiveness of the procedure and the lifelong implications, I expect any increase would be modest.

What do you make of Sue Rabbit Roff’s argument that live donors should be paid the equivalent of an annual income for donated kidneys?

This payment would obviously be a lot higher than just reimbursing for costs incurred and time off work so it may well prove to be a greater incentive.

In this scenario, the question of coercion comes more into view and you have to ask whether this will persuade certain people, particularly people with low income, to consider donating their kidney when otherwise they wouldn’t.

And does that amount of money, or that degree of compensation, render their decision somehow coercive or involuntary?

There’s no in-principle answer to that – coercion won’t necessarily occur. But in certain cases you might find that someone who is desperate for money will become involved, when otherwise they wouldn’t have.

This is certainly not the first time that payment for organs has been proposed.

The prevailing view is that we shouldn’t have an organ market because it should be an altruistic arrangement. But there has certainly been pressure mounting over the years to find ways to increase the number of organ donors.

How is the cash for organ idea playing out internationally?

There’s a market for organs – it’s perfectly clear that’s happening. It’s also clear that there are vulnerable groups who are more subtly coerced or blatantly exploited.

The far extreme of that is criminal activity where people are abducted and have their organs removed. That’s not a common occurrence though we know it does happen.

We’re aware of the Chinese situation – where executed prisoner’s organs are used – and this probably occurs in other countries as well.

We hear that the Chinese are attempting to regulate this practise more strongly but it’s difficult to know exactly where they’re at.

So there are markets and activities occurring around the world which are different from the standard altruistic practise of organ donation.

These underground activities are different from the proposed compensation of wages lost or even an annual income – they’re somewhere along that continuum but not quite at that far down the end.

More broadly, how can we increase rates of organ donation in Australia – is an opt-out policy, where consent is assumed, the answer?

No. Where the organ donation rates are significantly higher than Australia’s, it’s more a result of the quality of the processes that have been instituted in hospitals and other healthcare institutions, such as the introduction of transplant coordinators, financial supports, and so on, rather than the adoption of an opt-out system.

Spain, for example, has the highest rate of organ donation in the western world and this likely comes down to the processes in place rather than whether they’ve got an opt out system.

I wouldn’t predict an opt-out organ donation system would have a huge impact in Australia.