This is going to rub a lot of people the wrong way as unethical, but the best way to incentivize organ donation is if the donors get paid a market price for the organ. The donor is giving up a valuable piece of their body, taking time and large medical risks in surgery, and likely reduced life expectancy.
If you walk through the current process, everyone in the donation gets paid -- doctors, nurses, hospital, pharma -- except the donor.
There are a number of advantages of donors getting paid:
1. The supply market would increase dramatically. Thus many more people receiving organs who would have otherwise died waiting.
2. Heirs to people who have died young, with healthy organs could get paid for donating their organs.
3. Black markets would be dramatically reduced, since people in desperate need of an organ could pay in the open, rather than secretly paying a donor.
4. People without money can legally open a Kickstarter to raise funds for an organ donation.
Note Iran has partially done this, and the results have been very positive [1].
The blood market is very different from the kidney market, and simply translating conclusions from one to the other is very dubious.
Blood donations produce the needed amount of blood, and that system basically works. So it makes sense to not take any risks to expand the already sufficient supply.
Meanwhile the kidney transplant world is desperately tragic. About a dozen Americans die each day from lack of a kidney. Even if an added kidney supply would be lower quality on the margin, it would save a huge amount of lives.
The biggest difference between blood and organs is scale. Organs are sold for largest sums of money which means that there is much more money and time available to do full medical work ups and tests to verify the quality of the organs.
As well as a significantly stronger motivation to deceive in order to secure the payout. Assuming that verification procedures against a hostile donor can maintain quality vastly overestimates the tests.
The deception is made more difficult via the significant match screening required. When I donate blood, they ask me a series of questions. I can answer as truthfully as I like. How much testing they do to the whole or processed blood likely differs widely from facility to facility.
Before donating a kidney, I went through half a dozen invasive, detailed medical exams that didn't depend on my given answers at all.
I request you to kindly read up more on this subject. Your 'big issue' already exists today! The poor in countries like India are already forced to sell their organs to rich donors in the West through the black market where they are paid a pittance. Debt collectors in India make a killing by preying on the poor. The rich pay the middle-men a truck load of money, but the actual donor gets very little at the end. Formally paying donors will at-least give them a much better price without the middle-men taking most of the money.
I don't have worry about the welfare system not giving aid. The condition are generally often quite reasonable and there are going to be plenty of organisation to watch that over.
What I worry about, is in countries like the US/UK where "having a student debt" has somehow become a badge of honour, I can see "selling a kidney" to get through university becoming the same honourable demonstration that you are committed to do what it take to succeed.
... and by extension, show people who are not as committed. You can see it coming: "my son sold his kidney to succeed, why should we give even more to the people that are not even ready to take such a small step".
In general, we seem to expect people to take an ever growing amount of risk for the reward of maintaining their social standing. Being able to sell your body in piece is just raising the bar even higher.
At the risk of sounding bitter: it's from a UK "newspaper" and it concerns mainland Europe. You should assume the article needs additional proof, not just verification.
a rather easy solution to that would be to bar the poor from being paid. Sounds unfeasible, but for example -- we were also able to bar the poor from investing with the "accredited investors" title.
That's what's happening right now on the black market. With a real market you can ensure that this kind of things does not happen. (or at least control it)
I'm sorry, but why would you risk death to make a few thousand dollars if you're not poor? This practice significantly targets the poor and desperate. The same issues that come with legalization of prostitution and sex trafficking impact the organ trade.
So do the same failed arguments -- how has legalization and regulation of the market gone for Germany? Or rather how has it gone for German prostitutes, because from a tax revenue perspective Germany is doing wonderfully, with the perverse incentive to keep exploiting poor and trafficked women.
Because a common occurrence when your poor is:
You need $500 to pay for some debt now or a chain reaction will destroy your life. You've taken as much as your family has been willing to lend you and you've taken as much as the system (as much as you can understand it) is willing to loan you. You don't have that money.
Luckily, someone is offering $1,000 for a kidney and you're compatible! You can fix your car / post your bail / pay the loan shark, with $500 left over!
You're pretty much forced to sell your organ at this point. And this point is reached all the time by the economically disadvantaged.
Of course, without the last resort of selling body parts they'd be even more screwed, so I don't know the right thing to implement in this case. Just wanted to answer your question.
I don't disagree the poor would be targeted or coerced to participate. I do disagree people would be "forced," en masse, to donate organs. I also think removing it as an option misses a lot of opportunities.
If you can't get government assistance because you have an "extra" kidney, and you need to feed your family, I wouldn't call that decision anything other than forced.
Is a government somewhere witholding assistance from anyone because they're not donating blood or an organ? Or is this a "logical conclusion" you presume it would be taken to should monetary compensation be made available to donors?
While there is a short fall of viable organs for donation, the issue the author raises here is one of long term risk.
This is what gets brushed aside when the organ donation process is activated. Only now do we have results from long term study of donors and some of them as pointed out by the author are not good at all.
This problem is not confined to kidney donations for instance, is a growing body of evidence that points to long term complications from another medical procedure - laser surgery (lasix). Here many patients suffer degenerative vitreo-reinal changes over time (if you can, avoid it).
It is not actually the case that donors do not benefit from the current process. Outside the US in the largest market for kidney surgeries India, they are paid; as well as in the Thailand and the middle east.
End stage renal disease is one of the worst conditions to die from, and everyone involved with an afflicted patient is desperate for a solution since they suffer almost as much as him/her.
So,No. Paying for organs will not solve this particular problem. But neither will doing nothing.
One solution that can improve the number of donor organs is to make it mandatory that organs from qualified people who die violent or accidental deaths be immediately considered for transplant to those who need them. But you can guess this proposal would be (illogically imo) opposed in many countries.
Edit: On a related note, I have been mulling over an idea for a while for a startup to reduce the cost of dialysis for patients with renal disease. At present, it is prohibitively expensive and some patients require 2 sessions a week. If anyone is interested in joining me, reach out. My email address is in my profile.
"Lasix" is not one technology or surgery. If you meant the oldest variant of LASIK or LASEK, the complications are known, it is quite major eye surgery. Newer variants have lower rate of both short and long term complications. (femto-LASIK, the Epi-LASIK and more modern no-touch variants)
Also there are a few big studies comparing long term quality of life. Pretty favourable for surgery. This easily trumps "we found changes in cornea".
Wow! I had no idea that there were any links to long term problems with lasix. I have been considering the procedure for over 15 years, but never pulled the trigger. If there are long term risks, I think that I will just stick to glasses.
You know, I hear those stories - that hospitals won't work as hard for you if they know you are a donor. Yet I've not seen any numbers on this. The same folks usually state things about an open casket and other such things. I'm guessing it happens, but I'm also guessing that most times, this isn't on the Doctor's and Nurses's minds in an emergency. Besides that, one can have some policies that help negate this: For example, no financial kickbacks.
I suspect that if organ donation is widespread, it becomes much more normal, and this would cease to be an issue/rumor at all. And I do think the OP is correct - the bigger problem is families and religious views more than folks simply letting people die.
But a huge problem also is that many relatives will baulk at the idea of their loved ones being harvested and also some religions have injunctions against this
One change could make a difference to the availability of transplantable organs in the US: make donation upon death opt-out vs opt-in on drivers' licenses.
There are arguments on both sides of opt-out ("presumed consent"), but even the cons argue more about ethics and lawsuits -- re dead people who clearly no longer need the organs -- than that there'd be more organs available to the living who might.
My initial reaction to this suggestion is horror, in part because I feel strongly that it disincentivizes finding other solutions to serious health issues. I have a condition that accounts for something like a third of all lung transplants and half of all pediatric lung transplants. I find the emphasis on heroic medical interventions instead of improved diet, prevention, etc. to be really horrifying. Pursuing improved diet, prevention, etc. has gotten me extremely good results. I never know how to convince people of that. It happens to be a fact, but it is not acceptable to really say that anywhere at all and the whole thing makes me feel postal at times.
But, please, let's stop parting people out as the easy answer and try a little harder to solve serious medical conditions some other way.
I wish I was at home so I could type out a full reply. I have lots of thoughts on this as I found out my kidneys were failing a short time ago. At least for kidneys I think we need to attack the problem well before it reaches transplant stage. Better proactive screening would help a lot. Some simple medicines would help a bit it given earlier. There is some research on alternatives to transplants. UCSF has plans for an artificial kidney but they are still looking for more funding. There is also some early work to use stem cells to heal kidneys. This stuff needs more research. With a little bit of assistance many could stretch their weakened kidneys through their lifetime. Transplants are not a cure. One has to live with a life of anti rejection drugs with their risks.
But who pays and how do you avoid adverse selection problems? In the study you cited, it sounds like compensation often comes from the recipient (in addition to a payment from the government). This seems like it would skew towards ability to pay on the recipient side, and towards the less affluent on the donor side.
Because then there would be no possibilities for new startups to arise. I already have a good idea: Something Tinder-like for potential donors and receivers ("Let me fuck you for a kidney!", "Suck my dick for a part of my liver.", etc.)
If you walk through the current process, everyone in the donation gets paid -- doctors, nurses, hospital, pharma -- except the donor.
There are a number of advantages of donors getting paid:
1. The supply market would increase dramatically. Thus many more people receiving organs who would have otherwise died waiting.
2. Heirs to people who have died young, with healthy organs could get paid for donating their organs.
3. Black markets would be dramatically reduced, since people in desperate need of an organ could pay in the open, rather than secretly paying a donor.
4. People without money can legally open a Kickstarter to raise funds for an organ donation.
Note Iran has partially done this, and the results have been very positive [1].
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1819484/