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Albertsen A. Unjust organ markets and why it is irrelevant that selling a kidney is the best option. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109593. [PMID: 38806229 DOI: 10.1136/jme-2023-109593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 04/17/2024] [Indexed: 05/30/2024]
Abstract
An important argument against prohibiting organ sales is that it removes the best option available to individuals in dire circumstances. However, this line of reasoning fails to recognise that selling a kidney on a regulated market is only the best option in a very narrow comparison, where a regulated organ market is compared with banning organ sales. Once we acknowledge this narrowness, selling a kidney is not the best option. This paves the way for a distributive justice-based critique of the 'best option' argument for organ markets, which illuminates that organ markets should be compared with a broader set of alternatives. If providing the option of selling a kidney is not the best option, but rather the best option we are willing to provide, and one which means that many people will remain in poverty and unjust circumstances, then this reflects poorly on those societies willing to offer only this option and not a better one.
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Affiliation(s)
- Andreas Albertsen
- Department of Political Science, School of Business and Social Sciences, Aarhus Universitet, Aarhus, Denmark
- The Centre for the Experimental-Philosophical Study of Discrimination-CEPDISC, Department of Political Science, Aarhus University, Aarhus, Denmark
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2
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Ambagtsheer F, Bunnik E, Pengel LHM, Reinders MEJ, Elias JJ, Lacetera N, Macis M. Public Opinions on Removing Disincentives and Introducing Incentives for Organ Donation: Proposing a European Research Agenda. Transpl Int 2024; 37:12483. [PMID: 38644936 PMCID: PMC11027084 DOI: 10.3389/ti.2024.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/04/2024] [Indexed: 04/23/2024]
Abstract
The shortage of organs for transplantations is increasing in Europe as well as globally. Many initiatives to the organ shortage, such as opt-out systems for deceased donation and expanding living donation, have been insufficient to meet the rising demand for organs. In recurrent discussions on how to reduce organ shortage, financial incentives and removal of disincentives, have been proposed to stimulate living organ donation and increase the pool of available donor organs. It is important to understand not only the ethical acceptability of (dis)incentives for organ donation, but also its societal acceptance. In this review, we propose a research agenda to help guide future empirical studies on public preferences in Europe towards the removal of disincentives and introduction of incentives for organ donation. We first present a systematic literature review on public opinions concerning (financial) (dis)incentives for organ donation in European countries. Next, we describe the results of a randomized survey experiment conducted in the United States. This experiment is crucial because it suggests that societal support for incentivizing organ donation depends on the specific features and institutional design of the proposed incentive scheme. We conclude by proposing this experiment's framework as a blueprint for European research on this topic.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eline Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Liset H. M. Pengel
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marlies EJ Reinders
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Julio J. Elias
- Department of Economics, School of Business, University of CEMA, Buenos Aires, Argentina
| | | | - Mario Macis
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
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Gonen LD, Bokek-Cohen Y, Tarabeih M. The general public's attitude towards accepting payment for kidney donation. Front Med (Lausanne) 2023; 10:1282065. [PMID: 38162890 PMCID: PMC10756681 DOI: 10.3389/fmed.2023.1282065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction Kidney transplantation has become the most cost-effective treatment for patients with end-stage kidney disease (ESKD) and offers them the highest quality of life. Yet, kidney donation is often inaccessible due to cultural and traditional beliefs about organ donation. The goal of our study is to assess the value of kidney donation using the Willingness to Accept (WTA) technique. We also aim to understand the factors influencing an individual's willingness to donate an organ. Methods A self-administered survey was completed by 985 participants from the general public. The quantitative method and survey design that were chosen used descriptive, correlational, nonparametric, and multivariate statistical tests. Results Most of the respondents, 895 (90.9%) are not willing to donate a kidney while alive. Four hundred and five (41.1%) of the respondents are not willing to donate a kidney after their death, while the rest are willing to donate their kidney after their death without financial compensation. The same attitude applies to the donation of a kidney from their relatives. Significant predictors from the results of the logistic regression model in predicting the lowest (minimal) amount that will encourage donation of one kidney after death were: Marital status; Nationality; Adi card holder; Knowing people who need a kidney donation; confidence in the medical staff; and consideration of the family's opinions regarding organ donation. Discussion Using cost benefit analysis (CBA), with the aim of evaluating the willingness of individuals to accept payment for innovative medical procedures, such as kidney donation, allows an assessment of the perceived value of the medical procedure and enables policymakers to decide whether to allocate funds or offer subsidies for kidney donation, given the limited healthcare resources available. During our research, we found that most participants did not support the commercialization of organs. Our recommendation for policymakers and health professionals is to continue providing adequate funding for kidney donations and to implement educational programs aimed at improving attitudes towards organ donation.
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Affiliation(s)
| | | | - Mahdi Tarabeih
- School of Nursing, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel
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Guttman N. "Look After Each Other"- Ethical Concerns in the Use of Communicative Appeals to Solidarity in the Face of a Pandemic. HEALTH COMMUNICATION 2023; 38:2795-2805. [PMID: 36043242 DOI: 10.1080/10410236.2022.2114771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
During the recent COVID-19 pandemic international organizations and national and local governments employed appeals to solidarity or "we-messages" for the purpose of encouraging the public to adopt mitigation measures and to help more vulnerable others. Since appeals to solidarity inherently aim to influence people's views and practices, they raise ethical concerns similar to concerns associated with health communication persuasive campaigns (e.g. respect for autonomy, personal responsibility, stigmatization) and concerns more specifically associated with appeals to solidarity (e.g. divisiveness). The first part of the paper introduces a conceptual distinction between two types of approaches to solidarity according to an instrumental or moral emphasis. Appeals to solidarity according to this distinction are illustrated with examples from the COVID-19 pandemic. The second part summarizes normative justifications and advantages for employing appeals to solidarity. The third part presents ethical concerns associated with appealing to solidarity in the time of a pandemic. Drawing on these concerns, the final part presents propositions for normative conditions for employing solidarity appeals in a time of a pandemic and notes the importance of research needed to identify additional ethical concerns and conceptions of solidarity in multicultural societies. It concludes with noting the importance of employing appeals to solidarity that go beyond mitigating the pandemic and of conducting a critical discourse on the mandate of the state to make "top-down" moral demands.
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Affiliation(s)
- Nurit Guttman
- The Department of Communication, Tel Aviv University, Tel Aviv, Israel
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Loh PS, Bershteyn A, Yee SK. Lessons Learned in Piloting a Digital Personalized COVID-19 "Radar" on a University Campus. Public Health Rep 2022; 137:76S-82S. [PMID: 35861290 PMCID: PMC9678787 DOI: 10.1177/00333549221112532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Health authorities encouraged the use of digital contact tracing mobile applications (apps) during the COVID-19 pandemic, but the level of adoption was low because apps offered few direct benefits to counterbalance risks to personal privacy. Adoption of such apps could improve if they provided benefits to users. NOVID (COVID-19 Radar), a smartphone app, provided users with personalized data on social proximity of COVID-19 cases and exposed contacts. We analyzed uptake of NOVID at the Georgia Institute of Technology (Georgia Tech) during the 2020-2021 academic year. Data included anonymous NOVID users who self-identified with Georgia Tech and their first- and second-degree network contacts. NOVID achieved 13%-30% adoption at Georgia Tech. Because of technical challenges, adoption waned after an initial peak. The largest increases in adoption (from 41 to 3704) followed administrative promotion of NOVID. Adoption increased modestly (from 2512 to 2661) after faculty- and student-led promotion, such as distribution of door hangers and a public seminar. Two-thirds of on-campus NOVID users were connected to a large network of other users, enabling them to receive data on social proximity of COVID-19 cases and exposed contacts. Network cohesion was observed to emerge rapidly when adoption rates passed just 10%, consistent with estimates from network theory. The key lesson learned in this case study is that top-down administrative promotion outperforms bottom-up grassroots promotion. Relatively high levels of adoption and network cohesion, despite technical challenges during the Georgia Tech pilot of NOVID, illustrate the promise of digital contact tracing when apps provide privacy and inherently beneficial personalized data to their users, especially in regions where Google Apple Exposure Notification is not available.
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Affiliation(s)
- Po-Shen Loh
- Department of Mathematical Sciences, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Anna Bershteyn
- Grossman School of Medicine, New York University, New York, NY, USA
| | - Shannon K. Yee
- GWW School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Chow KM, Ahn C, Dittmer I, Au DKS, Cheung I, Cheng YL, Lau CS, Yeung DTK, Li PKT. Introducing Incentives and Reducing Disincentives in Enhancing Deceased Organ Donation and Transplantation. Semin Nephrol 2022; 42:151268. [PMID: 36577641 DOI: 10.1016/j.semnephrol.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite the effectiveness of solid organ transplantation, progress to close the gap between donor organs and demand remains slow. An organ shortage increases the waiting time for transplant and involves significant costs including patient morbidity and mortality. Against the background of a low deceased organ donation rate, this article discusses the option of introducing incentives and removing disincentives to deceased organ donation. Perspectives from ethics, general public opinion, and the health care profession are examined to ensure a comprehensive appraisal and illustrate different facets of opinion on this complex area. Special cultural and psychosocial considerations in Asia, including the family based consent model, are discussed.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ian Dittmer
- Department of Renal Medicine, Auckland City Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Derrick Kit-Sing Au
- Centre for Bioethics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ian Cheung
- Cluster Services Division, Hospital Authority, Kowloon, Hong Kong
| | - Yuk Lun Cheng
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Chak Sing Lau
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | | | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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Beier K, Wöhlke S. An ethical comparison of living kidney donation and surrogacy: understanding the relational dimension. Philos Ethics Humanit Med 2019; 14:13. [PMID: 31533778 PMCID: PMC6749634 DOI: 10.1186/s13010-019-0080-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The bioethical debates concerning living donation and surrogacy revolve around similar ethical questions and moral concepts. Nevertheless, the ethical discourses in both fields grew largely isolated from each other. METHODS Based on a review of ethical, sociological and anthropological research this paper aims to link the ethical discourses on living kidney donation and surrogacy by providing a comparative analysis of the two practices' relational dimension with regard to three aspects, i.e. the normative role of relational dynamics, social norms and gender roles, and reciprocity. Based on this analysis, we derive conclusions for the framing of living organ donation and surrogacy in ethical theory and practice. RESULTS First, our analysis emphasizes the relevance of acknowledging the complex relational implications of living kidney donation and surrogacy. Underestimating this relational dimension may not only lead to individual crises but endanger existing as well as newly emerging familial relationships. Second, we point out differences in the normative assessment of social norms and gender roles in the ethical debates about living kidney donation and surrogacy. In particular, we show how different evaluations of altruism affect the understanding of autonomy in both contexts. In addition, we sensitize for biased perceptions of gender roles. Finally, we argue that challenges resulting from unresolved reciprocity are an issue in living kidney donation and surrogacy independent of whether the exchange of body parts or bodily services is framed as a gift or commercial exchange. By pointing out the limits of financial compensation, we stress the relevance of non-material, relational rewards as potential remedy.
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Affiliation(s)
- Katharina Beier
- Department of Medical Ethics and History of Medicine, University Medical Center, 37073 Göttingen, Germany
| | - Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center, 37073 Göttingen, Germany
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Teodorescu DI, Muñoz Sastre MT, Kpanake L, Sorum PC, Mullet E. Romanian Laypeople's and Health Professionals' Views Regarding Living Organ Donation. Transplant Proc 2019; 51:1644-1650. [PMID: 31255357 DOI: 10.1016/j.transproceed.2019.04.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 04/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Romanian laypeople's and health professionals' views on living organ donation were examined. METHODS From July 2015 to May 2016, 263 adults (among them 31 physicians and 20 nurses) judged the acceptability of living organ donation in 42 realistic scenarios composed of varying levels of 6 factors: 1. type of organ, 2. whether it could have been obtained from a cadaver, 3. donor-recipient relationship, 4. donor's level of autonomy, 5. financial compensation, and 6. patients' level of responsibility for their illness. In all scenarios, the patients were in need of either a kidney or liver transplantation. RESULTS The ratings were subjected to cluster analysis and analyses of variance. Seven qualitatively different positions were found that were termed never acceptable (12%), free market (44%), compensation (12%), altruism (6%), always acceptable (16%), responsibility (4%), and undetermined (6%). Physicians were more frequently in the free market or in the compensation clusters (81%) than laypeople (51%). CONCLUSION Only a few participants held the altruism model, even though this model has been promoted as the normative model by the World Health Organization and by most national legislations, including the legislation in Romania. Instead, the free market position and its variant-the compensation position-can be considered the majority positions (66%) in Romania.
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Affiliation(s)
| | | | - Lonzozou Kpanake
- Department of Psychology, University of Québec-TELUQ, Montréal, Canada.
| | - Paul Clay Sorum
- Department of Medicine, Albany Medical College, Albany, New York, USA
| | - Etienne Mullet
- Department of Ethics, Institute of Advanced Studies (EPHE), Paris, France
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Muñoz Sastre M, Pajot E, Kpanake L, Sorum P, Mullet E. Mapping French Laypeople's Views Regarding Living Organ Donation. Transplant Proc 2019; 51:613-618. [DOI: 10.1016/j.transproceed.2018.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/31/2018] [Indexed: 12/13/2022]
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10
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Opinions of Health Care Personnel Regarding Disincentives and Incentives for Living Kidney Donation at a Single Center. Transplant Proc 2018; 50:3053-3058. [PMID: 30577165 DOI: 10.1016/j.transproceed.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/19/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transplant societies continue to actively concentrate on increasing rates of living kidney donation (LKD) to bridge the gap between individuals awaiting transplantation and the number of kidneys available. A widely discussed strategy to increase living donation rates is the provision of incentives and removal of disincentives. Though opinions of the public regarding this strategy have been studied, the opinions of health care providers, including younger professionals, are less clear. We studied the opinions of medical students and other health care providers on strategies to increase LKD to determine if opinions were different among those < 25 or ≥ 25 years of age. METHODS A simple cross-sectional survey was conducted at an academic medical center. Participants included medical students and employees in Internal Medicine, General Surgery, and the Organ Transplantation Center. Pearson's χ2 and Fisher's exact test were conducted on the responses regarding disincentives and incentives to determine whether opinions differed based on age. RESULTS Six hundred and twenty-four participants completed the survey. There was no statistical difference in opinions between groups on reimbursing transportation costs, loss of wages, or childcare costs, but those aged ≥ 25 were more agreeable with covering food/lodging costs compared to those < 25 (96.5% vs 90.7%, P = .009). Respondents < 25 years old were more willing to donate a kidney for a financial incentive (P = .0002) accepting a median amount of $25,000. CONCLUSIONS Health care personnel broadly support removing financial disincentives for living kidney donation, and those ≥ 25 were more in favor of covering food/lodging costs compared to those < 25. Those < 25 years old were more likely to accept financial incentives towards donating their kidney compared to those ≥ 25 years.
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Martin DE, Danovitch GM. Banking on Living Kidney Donors-A New Way to Facilitate Donation without Compromising on Ethical Values. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2018; 42:537-558. [PMID: 28922903 DOI: 10.1093/jmp/jhx015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Public surveys conducted in many countries report widespread willingness of individuals to donate a kidney while alive to a family member or close friend, yet thousands suffer and many die each year while waiting for a kidney transplant. Advocates of financial incentive programs or "regulated markets" in kidneys present the problem of the kidney shortage as one of insufficient public motivation to donate, arguing that incentives will increase the number of donors. Others believe the solutions lie-at least in part-in facilitating so-called "altruistic donation;" harnessing the willingness of relatives and friends to donate by addressing the many barriers which serve as disincentives to living donation. Strategies designed to minimize financial barriers to donation and the use of paired kidney exchange programs are increasingly enabling donation, and now, an innovative program designed to address what has been termed "chronologically incompatible donation" is being piloted at the University of California, Los Angeles, and elsewhere in the United States. In this program, a person whose kidney is not currently required for transplantation in a specific recipient may instead donate to the paired exchange program; in return, a commitment is made to the specified recipient that priority access for a living-donor transplant in a paired exchange program will be offered when or if the need arises in the future. We address here potential ethical concerns related to this form of organ "banking" from living donors, and argue that it offers significant benefits without undermining the well-established ethical principles and values currently underpinning living donation programs.
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Nordfalk F, Olejaz M, Jensen AMB, Skovgaard LL, Hoeyer K. From motivation to acceptability: a survey of public attitudes towards organ donation in Denmark. Transplant Res 2016; 5:5. [PMID: 27222709 PMCID: PMC4878074 DOI: 10.1186/s13737-016-0035-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 05/10/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Over the past three decades, public attitudes to organ donation have been a subject of numerous studies focusing on donor motivation. Here, we present a fresh approach. We suggest focusing on public acceptability instead of motivation. The point is to understand public attitudes well enough to avoid risking public support for organ transplantation. We conducted the study in Denmark because there have been significant developments in public attitudes to organ donation in this country. In the 1990s, Denmark was a country with very low public support for organ donation and Denmark was the last country in Europe to introduce brain death as a legal criterion of death, whereas today Eurobarometer surveys rate Denmark as one of the European countries with the highest support for deceased organ donation from brain dead donors. METHODS We conducted a telephone survey in Denmark (N = 1195). A questionnaire was developed on the basis of preceding qualitative studies and pilot testing and included reuse of one item from earlier surveys to facilitate historical comparison. The analysis of the data was carried out using IBM SPSS Statistics 22 and focused on descriptive statistics. RESULTS A clear majority of 91.9 % are positive or very positive towards organ donation; 85.8 % like the idea of their body being used after their death, 85.0 % is willing to donate their own organs, 82.1 % to donate their tissue and only 2.3 % find that too much has been done to promote organ donation. There is limited support for monetary incentives for organ donation (5.8 %) and presumed consent (30.4 %), while a majority (63.9 %) supports making it mandatory to register a personal decision. Religious self-identification has limited impact on attitudes. CONCLUSIONS We can identify a shift over the past three decades from marked opposition to organ transplantation to strong support as well as a pattern in the contemporary public attitudes, which can help explain what is central to public acceptability: self-determination. Policies fostering choice are met with a majority of positive attitudes, while presumed consent and monetary incentives are met with more negative attitudes. Our approach calls for comparative studies in other countries to generate a better overall understanding of the conditions of acceptability, which need to be in place to ensure the long-term social robustness of organ donation and thereby safeguard this important medical technology.
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Affiliation(s)
- Francisca Nordfalk
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, DK 1014 Denmark
| | - Maria Olejaz
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, DK 1014 Denmark
| | - Anja M. B. Jensen
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, DK 1014 Denmark
| | - Lea Larsen Skovgaard
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, DK 1014 Denmark
| | - Klaus Hoeyer
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, DK 1014 Denmark
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Shaw RM, Bell LJ. 'Because you can't live on love': living kidney donors' perspectives on compensation and payment for organ donation. Health Expect 2015; 18:3201-12. [PMID: 25418552 PMCID: PMC5810734 DOI: 10.1111/hex.12310] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/30/2022] Open
Abstract
CONTEXT AND OBJECTIVE Living kidney donation accounts for approximately half of all kidney transplantation in many countries and is central to health policy focused on increasing organ supply. However, little examination of the economic consequences of living kidney donation has been undertaken from the perspective of donors themselves. This article documents living kidney donors' views regarding recompense and payment for organ donation, based on their experience. PARTICIPANTS Twenty-five living kidney donors from New Zealand participated in this study. METHODS This qualitative study, based on thematic analysis, uses semi-structured in-depth interviews to examine the experiences of living kidney donors. Themes were organized around altruism and the 'gift', perceptions of shared corporeality and identity, and donor support. RESULTS Most participants agreed the donation process was costly in terms of time and money. Many incurred personal costs, and some experienced financial hardship. All the participants viewed financial hardship as a barrier to organ donation and favoured recompense for direct and indirect costs. Most did not support payment for organs, and none supported commercialization. DISCUSSION AND CONCLUSIONS The findings show that framing organ donation as a 'gift' can stymie discussion about reciprocity, remuneration and exchange, making talk about financial recompense difficult. Financial well-being, nonetheless, has implications for the ability to care for self and others post-operatively. We conclude that the economic consequences for living kidney donors in jurisdictions where recompense for direct and indirect costs is insufficient are unfair. Review of financial assistance for live organ donors is therefore recommended.
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Affiliation(s)
- Rhonda M. Shaw
- School of Social & Cultural StudiesVictoria University of WellingtonWellingtonNew Zealand
| | - Lara J.M. Bell
- School of Social & Cultural StudiesVictoria University of WellingtonWellingtonNew Zealand
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14
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Martin DE, White SL. Financial Incentives for Living Kidney Donors: Are They Necessary? Am J Kidney Dis 2015; 66:389-95. [DOI: 10.1053/j.ajkd.2015.03.041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/06/2015] [Indexed: 12/17/2022]
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15
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Koplin JJ. From blood donation to kidney sales: the gift relationship and transplant commercialism. Monash Bioeth Rev 2015; 33:102-122. [PMID: 26458365 DOI: 10.1007/s40592-015-0035-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In The Gift Relationship, Richard Titmuss argued that the practice of altruistic blood donation fosters social solidarity while markets in blood erode it. This paper considers the implications of this line of argument for the organ market debate. I defend Titmuss' arguments against a number of criticisms and respond to claims that Titmuss' work is not relevant to the context of live donor organ transplantation. I conclude that Titmuss' arguments are more resilient than many advocates of organ markets suggest, and more relevant to the debate than is commonly appreciated.
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Affiliation(s)
- Julian J Koplin
- Centre for Human Bioethics, School of Philosophical, Historical and International Studies, Monash University, Menzies Building, 20 Chancellors Walk, Melbourne, VIC, 3800, Australia.
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Hoeyer K, Jensen AMB, Olejaz M. Transplantation as an abstract good: practising deliberate ignorance in deceased organ donation in Denmark. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:578-593. [PMID: 25655435 DOI: 10.1111/1467-9566.12211] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This article investigates valuations of organ transfers that are currently seen as legitimising increasingly aggressive procurement methods in Denmark. Based on interviews with registered donors and the intensive care unit staff responsible for managing organ donor patients we identify three types of valuation: the needs of recipients, respect for donors' autonomy and support of donors' relatives in their grieving process. Sometimes these modes of valuation conflict with each other, and we show how our informants then respond with a form of deliberate ignorance. We suggest that deliberate ignorance has a more general salience in the organ transplant field by way of facilitating a perception of organ transplantation as an abstract moral good rather than a specific good for specific people. Furthermore, we suggest that multiple forms of ignorance sustain each other: a desire for ignorance with respect to the prioritisation of recipients sustains pressure for more organs; this pressure necessitates more aggressive measures in organ procurement and these measures increase the need for ignorance in relation to the actual procedures as well as the actual recipients. These attempts to avoid knowledge are in remarkable contrast to the otherwise widespread policy emphasis on education and information in this medical domain.
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Affiliation(s)
- Klaus Hoeyer
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Denmark
| | - Anja M B Jensen
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Denmark
| | - Maria Olejaz
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Denmark
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Tong A, Chapman JR, Wong G, Craig JC. Perspectives of Transplant Physicians and Surgeons on Reimbursement, Compensation, and Incentives for Living Kidney Donors. Am J Kidney Dis 2014; 64:622-32. [DOI: 10.1053/j.ajkd.2014.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/20/2014] [Indexed: 12/19/2022]
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Impact of gender and professional education on attitudes towards financial incentives for organ donation: results of a survey among 755 students of medicine and economics in Germany. BMC Med Ethics 2014; 15:56. [PMID: 24996438 PMCID: PMC4107572 DOI: 10.1186/1472-6939-15-56] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/30/2014] [Indexed: 11/10/2022] Open
Abstract
Background There is an ongoing expert debate with regard to financial incentives in order to increase organ supply. However, there is a lacuna of empirical studies on whether citizens would actually support financial incentives for organ donation. Methods Between October 2008 and February 2009 a quantitative survey was conducted among German students of medicine and economics to gain insights into their point of view regarding living and deceased organ donation and different forms of commercialization (n = 755). Results The average (passive) willingness to donate is 63.5% among medical students and 50.0% among students of economics (p = 0.001), while only 24.1% of the respondents were actually holding an organ donor card. 11.3% of students of economics had signed a donor card, however, the number is significantly higher among students of medicine (31.9%, p < 0.001). Women held donor cards significantly more often (28.6%) than men (19.4%, p = 0.004). The majority of students were against direct payments as incentives for deceased and living donations. Nevertheless, 37.5% of the respondents support the idea that the funeral expenses of deceased organ donors should be covered. Women voted significantly less often for the coverage of expenses than men (women 31.6%, men 44.0%, p = 0.003). The number of those in favor of allowing to sell one’s organs for money (living organ donation) was highest among students of economics (p = 0.034). Conclusion Despite a generally positive view on organ donation the respondents refuse to consent to commercialization, but are in favor of removing disincentives or are in favor of indirect models of reward.
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Sharp C, Randhawa G. Altruism, gift giving and reciprocity in organ donation: a review of cultural perspectives and challenges of the concepts. Transplant Rev (Orlando) 2014; 28:163-8. [PMID: 24973193 DOI: 10.1016/j.trre.2014.05.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 04/07/2014] [Accepted: 05/20/2014] [Indexed: 11/19/2022]
Abstract
Living and deceased organ donation are couched in altruism and gift discourse and this article reviews explores cultural views towards these concepts. Altruism and egoism theories and gift and reciprocity theories are outlined from a social exchange theory perspective to highlight the key differences between altruism and the gift and the wider implications of reciprocation. The notion of altruism as a selfless act without expectation or want for repayment juxtaposed with the Maussian gift where there are the obligations to give, receive and reciprocate. Lay perspectives of altruism and the gift in organ donation are outlined and illustrate that there are differences in motivations to donate in different programmes of living donation and for families who decide to donate their relative's organs. These motivations reflect cultural views of altruism and the gift and perceptions of the body and death.
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Affiliation(s)
- C Sharp
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK
| | - G Randhawa
- Institute for Health Research, University of Bedfordshire, Luton, Bedfordshire, UK.
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Schweda M, Schicktanz S. Why public moralities matter--the relevance of socioempirical premises for the ethical debate on organ markets. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2014; 39:217-22. [PMID: 24847119 DOI: 10.1093/jmp/jhu016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The ongoing bioethical debate about organ markets rests not only on theoretical premises, but also on assumptions regarding public views of and attitudes toward organ donation that need closer socioempirical examination. Summarizing results from our previous qualitative social research in this field, this paper illustrates the ethical significance of such public moralities in two respects: On one hand, it analyzes the implicit bias of the common rhetoric of "organ scarcity" which motivates much of the commercialization debate. On the other hand, it explores the blind spots of the paradigm of "altruistic donation" which informs many arguments against commercialization. We conclude that the ethical discourse has to appreciate the social nature of organ donation as a reciprocal interaction between different parties with irreducibly different but equally relevant viewpoints. We criticize the neglect of such well-founded public considerations in certain philosophical-ethical approaches and stress the need for further systematic and comparative socioempirical studies about peoples' actual perspectives in bioethics.
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Affiliation(s)
- Mark Schweda
- University Medical Center Göttingen, Göttingen, Germany University Medical Center Göttingen, Göttingen, Germany
| | - Silke Schicktanz
- University Medical Center Göttingen, Göttingen, Germany University Medical Center Göttingen, Göttingen, Germany
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21
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Dew MA, Myaskovsky L, Steel JL, DiMartini AF. Managing the Psychosocial and Financial Consequences of Living Donation. CURRENT TRANSPLANTATION REPORTS 2013; 1:24-34. [PMID: 24592353 DOI: 10.1007/s40472-013-0003-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
There has been dramatic growth in the last decade in the literature on psychosocial and financial impacts of living organ donation. With this growth has come recognition that these impacts must be considered when educating prospective donors about the donation process, and when planning donor follow-up care after donation. Our review highlights recent studies that provide new information on the nature of psychosocial and financial outcomes in living donors, with special attention to studies examining unrelated donors (i.e., those with no biologic or longstanding emotional connection to the transplant patient), given that these individuals represent a growing segment of the living donor population. Limitations and gaps in available evidence are noted. We also discuss recent recommendations for post-donation monitoring of donors' psychosocial and financial outcomes, and we consider advances in evidence regarding interventions and prevention strategies to minimize any adverse psychosocial and financial impacts of living donation.
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Affiliation(s)
- Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, Biostatistics, and Clinical and Translational Science, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213 USA, 412-624-3373
| | - Larissa Myaskovsky
- Departments of Medicine, Psychiatry and Clinical and Translational Science, University of Pittsburgh School of Medicine and Medical Center and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, 230 McKee Place, Suite 600, Pittsburgh, PA 15213, 412-692-4856
| | - Jennifer L Steel
- Departments of Surgery, Psychiatry and Psychology, University of Pittsburgh School of Medicine and Medical Center, 3459 Fifth Avenue; MUH 7S, Pittsburgh PA 15213, 412-692-2041
| | - Andrea F DiMartini
- Departments of Psychiatry and Surgery, University of Pittsburgh School of Medicine and Medical Center, 3811 O'Hara Street, Pittsburgh, PA 15213 USA, 412-383-3166
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22
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Hoeyer KL. Commercialization of tissue-based research: time to move beyond the gift/market dichotomy. Biopreserv Biobank 2013; 11:397-8. [PMID: 24835370 DOI: 10.1089/bio.2013.1163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Klaus L Hoeyer
- Department of Public Health, Centre for Medical Science and Technology Studies , Copenhagen, Denmark
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23
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Martin D. Charitable incentives for blood donation are promising, but require careful consideration. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2013; 13:52-54. [PMID: 23641854 DOI: 10.1080/15265161.2013.781706] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Dominique Martin
- Centre for Health and Society, The University of Melbourne, Australia.
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