Financial Interventions and Living Organ Donation Research in a Learning Healthcare System

by Macey L. Henderson

Living kidney donation can potentially provide a solution for the growing waitlist in the United States, which is now holding steady at over 100,000 people. Through paired donation and kidney chains living donors could realistically be the solution to providing an unlimited number of transplants to those in need throughout the world, but the number of donors has been decreasing since 2004. Why? Leading groups of transplant surgeons and professionals have called for the active pursuit of health policies which achieve financial neutrality for the donor—meaning the donor wouldn’t be any financially worse off after donation than before. Other groups have charted an ethical course for the healthcare system to study financial interventions for living kidney donation with the goal of assessing donor attitudes and perceptions.

The Slow Evolution of Federal Transplant Law

Financial compensation as we understand to be “valuable consideration” under federal law is illegal in the U.S. under the National Organ Transplant Act of 1984 (NOTA) and while certainly possible, change to federal legislation is difficult and time consuming.   In 2007 NOTA was modified so that kidney paired donation activities did not constitute illegal or criminal activity by the Charlie W. Norwood Living Organ Donation Act. This change sparked the growth of programs providing algorithms that match incompatible donor pairs in the U.S.

The same legislation was responsible for modifications to a national program providing financial assistance based on donor and recipient income factors as well as other eligibility criteria set forth by the U.S. Department of Health and Human Services Poverty Level Guidelines.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.