When Martha Gershun donated a kidney, it cost her about $6000 out-of-pocket. The costs were for lost work, travel, and other incidental expenses. She and I wrote a book about the barriers that often prevent people from donating an organ and saving a life. Among other things, we discuss the blurry line between reducing barriers to donation through financial incentives and markets in organs. The line is getting less blurry and a robust consensus is forming.
A bill just passed by the NY legislature reflects that consensus. It offers incentives to reduce barriers to organ donation. Reimbursements for organ donation would include costs incurred by donation including lost wages, sick and vacation days, child care, travel, lodging or medical expenses. Other states offer some benefits to organ donors but this bill would make NY one of the most generous. The bill is on the Governor Hochul’s desk. I urge her to sign it. You can too, right here.
The package of benefits in the NY bill is similar to what is offered in Israel. Israel has the highest rate of living kidney donation in the world. It is probably not a coincidence that they offer one of the most generous packages of benefits for kidney donors. Kidney donors in Israel are entitled to receive compensation for lost work days (up to 40 days), travel reimbursement with no receipts required, 5 years of supplemental private health insurance, life insurance, and disability insurance, five psychotherapy sessions, a week in a resort hotel, and exemption from paying the national health tax for three years.
They also are given lifetime membership in all of Israel’s national parks.
These approaches are an appropriate recognition of the burdens of donation. They are a reasonable and ethically defensible way to reduce barriers that have long prevented many people from donating. They have been endorsed by transplant physicians, economists, and national professional organizations. And they are, essentially, a rigorously regulated market.
Some fear that they violate Kantian ethics, or are the thin edge of the wedge by which we will eventually end up with ethically abhorrent markets in organs.
The emerging consensus balances the concerns of both sides. It rewards donors but in ways that are unlikely to be coercive or exploitative. There clearly is an ethically sturdy middle ground between unregulated markets in organs and fair compensation for donors. Lifetime membership in national parks is not coercive. It is kind.
The New York bill will save lives, reduce costs, reduce disparities, and appropriately acknowledge the admirable altruism of organ donors. Please sign it, Governor Hochul.