The American Society of Transplantation and the American Society of Transplant Surgeons are working to find innovative strategies to address the organ transplant shortage, according to an article published in the American Journal of Transplantation.
The article pointed to the growing need for kidney transplantation and lack of available donors.
“The list of active patients waiting for kidney transplants is now over 75,000, yet we will transplant less than 17,000 this year,” researchers stated in the study. “The average wait for a kidney transplant has risen to almost five years (much longer in some parts of the country); about 4,000 patients die waiting on the list each year with more removed from the list because their health status has deteriorated to the point that they are too sick to withstand transplantation. Moreover, recent studies clearly demonstrate that the longer a patient is on dialysis before transplantation, the greater the risk of complications and death following transplant.”
Incentives Workshop Group
The AST and ASTS formed the Incentives Workshop Group to have a shared approach for modifications in public policy. Leaders have conceived an “arc of change” that begins with work to remove all financial disincentives to organ donation for both living and deceased donors.
“As we follow the arc of change from removing disincentives like loss of wages and travel costs, we must move to considering incentives for donation like health insurance postdonation to ensure the long-term safety of donors,” lead author Daniel Salomon, MD, of The Scripps Research Institute, in La Jolla, Calif., said in a press release. “However, when speaking in terms of removing disincentives and considering incentives, there is little agreement on exactly where the line exists separating the two.”
Salomon organized the IWG with Alan Langnas, DO, of the University of Nebraska, to discuss the issue, noting the importance of involving physicians, surgeons, government officials, patients, families, ethicists and legal scholars in defining that line.
Some people may feel that health insurance provision is off the table for ethical reasons or because it could gravely damage the current organ donor process that is based on altruism, the study stated.
Salomon and his colleagues would like to see studies designed to cautiously but effectively determine the true potential and impact of incentives of different kinds in the U.S. “Which of our current assumptions are true, what innovations will be effective, what unintended consequences (including impacts internationally) will be realized, and what will ultimately be acceptable in legal, ethical and personal terms?” Answering these questions should be the purpose of well-designed and critically reviewed pilot projects,” researchers stated in the article.
Authors discussed an accompanying viewpoint article that provides ethical justification for conducting a pilot study of a federally regulated approach to providing financial incentives to living kidney donors, with the goal of assessing donors’ perceptions. Another viewpoint suggests that if human organs become commodities, they’ll come from the most financially vulnerable in society, they said.
Authors concluded that the number of organs available for transplant should be increased only by removing financial disincentives.
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