U.S. TRANSPLANT LAW AND THE NEED FOR REFORM


The National Organ Transplant Act of 1984, also known as NOTA, includes this prohibition of compensation for organ donors:

Prohibition of organ purchases​
(a) Prohibition
It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce. The preceding sentence does not apply with respect to human organ paired donation.

(b) Penalties
Any person who violates subsection (a) shall be fined not more than $50,000 or imprisoned not more than five years, or both.

(c) Definitions
For purposes of subsection (a):
(1) The term "human organ" means the human (including fetal) kidney, liver, heart, lung, pancreas, bone marrow, cornea, eye, bone, and skin or any subpart thereof and any other human organ (or any subpart thereof, including that derived from a fetus) specified by the Secretary of Health and Human Services by regulation.
(2) The term "valuable consideration" does not include the reasonable payments associated with the removal, transportation, implantation, processing, preservation, quality control, and storage of a human organ or the expenses of travel, housing, and lost wages incurred by the donor of a human organ in connection with the donation of the organ.
(3) The term "interstate commerce" has the meaning prescribed for it by section 321(b) of title 21.
(4) The term "human organ paired donation" means the donation and receipt of human organs under the following circumstances:
(A) An individual (referred to in this paragraph as the "first donor") desires to make a living donation of a human organ specifically to a particular patient (referred to in this paragraph as the "first patient"), but such donor is biologically incompatible as a donor for such patient.
(B) A second individual (referred to in this paragraph as the "second donor") desires to make a living donation of a human organ specifically to a second particular patient (referred to in this paragraph as the "second patient"), but such donor is biologically incompatible as a donor for such patient.
(C) Subject to subparagraph (D), the first donor is biologically compatible as a donor of a human organ for the second patient, and the second donor is biologically compatible as a donor of a human organ for the first patient.
(D) If there is any additional donor-patient pair as described in subparagraph (A) or (B), each donor in the group of donor-patient pairs is biologically compatible as a donor of a human organ for a patient in such group.
(E) All donors and patients in the group of donor-patient pairs (whether 2 pairs or more than 2 pairs) enter into a single agreement to donate and receive such human organs, respectively, according to such biological compatibility in the group.
(F) Other than as described in subparagraph (E), no valuable consideration is knowingly acquired, received, or otherwise transferred with respect to the human organs referred to in such subparagraph.

NOTA was enacted as Public Law 98-507 on October 19, 1984. The prohibition above is now part of the U.S. Code as Title 42, Chapter 6A, Subchapter II, Part H, Section 274e.

The problem with NOTA is that it prevents even small experiments with compensation for organ donors. We know that the current system isn’t working. It has a waiting list of almost 120,000 people, thousands of whom will die before they can receive an organ transplant. Why forbid even experimenting with changes that could be literally lifesaving?

In response to the problem, Rep. Matt Cartwright (D-PA) introduced a bill in 2016, the Organ Donor Clarification Act , that would allow pilot programs to experiment with compensation. The bill did not pass during that session of Congress, but we understand that Rep. Cartwright and his staff would like to reintroduce the bill during the current Congress, and that they are interested in permitting experimentation on a larger scale if other members of Congress would support it.