Q. Why is there a need to reform the law on organ transplants in the United States?

A. As of early 2019, about 114,000 people in the United States are on waiting lists for organ transplants to prolong their lives. Many of them will die before they can get an organ because there are not enough donors.

Q. How would you summarize the problem?

A. Not enough strangers donate organs to other strangers. Families and friends donate, which is terrific, but too often, those who want to donate are not a good enough match for their relative or friend. To end the shortage, many more strangers need to donate to other strangers.

Q. What organs are needed?

A. The most needed organ is kidneys ; about 95,000 people are currently awaiting a kidney transplant. There are 13,000 people waiting for a liver transplant, and 8,000 people waiting for transplants of other organs. (These numbers don’t add up to the total of roughly 114,000 people because some people need multiple organs.) 

Q. How does organ donation work?

A. It differs by organ. Many organs are given by people who have died. They or their next of kin have thoughtfully allowed the organs to be donated to give life to other people.

Kidneys and livers can be given by living donors. Most people have two working kidneys and can live normally with only one, making the other potentially available for donation. People only have one liver, but unlike a kidney it grows back if part is removed. A living donor can give a part of the liver to a recipient. The parts in both people will then grow to allow normal functioning.

Kidneys and livers from living donors typically have somewhat higher long-term  success rates in recipients than those from deceased donors.

Q. When you talk about compensating organ donors, what do you mean?

A. We should see what is most effective for increasing the number of donors. Compensation could take various forms: a tax credit ; educational tuition; payment of wages lost during testing, surgery, and recovery for living donors; funeral assistance for deceased donors; perhaps even cash.

Q. How much compensation are you talking about?

A. A 2015 study by doctors and scientists at Stanford University estimated that a one-time fee of $45,000 would be enough to ensure that every American who needs a kidney would be able to get one in a timely manner. Some economists are currently studying the issue as well.

Q. What are the potential savings?

A. The savings are huge in terms of lives, happiness, and dollars.

First, lives. Everybody on a waiting list for an organ transplant is a life that could be saved. Many people never even make it onto the waiting list because the waiting times are so long that they are unlikely to survive until an organ becomes available. Many of them could also be saved. People who receive kidneys have a life expectancy seven years long than those who do not.

Second, happiness. For many people, weak or failed organs prevent them from holding a job, performing the tasks of everyday living, and leading normal lives. Families also suffer because relatives spend time taking care of the sick rather than enjoying the company of the healthy.

Finally, dollars. Under a 1972  law , the federal government  pays  for kidney dialysis for every American whose private insurance does not cover treatment  Enabling those people to get off dialysis would result in an estimated $150 billion of savings for the federal government over the next decade. Even bigger benefits would accrue to the recipients of kidneys. The Stanford University study estimated  that the higher quality of life and the longer lifespan that kidney recipients would have, and the ability of at least some to resume working, would add up to $50 billion worth of benefits a year.

These figures are at the low end of potential savings because for simplicity we have only discussed kidneys and have not taken into account similar savings for recipients of other organs.

Q. What do major religions say about compensation for organ donors?

A. We know of no teaching in the scriptures of any major religion that prohibits compensation for organ donors. Some religious leaders have expressed support for compensation, while others have expressed opposition. Most have not expressed a view. Those opposed to compensation have based their views on ethical grounds that they consider compatible with their religious beliefs but are not directly based on any scriptural teaching.

Some Catholic thinkers have opposed compensation for organ donors based on considerations expressed most notably by Pope John Paul II . The late Michael Novak, possibly the most important lay Catholic thinker in the United States over the last generation, laid out a case for supporting compensation here .

If federal law were amended to allow compensation for organ donors, potential donors who had moral objections to compensation could still donate for free. People awaiting transplants who had moral objections to compensation could accept only organs donated for free.

People who favor prohibiting compensation for organ donors do not, to our knowledge, have any effective or even potentially effective ideas for increasing the supply of organs for transplantation. We suggest to them that saving the lives of people who need transplants is far more ethical than forbidding prospective donors from volunteering to save lives.

Q. Is allowing organ donors to receive compensation immoral?

A. Compensation is a recognition that organ donation involves costs to donors. We don’t expect strangers to bake our bread, police our streets, or produce life-saving medicines for free, and we understand that not compensating them would lead to grievous shortages. In contrast, the United States has more than 30 years forbidden compensation to organ donors. The predictable result is a shortage. For instance, fewer than 300 living donors of kidneys a year are strangers donating to other strangers ("nondirected" donations).

The greatest immorality is that people should die years or decades before they otherwise would. Allowing compensation for organ donors would reduce or even eliminate that evil.

Q. If donors are compensated, will most be people who are poor, down on their luck, uninformed, or otherwise vulnerable? In other words, isn’t such a system ripe for abuse?

A. Many safeguards are already built into the system of organ donation. One example is that psychologists often interview prospective living donors to ensure that they do not have mental disturbances that surgery might worsen. With a larger pool of potential donors, it would be possible to increase safeguards if considered necessary, because rejecting a potential donor would not mean eliminating someone’s chance to receive a transplant, as it does today.

Q. If donors are compensated, will they be disproportionately ethnic or other minorities?

A. Possibly. If so, the greatest beneficiaries will be their fellow minorities. Blacks, Hispanics, and Native Americans have higher incidence of end-stage renal disease and  are on organ transplant waiting lists in higher proportions than their shares of population. They are also more likely than whites to die while waiting for an organ. Because of the characteristics of kidneys, some matches are likelier between people of the same race or ethnicity. Increasing the supply of organs by compensating donors would be a huge boon to minorities needing organ transplants, along with everyone else.

Q. Isn’t donation by living persons risky?

A. Surgery today is safer than it has ever been, but any surgery carries some risk to the patient. That is in fact one reason that compensation for donors should be allowed. And consider the other side of the risk: somebody who needs but cannot get an organ transplant is almost certain to die prematurely.