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Poll: Americans Show Support For Compensation Of Organ Donors

May 16, 2012
Originally published on May 16, 2012 6:47 am

The shortage of organs for transplant continues to grow, despite years of work to get more donors on board.

Facebook jumped in this month by making organ-donation status something you could add to your profile. And the social media giant made it easy to connect with a registry to sign up as a donor.

Federal law bans payments for organs. But given the need, we wondered what Americans thought about compensation for three kinds of donations that can be made while people are alive: kidneys, bone marrow and a portion of liver big enough to help someone whose liver is failing.

So we asked 3,000 adults across the country as part of the NPR-Thomson Reuters Health Poll, and here's what they told us.

If compensation took the form of credits for health care needs, about 60 percent of Americans would support it. Tax credits and tuition reimbursement were viewed favorably by 46 percent and 42 percent, respectively. Cash for organs was seen as OK by 41 percent of respondents.

Among people who said some form of compensation was acceptable, 72 percent said it should come from health insurers, followed by private charities at 62 percent and the federal government at 44 percent.

For all forms of compensation, rates of support tended to fall among older respondents.

There's been longstanding resistance to compensating donors financially in this country. There are concerns about exploitation and also worries that even small amounts of compensation would undercut a system that depends on altruism.

But it may be time to reconsider, Dr. Stuart Youngner, a bioethicist at Case Western Reserve University's med school, told Shots. "I think the market has become such an important guiding principle in so many areas of lives, including health care, that it becomes harder to say why shouldn't a person who donates organs make some money too," he said. "Altruism is very, very important, but in this case the lives of people are very, very important."

After reviewing the results of our poll, Youngner said it would have been stronger if we had asked people whether or not they were registered as organ donors and then investigated how financial incentives might have influenced their decisions.

As it was, we asked about three different donations, and the results came in about the same. About 87 percent of respondents in favor of compensation though it was OK for kidneys. About 85 percent felt that way about livers, and 83 percent for bone marrow.

It seems worth noting that the 9th U.S. Circuit Court of Appeals in March affirmed an earlier decision that compensating people for marrow cells drawn from their blood wouldn't run afoul of the federal law banning payment for organ donations.

OK, so let's say donors could be compensated. How much should it be? Thirty-seven percent of respondents said it should be less than $10,000, and 27 percent said it should be more than $10,000 and less than $25,000.

Finally, we asked if there is a difference between compensating people for organ donations compared with buying them outright. Around 40 percent don't see one. Sixty percent of people said compensation isn't the same thing as a purchase.

"It's clear they're saying there is a difference," Dr. Ray Fabius, chief medical officer for Thomson Reuters' health unit, told Shots. And, overall, the results show that a majority believes "any living donor should be recognized, and it should be handled by insurance companies," he said.

The telephone poll across the country was conducted during the first half of February. The margin for error is plus or minus 1.8 percentage points. Click here to read the questions and complete results. You can find the previous polls here, or by clicking on the NPR-Thomson Reuters Health Poll tag below.

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Despite years of work, there is still a drastic shortage of organs for transplant in the United States. In fact, the numbers are getting worse. Facebook has come up with one new idea. The company's making organ-donation status something that you can add to your profile.

Another idea that's been tossed around for some time is compensation for a donated organ. And a new poll, conducted by NPR and our partner Thomson Reuters found a lot of support for that, even though federal law currently bans payments for organs. Scott Hensley, the host for our health blog, Shots, is here to share what the poll found.

Scott, thanks for coming in.

SCOTT HENSLEY, BYLINE: My pleasure.

GREENE: Your poll reached out to 3,000 people, as I understand it. What kinds of donations were you asking people about?

HENSLEY: We asked people about the kinds of donations they can make while they're still alive. So we concentrated on kidneys, a portion of liver, and also bone marrow. Three things that are in high demand.

GREENE: So we're talking about while you're still alive. This is different from, you know, if I die, you know, they can take an organ in those first hours after death and donate them to someone.

Right. We thought if we were going to concentrate on the compensation question that it would make sense to look at those things where somebody could benefit from the compensation that they would conceivably get if they decided, yes, I'll go ahead and make my organs available.

OK. What sorts of options are we talking about and how did people react to the idea of compensation?

HENSLEY: Overall, 60 percent of the people who we asked said they were in favor of compensation for organ donation if it took the form of credits towards some future health care expense, like getting treated for something or health insurance. When we asked other options, like a tax credit or reimbursement for tuition or cash, then it dropped below a majority. And those responses were all in the 40 percent range.

INSKEEP: And why do you think that is? Why would people be more supportive of helping me with my own health care in the future, less supportive of, you know, some sort of tax credit?

HENSLEY: I suspect that people recognize that when people make a donation of a kidney, for instance, that there is the potential that down the road something might happen to them and they might need extra care. So it probably makes more sense to people; yes, if we're going to compensate someone let's do it kind of in kind. Give it to them for something that would help them with a health care problem that they might have down the road.

GREENE: Did you ask about who might be paying this compensation and did people offer preferences about that?

HENSLEY: We did ask. And it did make a difference. So when it came to the preferred group to make that payment, it was health insurers at about 72 percent. And then after that the next most preferred were either the government or a charity.

GREENE: That's 72 percent saying that they'd be in favor of health insurers carrying the burden for this compensation.

HENSLEY: Correct.

GREENE: If we're talking about potentially, you know, tax credits or some sort of future health care benefit as compensation, what kinds of values are being discussed?

HENSLEY: Pretty modest, it turned out. So the most common response was that it should be less than $10,000. Thirty-seven percent of the respondents who were in favor of some form of compensation said it should be that amount or lower. And then the next most common response at 27 percent was that it should be between $10,000 and $25,000.

GREENE: Just so we're clear, as we mentioned, federal law has restrictions on this. Right now, these sorts of options - tax credits, health care benefits - would not be permitted under the law.

HENSLEY: That's right. Although, in the case of bone marrow there's been litigation around this. And recently the Ninth Circuit Appeals Court upheld the notion that some form of compensation for bone marrow would be OK. There's a way to take bone marrow out of circulating blood. And that might be a way to get around the core of the law.

GREENE: And why does federal law restrict it in most cases right now?

HENSLEY: There's a real worry that this system that's built on altruism could be eroded by the financial compensation. So would there be an exploitation of poor people who would rush forward to give organs in order to make a little bit of money if they were paid cash, for instance.

GREENE: And right now, if I decide to donate my kidney, is there any type of compensation that I get?

HENSLEY: A pat on the back, a good feeling in your heart that you did a good deed.

GREENE: OK. Scott Hensley is the host of our health care blog Shots, and he's speaking to us about a new poll asking respondents what they think of compensation in theory for donating organs.

Scott, thanks for coming by.

HENSLEY: My pleasure.

GREENE: And for the complete text of the questions asked in that poll and a breakdown of the responses, check out the Shots blog at NPR.org. Transcript provided by NPR, Copyright NPR.