Panel Says Ethics Allow Compensation for Organ Donations

It’s ethical to pay families who donate a loved one’s organs, as long as the money isn’t enough to constitute a bribe, a newly created organ transplant advisory committee was told Monday.

The committee, meeting for the first time, is charged with advising the secretary of Health and Human Services on ways to increase organ donation and how best to distribute organs that are donated.

On Monday, the focus was increasing donation, and members considered a variety of ideas. Among them: new ways to financially and otherwise help the growing number of living donors, and efforts to procure organs from older people and others traditionally passed over.

More than 80,000 people are on organ transplant waiting lists, and more than 5,700 died waiting last year. The families of many potential donors are never approached about donation, and fewer than half of those who are asked say yes.

One of the more controversial ideas involves financial compensation for donor families. Some fear that families in financial need will be coerced into donation; others fear the idea will repel people motivated by altruism.

Federal law bars paying for organs, but over the weekend, an American Medical Assn. committee recommended that the issue be studied.

Earlier this year, the American Society of Transplant Surgeons convened a panel of ethicists that concluded compensation is ethical if it is small enough to be seen as a thank you, and “not so large it becomes a bribe,” said Dr. Francis L. Delmonico, chief of transplant services at Massachusetts General Hospital.

“It has to be considered to be a thank you, an expression of appreciation,” he told the advisory committee.

Dan Brock, a bioethicist at Brown University, said efforts such as one in Pennsylvania, where officials considered paying a stipend for funeral expenses if a family donated organs, are likely to become more common.

“People have proposed all kind of schemes like this to get the benefits of compensation without the look of buying and selling body parts,” said Brock, a committee member.

Other ideas discussed:

* Paying expenses of living donors, who will soon outnumber dead donors. Also, assuring that living donors who need a transplant of their own in the future go to the top of the waiting list.

* Developing registries of people who want to be organ donors when they die. Still unsettled is whether the list should be considered binding, meaning a person who has signed up while living would be a donor regardless of his or her family’s wishes.

* Public education, including an emotional hourlong documentary promoting donation that PBS stations plan to air in April.

The committee was created to inject expert opinion into what has been an emotional debate over how to allocate scarce organs. In recent years, there’s been a fierce fight over the geographic lines that govern the distribution system.

Since taking office, Health and Human Services Secretary Tommy G. Thompson has pushed the discussion away from distribution issues toward ways to increase donation. He doubled the committee’s membership to 40 and charged it with considering donation as well as allocation.

“If I can get these individuals, these leaders to lower their rhetoric and their animosities about who gets what and where, I will have accomplished a great deal,” Thompson said in an interview Monday.

The committee planned to discuss the more contentious issues of organ allocation today.