ORGAN DONATION'S COMPENSATION DILEMMA.

• Author: Doren, Peter Van
• Position: MEDICINE & HEALTH

"... The entire organ donation system .. . sorely is in need of reform, but the ultimate issue with U.S. organ donation is that there is a supply shortage caused by laws banning compensation for donors."

THE WASHINGTON POST has reported on the logistic and technological failings of the United Network for Organ Sharing (UNOS), the private nonprofit agency with a government-enforced monopoly on the U.S. system of procuring organ donations and matching donated organs to the more than 100,000 people waiting for them. A report from the White House U.S. Digital Service found that UNOS has been ineffective, lacks transparency, and relies on outdated software with frequent system failures and cybersecurity concerns. While UNOS has resisted efforts to modernize and reform, these problems have necessitated billions of dollars every year for continuing medical treatments like dialysis and meant that the organ donation system has failed to prevent the deaths of thousands who could have been saved by getting a donated organ.

UNOS, and the entire organ donation system, sorely is in need of reform, but the ultimate issue with U.S. organ donation is that there is a supply shortage caused by laws banning compensation for donors. The Summer 2022 issue of Regulation features ideas on how to overhaul the system from some of the specialists involved in efforts to change U.S. organ donation policy.

Most of the current problems stem from the National Organ Transplant Act (NOTA) of 1984, which established the system of monopoly contractors to supply donated organs (organ procurement organizations or OPOs) overseen by an organ procurement and transplantation network (OPTN). UNOS has been the OPTN since a contract was finalized in 1986.

At the same time, NOTA banned the purchase of organs, making it a Federal crime 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 justification for this ban was to prevent the exploitation of the poor by wealthy patients in need of organ transplants, but its effect has been to severely curtail the availability of donated organs.

The easiest way to address the shortage would be to provide some type of incentive for organ donors. As one of this article's coauthors (Van Doren) has discussed previously, many people have animosity towards the sale of human organs, but if it is not immoral to do...