This is a great idea, why should people expect to get organs if they are not willing to donate. You've just made it into a club. Though I don't know that this will actually cause people to register themselves to donate, I do think it is a good idea to have those who proactively register benefit.

That's a good point, but I suspect that another reason is the registration process. I'm not sure that I'm a registered organ donor and off the top of my head, am not sure how I would become one. Along with the incentive, why not find a way to put the sign ups into a regular process such as driver's license renewals? That way, the majority of people would be asked the questions at some point (and the question would continue to be asked) and the organ donor database could pull data from the DMV database. Just a thought ..

The surgeon gets paid quite well for an organ transplant, as does the hospital, the drug companies, the medical equipment supply company, etc. Maybe $50 - 100K. The donor, who enables it all to happen gets paid nothing. Seems like the best solution is to have $1000 or $5000 paid to the donor's family to cover the donor's funeral arrangements. A lot more people would sign up to donate. A small price to pay for the thousands of people waiting for a kidney.

"Consider the scenario of two medically similar patients, for whom preferred status would be the tie-breaker. One patient has signed an organ donor card, but has had a life of doing harm to society, robbing and beating others. The other patient has lived an exemplary life, has contributed financially and personally to medical causes including transplantation, and therefore has directly benefited many other people, but has not felt comfortable with agreeing to organ donation. Is there justice in the former person receiving the organ, allowing the one arbitrary fact of opting into the system to override all the other comparative points, which would tend the choice toward the latter?"

See the entire essay.

Mr. Big Bully – interesting scenario and valid point….but I’ve got a solution. How about if we incent Mr. Humanitiran-in-need-of-an-organ to knock off Mr. Menace-to-society-and-in-need-of-an-organ. This increases organ availability and rids our world of Mr. Menace – 2 problems solved, 1 piece of lead. Seriously, the objective is to significantly increase the number of organs available…if that goal really was to be met, I would not initially be too concerned about the Mr. Menaces that hopefully make up less than ½% of the population. If a program provides say 1000 incremental “solutions”, should we not proceed knowing 5 may be in error or unfair?

Unfortunately, this suggestion will do little, if anything to help the current situation. Keep in mind that the percentage of individuals that are eligible donors at the time of death is infinitesimal. Since the vast majority of individuals on the transplant waiting list are ardent supporters of organ donation, we cannot expect to see much of an increase in the total number of registered donors due to such a change.

What this proposal may lead to is the dangerous trend of subjectively evaluating how deserving an individual is of a transplant. I would contend that an individual's need for a transplant should be solely based on their health needs as determined by medical professionals, not by legislatures or others trying to evaluate their altruism.

On the other hand, if we made a serious effort to increase the number of organs available for transplant (per my suggestion above), both Mr. Humanitarian and Mr. Menace could both get transplants, eliminating the ethical dilemma as to which one has to do without.

As it is, a number of factors are considered regarding who gets organs. Tissue typing is obviously of key importance, or the organ is rejected and wasted. Sicker patients have priority over healthier ones (they really-really-really need them). Length of time on the waiting list is a factor.

But so are a lot of "squishy" factors in transplant ethics. Because organs are precious, transplant teams want the organs to go to people who will take good care of them--not "waste" them. Taking care of a donated organ is a lifelong endeavor. It's hard work. The recipient is really just trading one set of problems for another. The recipient can't skip anti-rejection medication because they are forgetful or can't pay for the medicines. They need to have the resources (read: insurance coverage) for continual follow-up, first weekly, then monthly, and eventually just semi-annually or annually. Etc., etc., etc.

And so while the transplant team does what they can to help people stay on the list, patients do get removed for reasons that aren't strictly medical. A patient waiting for a liver who keeps drinking isn't going to be able to care for a new liver, so she'll be removed from the list. A patient who is always non-compliant with his meds will be passed over because this indicates he won't be able to comply with an anti-rejection medication regimen either. So these factors already come into play.

I don't understand the tax incentive idea. At all. Organ donors (with the exception of some kidney donors) are already dead. They don't care about taxes any more at that point. If you instead gave the incentive to everyone who signed up, okay some folks would line their pockets, but that wouldn't change the problem in the ICU of grief-stricken families saying, "no, we don't want you to take his organs" because they are shocked and confused and in denial about the death, and weren't really sure about their loved one's wishes in the first place.