Editorial Board

Better Incentives for Organ Donors Can Thwart Black Market: View

In a world of difference, how’s this for universality? Almost every country has a law prohibiting the sale of vital organs for transplant. You can’t donate a kidney for money, say.

The ban extends after death, too: It’s against the law to promise payment to the estate of someone who agrees to donate organs.

The concept of selling body parts is inherently offensive. What’s more, governments are loath to allow the poor to be motivated by financial need to provide vital organs for the wealthy.

In the place of legitimate trading of human parts, however, a global black market in kidneys, liver lobes and other organs has developed, and is steadily growing.

An investigation in the December issue of Bloomberg Markets magazine documented how donors from Belarus, Moldova and Ukraine traveled to other countries to have kidneys removed, returning with lasting pain from botched surgeries and payments of $5,000 to $10,000 -- often less than the amount promised.

In one case, a man from Belarus who answered an Internet ad was directed to take a train to Kiev, Ukraine, and from there made to fly 16 hours to Quito, Ecuador, where he was locked in a small apartment with two other organ sellers for four weeks before his left kidney was removed.

What can be done to stop this? One strategy is to increase law enforcement. Israel, where a great number of black-market organs end up, has instituted stiffer prison penalties for people who buy or sell body parts, required hospitals to better scrutinize donations from nonrelatives, and banned insurers from funding transplants performed outside Israel.

But law enforcement alone can’t destroy the black market. Another approach is to encourage more people to donate organs. To this end, in October, a bioethics council in the U.K. recommended that pilot programs be created to test whether more people would be prepared to bequeath their body parts after death if, in return, the government offered to pay their funeral expenses.

This is a smart approach. Covering funeral costs could encourage altruism without actually motivating people who would otherwise not donate to do so for the payoff.

Other reasonable enticements have been proposed for “cadaveric donation” of hearts, lungs, livers, pancreases, kidneys, corneas and other organs for transplant. These include reduced fees on driver’s licenses, payments after death to a charity of the donor’s choice, and allowing donors greater priority if they themselves need an organ transplant. The priority-for-transplant strategy is being tried in Israel and Singapore, but it isn’t yet known whether it’s getting more people to agree to donate.

Strategies to encourage donation necessarily vary from country to country because different cultures accept different practices.

But simple pleading isn’t enough anywhere. Countries worldwide should look for the best ethical approaches to persuade people to donate their organs.