Organ incentives

Were I a Facebook person, I'd be hitting the "Organ donor" button, now apparently active in New Zealand.

Last week New Zealand became the latest to approve a Facebook initiative that allows people to state that they want to be organ donors.

The global scheme works to promote organ donation, by allowing people to create a "life event" on their timeline saying they wish to become a donor.

Family members are still requested to give permission when the time comes, but the Facebook initiative is helpful in promoting discussion of the issue, Facebook's Australia and New Zealand communications and policy manager Mia Garlick said.

I'd want a slightly stronger button indicating LifeSharers membership.

Michelle Robinson's article makes the case for compensating live donors, drawing on a few bits from me. She uses some of the best quotes I'd sent; the full text I'd provided is below.

"There are a few reasons for New Zealand's relatively low organ donation rate. To start with, we don't have great awareness campaigns around organ donation. So when people renew their driver's licence, they've not really put much thought into the donation decision, and nothing around the driver's licence scheme really helps to encourage an informed decision. Next, to be eligible to be an organ donor, you have to be in an ICU bed when you die; doctors here seem reluctant to assign a terminal patient to a scarce ICU bed in hopes that the patient's family will consent to donation. Finally, because the driver's licence scheme does not constitute informed consent, doctors feel the need to seek explicit family permission for organ donation at what is the worst possible time for families to be making that kind of decision. So it's no surprise that half of families asked decline that the deceased's organs be made available for transplant." 

"Other countries have tried a variety of approaches to increase both live and cadaveric donation rates. Even if everyone signed their organ donor card, we just couldn't meet demand for kidneys; live organ transplants help to fill that gap. Israel has had great recent success with a combination of two policies. First, they have increased compensation for live organ donors. Donating a kidney or a liver lobe is pretty safe - fishermen have a higher on the job fatality rate than do live donors of liver lobes. But, the donation means time away from work both before the transplant and in post-operative care. Israel compensates donors with up to 40 days' lost wages and expenses. Given the costs of dialysis for public health systems, this kind of compensation isn't nearly as expensive as you might think. M.P. Michael Woodhouse has a Private Member's Bill in the New Zealand Parliamentary ballot that would enhance compensation to live donors here. Second, Israel introduced the "Priority System". If you agree that your organs should be available for others if you die, you're given priority should you ever need an organ donation. While medical ethicists worry that it might not be fair that people who are unwilling to share with others might have a lower position in the queue, we have to remember that measures like this don't just change peoples' positions on the list, they also increase the number of organs available for transplant. Israel saw a sixteen percent increase in the number of registered donors with the Priority Law; we have to weigh any of these fairness worries against that these policies save more lives." 

"There are other measures New Zealand could reasonably consider. One policy that should neither be terribly controversial nor terribly expensive would be payment towards the funeral costs of organ donors. This simple policy could help push the organ donation decision from being an afterthought at the drivers' licence office to being something that families talk about together when planning their estates. That takes the emotional heat out of the decision and helps a grieving family to know and respect their loved one's wishes when a nurse or doctor asks about organ donation. And, as the University of Otago Medical School is already covering cremation costs for those donating their bodies for medical research, a subsidy worth about $1500, extending partial payment of funeral costs to organ donors would only really be an extension of something that's currently allowed. WINZ helps defray funeral costs for the poor; why can't we also defray the funeral costs of those helping to save others' lives and reducing the burden on the public health system through their donation decision?" 

"One option I particularly like is LifeSharers. LifeSharers is a club that's free to join. All you have to do is agree to be an organ donor - there are no fees and nobody is excluded, even if medical problems mean your organs might never be used. Being willing to share is all that's required. If you're a LifeSharers member, you agree not only to be an organ donor, but also that first call on your organs should go to a LifeSharers member on the organ waiting list who is a suitable tissue match. If nobody on the LifeSharers list is a good match, your organs go into the general pool. The beautiful thing about LifeSharers is that every person who joins it increases the benefits to anybody else considering signing up as an organ donor with LifeSharers; it's the private equivalent of Israel's Priority Law. If I sign only my driver's licence, I don't do much to encourage anybody else to be an organ donor. But if I join LifeSharers, I help to make it be in your interest to become a donor member. The transplant ethicists here in New Zealand don't particularly like it because they worry that somebody who refuses to share, for whatever reason, might be disadvantaged; I worry more about all the people who are disadvantaged when too few people sign up as organ donors." 

"It's also good that New Zealand is starting to explore running something like America's Kidney Exchange system; National's proposed changes include a feasibility study. Suppose that I wished to donate a kidney to my wife, but I'm not a good tissue match for her, and you're a poor tissue match for your partner, but I'm a match for your partner while you're a match for mine. The Kidney Exchange looks for situations like this and builds chains of living donors. This February, The Kidney Exchange built a chain of thirty kidney transplants involving sixty people. With a smaller population, New Zealand wouldn't be as likely to build these long chains of living donors, but it would still be a great way of helping to increase live donation rates. I hope we move quickly to implementation."