Should people be paid if they donate an organ? A focus group in Australia turned up a variety of opinions

Focus groups with 113 participants from the general public in three Australian states considered reimbursement and justifiable compensation of costs related to organ donation to be legitimate ways of supporting donors. Financial payment beyond reimbursement was regarded as “morally reprehensible and would threaten community values of goodwill, human dignity, and fairness, with the potential for exploitative commercialism,” the researchers reported.

Some participants believed that regulated compensation could be defensible provided that mechanisms are in place to protect donors. The findings in the article, “Focus group study of public opinion about paying living kidney donors in Australia,” published online last month in the Clinical Journal of the American Society of Nephrology by Tong and colleagues, suggest that addressing the removal of disincentives to donation would be more acceptable to the general public than providing financial incentives.

The unmet demand for kidney transplantation has “generated intense controversy about introducing incentives for living kidney donors to increase donation rates,” the authors wrote in the paper. “Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors.”

Twelve focus groups were conducted with 113 participants recruited from the general public in three Australian states in Feb. 2. Five themes were identified:

  • creating ethical impasses (commodification of the body, quandary of kidney valuation, pushing moral boundaries)
  • corrupting motivations (exposing the vulnerable, inevitable abuse, supplanting altruism)
  • determining justifiable risk (compromising kidney quality, undue harm, accepting a confined risk, trusting protective mechanisms, right to autonomy),
  • driving access (urgency of organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets), and
  • honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense).

Reimbursement and justifiable recompense are considered by the Australian public as a legitimate way of supporting donors and reducing disadvantage, the authors wrote. Financial payment beyond reimbursement is regarded as morally reprehensible, with the potential for exploitative commercialism.

“The perceived threat to community values of human dignity, goodwill, and fairness suggests that there could be strong public resistance to any form of financial inducements for living kidney donors. Policy priorities addressing the removal of disincentives may be more acceptable to the public,” the authors wrote.