This paper examines a Wisconsin Senate bill proposing a $20,000 refundable tax credit for living organ donors, situating it within the broader national debate over financial compensation for organ donation. With over 101,000 Americans on organ transplant waiting lists, the paper presents both sides of the ethical controversy: proponents argue that incentives address a critical shortage and align with utilitarian principles, while opponents raise concerns about the commodification of the human body and the potential exploitation of economically vulnerable populations. Economic factors, including the cost-effectiveness of transplantation versus dialysis, are also considered.
A Wisconsin Senate bill asks voters to decide upon a program to compensate living organ donors who choose to donate one or more of their organs. The bill would provide a fully refundable tax credit of $20,000 for donations, serving as an add-on to existing legislation passed in 2004 "which allows living donors in Wisconsin to receive an income tax deduction to recoup donation expenses like travel costs and lost wages" (University of Minnesota.edu, February 2004). The bill is not unique, as other states have introduced legislation to provide some measure of financial support to living organ donors. One example is the Pennsylvania gift-giving program, which awards money to a living donor or to the family of a deceased donor that can be used for reimbursement of food and lodging expenses incurred during the donation process (ABC News, June 16, 2002).
At issue with these and other programs, however, is the moral and ethical dilemma associated with direct financial compensation for the donation of an organ. With over 101,000 individuals waiting for an organ transplant according to the United Network for Organ Sharing (UNOS) (Rettner, R., August 10, 2009), the consideration of insufficient supply to meet accelerating demand brings the debate over payment to living donors to the forefront.
According to UNOS, "the primary ethical dilemmas surrounding organ transplantation arise from the shortage of available organs" (University of Minnesota.edu, February 2004). The particulars of this statement are best understood in the context of kidney donation, as "not only is the need for this organ the greatest, but it is one of the few organs that can come from a living donor" (Rettner, R., August 10, 2009). The most recent data reflect that 16,000 kidneys were donated on an annual basis, while there were 80,000 potential candidates for transplant (Rettner, R., August 10, 2009).
Proponents of the State Bill argue that, given such great need for organs — particularly kidneys — living donors represent "a major focus as a way to reduce the shortage of organs in America" (University of Minnesota.edu, February 2004). The proponent argument acknowledges ethical concerns with living donor incentives, including donor safety and socioeconomic considerations (University of Minnesota.edu, February 2004). However, the reality of persistent organ shortages underscores the necessity of examining all avenues for increasing supply. This point is not lost on the American Medical Association (AMA), which "testified before the United States Congress that the shortage of organs is so critical in America that studies need to be conducted on the effectiveness and outcomes associated with incentivized donations, including possible financial incentives" (University of Minnesota.edu, February 2004).
The ethical framework underlying the proponent position is best summarized by the utilitarian notion of the greatest good for the greatest number of people. If lives can be saved by the donation of kidneys from living donors, is there not a moral imperative to facilitate that exchange — including through the use of financial incentives?
"Transplants are cost-effective versus long-term dialysis"
"Ethical objections to organ commodification and exploitation"
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