Pennsylvania to launch pilot program offering $300 stipend to cover funeral expenses of families of organ/tissue donors; plan praised, questioned

Transplant News, May 14, 1999

In the first-of-its-kind of plan that is already stirring up ethical questions over the "sale of organs," Pennsylvania is about to launch a pilot program that will offer a $300 stipend to each family of organ and tissue donors to cover funeral expenses. The stipend, which is expected to begin early next year, will not be paid directly to the relatives of the deceased donor, but will go to the funeral home unless the donor family opts out. The pilot program, which will run for three years, will be monitored by medical ethicists from the University of Pittsburgh and University of Pennsylvania to see if it affects donation rates. "This is has been touted as money for buying organs and that is absolutely untrue," Howard Nathan, executive director of the Gift of Life Donor Program (formerly the Delaware Valley Transplant Program) in Philadelphia, told Transplant News. "This is a voluntary death benefit for people who have given the gift of life. It is not an incentive per se because the money is no where near enough to be an incentive. It is a way of saying thank you informally to Pennsylvania residents who donate."

The pilot program, which was funded by donations from Pennsylvanians renewing their driver's licenses, will be administered by the state Department of Health. Nathan expects there will be about $120,000 available early next year.

"I'm guessing we will make payments to about 400 donors," Nathan said. "The idea is that it will be an automatic part of the normal consent process as long as the donor family tells us who the funeral home is. It will inclusive and all donors will get the payment unless the family opts out. The credit will then be applied to the families funeral expenses."

Final details of the plan are expected to be worked out by a panel of advisers and presented on June 9 to Pennsylvania Governor Tom Ridge. Once details are finalized, the state will sign contracts with Pennsylvania two organ procurement organizations (OPOs) - the Gift of Life Program and the Center for Organ Research and Education (CORE) in Pittsburgh to administer the pilot program.

The two OPOs however, are quick to point out the payment scheme was not their idea.

"The pilot program was part of the 1994 law put in by legislators, it was not our idea," pointed out Kevin Sparkman, director of the Gift of Life community something. "When it was proposed we didn't object and thought we should give the idea an opportunity."

Whether the program will result in increased organ donations is also debatable.

"The question on many people's minds is, 'Will incentives increase donation?' " Brian Broznick, CORE executive director, told the Philadephia Inquirer. "I'm not sure this amount of money is enough to test that theory." Nevertheless, Broznick feels the arguments for trying the program outweigh the moral and ethical arguments against it. "Imagine a young woman who just lost her husband and who, through organ donation, provided life to seven people," he said. "She tells you she doesn't have enough money to bury him and you're supposed to say, "Sorry, we can't help you."

In one of the few studies conducted on the public's attitudes about financial compensation for donation, the National Kidney Foundation (NKF) found in 1991 through a nationwide telephone poll that 49% of Americans favored some form of compensation, 42% opposed and 9% were undecided.

Based on those numbers, Dolph Chianchiano, NKF's director of scientific and public policy, supports the Pennsylvania pilot. "Our position is that this should be tested to see whether it serves a purpose," he said. "We are not talking about the highest bidder, or that there should be a market for organs. We are talking about a limited, specified amount of money paid to a third party."

However, Antonio Benedi, a liver recipient and past president of the Transplant Recipients International Organization (TRIO) in Washington, DC, felt payment in any form was dangerous.

"I think it is very murky ground to get into when we put a monetary incentive for such an altruistic gift as organ donation," Benedi said. "Obviously, there are some folks that need help as far as funerals go, but to attach it to the actual donation, I think, is very dangerous."

The Pennsylvania program has captured the attention of a number of other states, however, Nathan said. "We've heard from Arizona, New York and New Jersey," he said. "Not that they are going to emulate what we're doing but they are curious. We're going to take an academic approach to this, its been debated for a long time and Pennsylvania is going to do it. Ultimately the idea is to see how we can increase donations in an organized fashion so it can be duplicated elsewhere just like routine referral. So to me, implementation is going to be everything."