Jane McCredie: Incentivising organ donors

It’s an often-lamented fact that Australia has one of the lowest rates of organ donation in the developed world.

According to the Australia and New Zealand Organ Donation Registry, about 1500 people are currently on transplant waiting lists in this country, most of whom are in need of a kidney.

An analysis of Australian renal transplant waiting lists earlier this year suggested the problem might actually be much larger, as many patients who seemingly fit the criteria for receiving a donor kidney never make it to the list in the first place. In one jurisdiction (NT) they found that only 1% of dialysis patients were on the transplant waiting list!

Back in 2008, the Rudd government sought to address the problem with a $150 million package designed “to establish Australia as a world leader in organ donation and transplantation”.

The reforms included establishment of a new national coordinating authority along with extra funding for hospitals and specialist organ donation staff, counselling of bereaved families and public education.

They stopped short, however, of moving to the opt-out approach favoured by many European countries, under which people are assumed to have consented to donation unless they have indicated otherwise.

Donation rates have risen slightly since the package was introduced — from 12.1 per million population in 2008 to 14.9 last year — though it’s not clear how much of this can be attributed to the reforms.

In any case, we are still well behind many European countries and the US, where donors per million population are in the 20s or even 30s.

Apart from the opt-out approach — highly effective, but controversial — various strategies have been suggested for raising donation rates, from reimbursement of donors’ funeral expenses to the system introduced in Israel in 2010, that sees registered donors given priority on waiting lists if they later need a transplant themselves.

Two Danish philosophers are now suggesting the possibly more palatable approach of giving registered donors a tax break — perhaps 200 pounds (AUD 300) per year — in much the same way we currently allow tax deductions for charitable donations.

“Compensating people who do something good — for example, creating tax incentives to encourage people to donate money to charity — is a well-known practice and is considered by many people to be both legally and morally desirable because it increases the total amount of money donated”, they write.

“Why not use tax credits to save the lives of people who need an organ?”

To avoid fraudulent claiming of the benefit, relatives of those who have claimed the deduction should not be allowed to veto donation after the potential donor’s death, the authors propose.

Obviously, any government looking at introducing a scheme like this would need to examine its cost-effectiveness: what would the tax incentives cost, and what would be the benefits in improved longevity and quality of life or in savings to the health system from, for example, reduced demand for dialysis?

More difficult to quantify are the ethical ramifications of providing a financial reward for the donation of human biological material, something we in Australia have always tended to resist, generally for the best of reasons.

Some would argue, though, that our relatively hard line has led to potentially exploitative practices, as some Australians travel to countries where it is possible to purchase such materials without proper regulatory control.

Maybe it’s only that the tax break would not, in most cases, be linked to an actual donation, but this proposal somehow seems a lot less problematic than the idea, for example, of offering cash payments to bereaved families who agree to donate.

Given our abysmally low donation rates, and assuming an opt-out system is off the table, perhaps this is something we need to discuss.

Jane McCredie is a Sydney-based science and medicine writer.

Posted 30 July 2012