Many countries are already testing the idea of some form of incentive, even if it's not monetary. Israel has created a law where people who commit to being donors after they die may jump the line if they or a family member need a new organ themselves. In Britain, consultations are being held to decide where the public stands, for instance, on the idea of covering some funeral expenses for donors. A University of Montreal researcher recently proposed a tax credit for consenting donors that after their death would go to their next of kin.
Would poor people become an organ pool?
The case against allowing people to profit off their organs is usually moral: Critics say it would stop people from giving altruistically, make poor people an organ pool for the wealthy and even encourage the more nefarious among us to hasten the death of unwanted, but organ-rich, relatives. Could someone deep in gambling debts be pressured to give up a kidney?
While donors are rigorously screened, even Dr. Matas concedes that concerns about abuses are legitimate - though safeguards, such as keeping the benefit small, should be part of any debate. "Why do I have to design a perfect system before this concept can be acceptable?" he asks.
Some economists, such as University of Chicago Nobel laureate Gary Becker, argue that something closer to a freely competitive market would stabilize prices and mitigate organ trafficking while recognizing individual freedom. But Dr. Matas envisions a regulated organ market in which governments would determine the compensation for living donors and still control who receives the organs based on need. (At this point he is not including deceased donors, as it's difficult to decide who receives the benefit.)
The cost to taxpayers would be offset by the health-care savings: In Canada, statistically, giving someone on dialysis a transplant saves about $50,000 a year.
Under Dr. Matas's system, people would be properly educated about the risks of donation and would receive a financial perk - perhaps in the form of discounted college tuition, or $1,000 each time they go to the doctor for an annual checkup after the operation, as an incentive to take care of their own health as well.
He scoffs at the notion that this would sully the purity of the donor's act of giving. "This concept that donors today are gaining nothing is ridiculous. If your husband is sick and you donate a kidney to him, you benefit from having a healthy husband," he argues. "There are huge other things going on in conventional donation beyond pure altruism. In what other situation do we say that you can do something for free, but you can't do it for an incentive? There is no parallel."
Even the pairing approach to kidney transplants - which allows families to exchange kidneys when they don't match for their own relatives - is a form of transaction. What makes a bonus compensation so different?
Risk and reward - a time-honoured combination
A large part of the resistance is that compensation such as cash or discounted college tuition is mainly an incentive for lower-income people. "Why is that bad? Poor people do all sorts of things that rich people aren't doing," Dr. Matas says. "Well-informed people are capable of making decisions in their best interest. I won't argue with that the fact that billionaires aren't likely do this. So what?"
Altruism doesn't preclude compensation: Society already rewards people such as firefighters and soldiers for taking on dangerous roles that serve the public good. An organ donor is no different, suggests Phil Halloran, a transplant surgeon at the department of medicine at the University of Alberta and the editor-in-chief of the American Journal of Transplantation.
"You are getting paid for what you do," he says. "Surgeons get paid for what they do. Health care works on the basis of people providing good services to other people - and they get paid."
As for the risk of exploitation, he argues that people are already receiving unequal care because organs are in shorter supply in certain locations and because the wealthy can seek out other options.