Financial incentives: alternatives to the altruistic model of organ donation.

Improvements in transplantation techniques have resulted in a demand for transplantable organs that far outpaces supply. Present efforts to secure organs use an altruistic system designed to appeal to a public that will donate organs because they are needed. Efforts to secure organs under this system have not been as successful as hoped. Many refinements to the altruistic model have been or are currently being proposed, such as "required request," "mandated choice," "routine notification," and "presumed consent." Recent calls for market approaches to organ procurement reflect growing doubts about the efficacy of these refinements. Market approaches generally use a "futures market," with benefits payable either periodically or when or if organs are procured. Lump-sum arrangements could include donations to surviving family or contributions to charities or to funeral costs. Possibilities for a periodic system of payments include reduced premiums for health or life insurance, or a reciprocity system whereby individuals who periodically reaffirm their willingness to donate are given preference if they require a transplant. Market approaches do raise serious ethical issues, including potential exploitation of the poor. Such approaches may also be effectively proscribed by the 1984 National Organ Transplant Act.