부산대학교 도서관

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1600-6143.2006.01492.x Byline: R. S. Gaston (a), G. M. Danovitch (b), R. A. Epstein (c), J. P. Kahn (d), A. J. Matas (e), M. A. Schnitzler (f) Keywords: Incentives; kidney transplant; living donor; public policy Abstract: Availability of kidney transplantation is limited by an inadequate supply of organs, with no apparent remedy on the immediate horizon and increasing reliance on living donors (LDs). While some have advocated financial remuneration to stimulate donation, the National Organ Transplant Act (NOTA) of 1984 expressly forbids the offer of 'valuable consideration.' However, recent developments indicate some fluidity in the definition of valuable consideration while evolving international standards highlight deficiencies (particularly regarding long-term care and follow-up) in the current American system. Recognizing that substantial financial and physical disincentives exist for LDs, we propose a policy change that offers the potential to enhance organ availability as well as address concerns regarding long-term care. Donors assume much greater risk than is widely acknowledged, risk that can be approximated for the purpose of determining appropriate compensation. Our proposal offsets donor risk via a package of specific benefits (life insurance, health insurance and a small amount of cash) to minimize hazard and ensure donor interests are protected after as well as before nephrectomy. It will fund medical follow-up and enable data collection so that long-term risk can be accurately assessed. The proposal should be cost effective with only a small increase in the number of LDs, and the net benefit will become greater if removal of disincentives stimulates even further growth. As importantly, by directly linking compensation to risk, we believe it preserves the essence of kidney donation as a gift, consistent with NOTA and implementable in the United States without altering current legal statutes. Author Affiliation: (a)University of Alabama School of Medicine, Birmingham, Alabama, USA (b)David Geffen School of Medicine at UCLA, Los Angeles, California, USA (c)University of Chicago Law School, Chicago, IL; Hoover Institution, Stanford, California (d)University of Minnesota Medical School and Center for Bioethics, Minneapolis, Minnesota, USA (e)University of Minnesota Medical School, Minneapolis, Minnesota, USA (f)St. Louis University School of Medicine, St. Louis, Missouri, USA Article History: Received 10 April 2006, revised 25 May 2006 and accepted for publication 22 June 2006 Article note: (*) Corresponding author: Robert S. Gaston rgaston@uab.edu