nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Wednesday, March 17, 2010

Paying Organ Donors: No Ethical Concerns?

This is an interesting study in the Annals of Internal Medicine (Mar 16).  The article is only available as an abstract.  The authors surveyed 550 people about their willingness to donate a kidney, with and without payment for the kidney.

Looking at the nuts and bolts of the study, they didn't have a huge population (they used public transportation commuters in Philadelphia), but the response rate was good (74%), and of those, 3 out of 4 were medically eligible to donate (it's important to ask about "willingness" from people who are "capable").

The researchers wanted to look at three things:
1.  Did the offer of payment affect how people perceive the risk of donating a kidney?
2.  Would low income people be unjustly induced to donate more than higher income people?
3.  Would the prospect of payment alter the willingness of those who donate from altruistic (not $$) motives?

They found the following:
1.  The higher the payment the more willing to donate.  (30% willing - huge compared to the current %)
2.  Payment did not alter perceived risk.
3.  There was no association between payment and income levels (odds ratio = 1.01, with confidence interval 0.9-1.1)
4.  No impact on those who act from altruistic motives (p = 0.40, well above the needed p<= 0.05).

This will cause controversy.  Ethicists have argued for a long time that bad things will happen if organ donation becomes a market, with donors earning $10-100K a pop.  On the other side, there are about 87K people waiting for a kidney; about 10% will get one.  That's a pretty bad consequence in itself.

These authors have targeted most of the specific concerns ethicists have brought up:  perceived risk, the poor, and altruism.  The study failed to validate all these concerns.  One significant criticism of the study is that it is "hypothetical."  It's different when people are confronted with the real situation.

Stand by for more argument.  This study isn't definitive...but it sure is provocative.

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