Numerous policies introduced by American states since the late 1980s to increase the supply of transplant organs have failed to have any measurable effect on the problem of short supply, which has continued to worsen.
This is the finding of a study published in JAMA Internal Medicine by authors including Erika Martin, PhD, of the University at Albany in New York City.
Between 1988 and 2010, the number of states passing at least one donation-related policy rose from a starting point of 7 to finally including all 50.
The authors’ analysis of the relevant data found that all the following policies “had no robust, significant association with either donation rates or number of transplants” – first-person consent laws, donor registries, public education, paid leave and tax incentives.
The outcome against which no success was observed was the yearly number of organ donors and transplantations in each state during the study period.
The researchers reviewed database information held by the nonprofit body the United Network for Organ Sharing (UNOS) and the US government’s Organ Procurement and Transplantation Network (OPTN).
The study also reviewed state-specific legislative codes on donation and transplantation as well as a comprehensive database of federal and state laws.
The official website of the US Department of Health & Human Services, organdonor.gov, recognizes a number of policies for organ and tissue donation so these were the ones reviewed by the researchers:
- Dedicated voluntary contributions by individuals and protected state funds for activities to increase donation and improve clinical transplantation practices. Activities included community outreach campaigns, worksite campaigns and hospital-based interventions
- Education programs on organ donation – through classes in public schools or driver education programs
- Leave of absence offered to people working in public and private sectors who donate
- First-person consent laws – individual consent for donation could be registered without family agreement at the time of donation
- Registries to document people’s consent to donation
- Tax benefits for donors to meet the costs of donation.
All except the first policy showed no observable effect on transplantation rates. Only the revenue-based policy to establish a protected state fund for donation promotion activities, to which individuals could contribute, was linked to an increase in the number of transplants – by 5.3%.
This sole effect represented 15 additional transplants per state per year on average, the results show. On the number of transplants of organs from deceased donors, these revenue policies across states were associated with an 8% increase, or an additional eight transplants per state per year.
A commentary in the same journal issue by Dr. Sally Satel, psychiatry lecturer at the Yale University School of Medicine in New Haven, CT, says it is time for “disruptive innovation:”
“By this concept, we mean compensating donors, not simply seeking to soften the financial ramification of donation.
It is time to test incentives, to reward people who are willing to save the life of a stranger through donation. […] Our current transplant system is inadequate for the task of boosting the volume of organs needed for life-saving transplantation. Altruism is not enough. Pilot trials of incentives are needed.”