Call for donors to be paid for supplying organs

Cash payments for donors are among the options that should be considered for boosting the supply of organs and other bodily tissues, ethics experts say today.

More than 8,000 people are on the transplant waiting list but only 3,500 operations are carried out each year because of the shortage of organs. Around 1,000 people a year are dying on the waiting list. In addition, there is a shortage of sperm and egg donors and 1,700 requests a year for donated eggs and sperm are not being met.

Launching a consultation document on measures to boost donations by the Nuffield Council of Bioethics, Hugh Whittal, the director, said attitudes to cash payments were inconsistent. Paying for organs and for blood was banned, but egg and sperm donors could receive expenses of up to £60 a day, with a cap of £250, he said. Women could receive free fertility treatment worth thousands of pounds in return for donating some eggs and volunteers who "donated" their bodies for medical research, such as testing new drugs, were paid thousands of pounds.

"Why are there these differences and are they justifiable?" Mr Whittal said.

Other options, including personal "thank you" letters and certificates, souvenirs such as T-shirts and mugs, and "presumed consent" systems are also explored. Many organs, such as the heart, can only be taken after death but others such as the kidneys can be given by the living without ill effects. Lobes of the liver and lung can also be donated by the living.

Professor Dame Marilyn Strathern, an anthropologist from the University of Cambridge and chair of the inquiry, said: "We could try to increase the number of organ donors by providing stronger incentives, such as cash, paying funeral costs or giving priority for an organ in future, but would this be ethical? We need to think about the morality of pressing people to donate their bodies. We ourselves or one of our relatives may one day need donated organs or tissue, and most of us are likely at some point to use NHS medicines that have been tested on healthy volunteers or human tissue. Given this perhaps donating parts of our bodies should be seen as a moral obligation for all of us."

The shortages were forcing people to travel to countries where different rules applied or illegal markets operated, the experts found. Around 30 people a year were going abroad, mostly for kidney transplants and most to Pakistan, according to Keith Rigg, a kidney transplant surgeon at Nottingham University Hospitals NHS Trust and a member of the inquiry team.

In one month, a survey found 53 women seeking fertility treatment went abroad to 46 different clincs, most in the Czech republic, Mr Rigg said. That implied hundreds or thousands of women were travelling abroad each year.

"Should we expect more donations or accept that we will never meet demand? If we offer payments or other incentives we may encourage people to take risks or go against their beliefs," he said.

In Israel, which has had a high rate of transplant tourism and low numbers on the organ donor register, offered options of a cash incentive for donors or priority for a transplant to those who joined the donor register. The public chose priority for transplants over the cash.

Mr Rigg said opinion among transplant surgeons over the use of cash incentives was split, but the majority felt "payment was not the way forward". In Iran, where payment for organs is permitted, there were knock-on effects resulting in very few people donating freely, he said. The consultation is open until 13 July and the report will be published in the second half of 2011.