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Incentives for Organ Donation in Canada: A Future Possibility?

Ariel Lekas (1L)

Every year in Canada, approximately 4000 people need transplants. Only one third of those people will receive the organs that they need to survive. Experts at the most recent Health Law Institute Seminar Series
panel discussion weighed in on the ethical, legal, and economic factors involved in the possibility of incentivizing organ donation in Canada, and how a new framework could help save the lives of thousands of Canadians in need of transplants.

Dr. John Gill, a kidney transplant specialist from Vancouver, admitted that this is a polarizing issue but advocated for a fresh approach to deal with the issue in Canada. Every year there are a significant number of possible organ donors who aren’t actually donating, and there is a significant potential to increase altruistic donations from both deceased and living donors. Offering incentives may be a way to increase donations.

Within the current legal framework, organs and tissues cannot be bought, sold, or dealt. While some provinces have programs to try and remove “disincentives” for organ donors by reimbursing them for expenses incurred during living donation, suggested incentive policies involving pair-exchange programs or paying funeral costs for deceased donors have yet to be tested in the Canadian context. It is unclear whether or not such programs would be permitted under existing legislation. Dr. Gill suggested that possible acceptable strategies in Canada could include establishing an appropriate remuneration framework to support and integrate organ donation into the health care system, increasing opportunities to consent for organ donation, providing incentives to encourage participation in living donor paired-exchange, and compensation for the pain and suffering related to live donation.

The University of Alberta researcher Dr. Scott Klarenbach of the Department of Medicine has analyzed Canada’s donation situation from an economic perspective. In this respect, kidney transplantation is the preferred treatment for end stage renal disease (ESRD). For each patient who receives a new kidney instead of undergoing dialysis, the Canadian healthcare system will save $100,000 over a 20 year period. From a potential donor’s perspective, the expenses related to living donation may play a part in their decisions of whether or not to donate. If Canada were to implement a strategy where each donor would receive $10,000 compensation, the number of donors would increase by only 5%. However, a 5% donor increase could still save the health care system money, as well as saving lives.

Of course, there are still legal and ethical factors that must be contemplated before any sort of incentive program could be implemented in Canada. It would have to be highly regulated and transparent, with harsh penalties for wrongdoing. However, considering the number of lives that could be saved by reorganizing the current organ donation system, incentivisation is a possibility that definitely deserves attention from legislators.