Dialysis patient attitudes toward financial incentives for kidney donation

Offering financial incentives to families of brain-dead individuals has been proposed as a way to increase the supply of organs for transplantation. However, such incentives may lead to weakening of altruism and exploitation of poor families. We investigated dialysis patient attitudes toward the potential benefits and problems of incentives. Using a structured questionnaire, we interviewed 60 randomly selected patients at three chronic hemodialysis units. Subjects were asked to make an explicit trade-off between maintaining altruism versus increasing the supply of kidneys. They were also asked to make a trade-off between protecting poor families versus increasing the supply of kidneys. In addition, we asked subjects how they thought incentives would affect donation by different types of families. We found that 37% of all subjects placed more emphasis on maintaining altruism, 42% placed more emphasis on increasing the supply of kidneys, and 22% placed an equal emphasis on maintaining altruism and on increasing the supply of kidneys. Similarly, 35% of all subjects placed more emphasis on protecting poor families, 33% placed more emphasis on increasing the supply of kidneys, and 32% placed an equal emphasis on protecting poor families and on increasing the supply of kidneys. Subjects thought financial incentives would greatly increase donation by poor families while having little impact on rich families. In conclusion, even though dialysis patients are likely to benefit from increasing the supply of kidneys, many of them want to maintain altruism and protect poor families even if that means fewer kidneys. These concerns should be addressed in proposals to modify the transplant system.