More states explore tax breaks to benefit organ donors

A dozen states are following Wisconsin's pioneering law, raising ethical questions about offering financial incentives.

For Luke Bassler, the money wasn't an issue. He would have donated a kidney to his brother without the tax breaks.

Still, as someone just starting up his own home-improvement business, he's hopeful that Wisconsin's groundbreaking organ donor law will help reimburse some of the income he lost when he took time off for the procedure. Even more, he hopes the law - which allows tax deductions up to $10,000 for expenses like travel, hotel bills, and lost wages when donating an organ - may raise the profile of organ donation and make the choice easier for people in tough financial situations.

The Wisconsin law, passed just last year, has already set a dozen similar bills in motion in other states. The approach is an attempt to tread ethically controversial ground between the high unmet demand for organs and caution over creating a financial market for them.

"There's a fine line there," Mr. Bassler says from his home in Milwaukee. "You want to ease the burden so that economics doesn't become the final choice as to why someone donates.... But it's important that they don't cross that line with the law, so that people say, 'I've got to figure out how to donate a kidney.' "

The labyrinthine world of organ donation - from who gets one to who donates - has always been ethically murky. As the procedures become more common, and the shortages more severe, increasing attention is being given to just how - or whether - to encourage donations.

The Wisconsin law hugs that ethical line tightly. Its creator, State Rep. Steve Wieckert (R), was determined to find a way to encourage organ donations without running afoul of strict prohibitions on organ sales. The strong antipathy to anything even remotely linked to payment for organs is one reason nothing like this has been tried earlier, though most people agree that Wisconsin's law won't give donors a significant financial advantage.

Since Wisconsin passed its law, a dozen other states quickly introduced comparable bills (and passed them in Georgia and South Carolina), and federal legislation this year gave tacit endorsement by authorizing grants to support similar reimbursement plans.

"It's a big topic of debate because the number of deceased donors has hit a wall," says Jim Warren, editor of Transplant News. Some ethicists, he adds, say any kind of financial encouragement is "a slippery slope, and opens the door to all kinds of bad things. But I think there are numerous ways you can give a financial incentive that doesn't mean flat-out payment."

When Representative Wieckert first started talking about his idea for tax breaks, he says he'd "get a knee-jerk reaction of 'You can't do that!' " But he was convinced a proposal limited to covering expenses could fall within legal boundaries. "We were the pioneers," he says. "This law breaks through the myth that you can't help living donors."

But not everyone is on board with the idea. Even if it isn't actually rewarding people, it gives live organ donation the government seal of approval, says Mark Kuczewski, director of the Neiswanger Institute for Bioethics and Health Policy at Loyola University in Chicago.

Dr. Kuczewski worries the tax break might encourage healthy people to donate organs to relatives who may not improve even with the transplant.

"When you use tax dollars, you want to foster the public good. But this is getting into an area that's not so definitively in the public interest," he says. "What's the long-term effect?"

He'd like to see other options to reduce organ waiting lists - from tax breaks to help with alcoholism treatment that would over the long run reduce demand for transplants, for example.

The other method with largest groundswell of support involves organs from deceased donors - paying family members or reimbursing them for burial expenses when an organ is donated. The American Medical Association and other groups have pushed for a pilot study, but all proposals have met with sharp opposition from some donor groups, and clash with the current ban on any payment for organs, even from deceased donors. Critics worry it will detract from the altruism of donation, and wonder if offering money to families of deceased donors could seem like coercion. Allowing the sale of live organs, most agree, could lead to exploitation.

But some wonder if it isn't time to start reconsidering blanket bans. "It's perfectly legal to sell your sperm, your eggs, or your uterus," says Eli Friedman, head of the renal division at Downstate Medical Center in New York. Selling organs "is at least something that should be discussed."

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