Proposed tax credit for organ donation raises ethical concerns.

Governments should issue tax credits for organ donations to ensure that bereaved families honor donor’s wishes, says an ethicist and visiting fellow at the Université de Montréal in Québec. If an advocate acting on behalf of a deceased donor received a modest tax credit, fewer donations would be “vetoed” by family members and people would be more likely to discuss organ donation with their loved ones, says Jurgen De Wispelaere, who along with Lindsay Stirton, a law professor at the University of Manchester in England, proposes that governments around the world adopt a new two-pronged organ donation policy. But organ donation experts in Canada aren’t sold on the idea, on the grounds it is not essential and that it may lead to the “commoditization” of organs. The two-pronged proposal would necessitate a redesign of the organ donation registration process to include the signature of a second person, or consenter, on organ donation cards (J Med Ethics 2010;36:180-3). It is that second person who would receive the tax credit for acting as an advocate on behalf of the deceased donor. “The second consenter becomes a living advocate of the donor after death and also represents the family to medical staff,” De Wispelaere explains. “This would combat a reluctance of the family to accept that the donor really was a donor. It would ensure that they are much more comfortable with [the person becoming an organ donor].” According to Stirton and De Wispelaere, there should be an incentive for people to take on the living advocate role — and then to make sure those people don’t change their minds. “The second consenter would get a tax credit for signing up,” says De Wispelaere. But the tax credit would be negated if he or she subsequently vetoed the organ donation. It’s a novel idea, says De Wispelaere, because it’s an incentive program which focuses on the donor’s family, rather than the actual donor. But Dr. Sam Shemie, medical director of organ and tissue donation for Canadian Blood Service, says the proposal, while provocative, is a “band-aid” solution to the organ donation problem. “Why is it that a Canadian can’t easily express their intention and why is it that that intention is not honored if they should die? Why would you really need an advocate?” explains Shemie. “To me, [this proposal] exposes some of the ineffectiveness of our Canadian system.” According to statistics from the Canadian Organ Replacement Register, there were 3796 Canadians on the organ donation waitlist in 2009 and 2155 organ transplants.