Incentivizing Deceased Organ Donation:

1. Incentivizing Deceased Organ Donation: A Swedish Priority Setting Prespective Faisal Omar, Gustav Tinghög, Stellan Welin Deparment of Medical and Health Sciences, Linköping University, Sweden

2. Why Incentives? Offer of urn increase sdonation for scientific purposes Incentives for deceased donation? What kind of incentives would be: Ethically appripriate publicly accptable Effective Challenges toSwedish healthcare?

3. Back Ground • Superiority of organ transplantation is well established • Better survival rates • Better quality of life • Superiority & persistent shortage : • Lengthening waiting lists • Unethical practices -- organ trafficking • Despite increases in living donation deceased donation remains corner stone • Vital to explore different ways of increasing deceased donation

4. Aims • Present an incentive scheme to increase deceased donation • Incentive: any factor (financial or non-financial) that motivates a particular course of action, or counts as a reason for preferring one choice to the alternatives • Behavioral agency theory to identify different types of motivation • Examine moral reasonableness of the scheme based on the Swedish priority setting ethical principles: • human dignity • needs and solidarity • cost effectiveness

5. Why approach this from the perspective of individual countries? “Individual countries will need to study alternative, locally relevant models, considered ethical in their societies, which would increase the number of transplants, protect and respect the donor” The 2000 Munich Congress on the Ethics of Organ Transplantation

6. What motivates people to act pro socially? • Extrinsic motivation • External to individual • ex: material rewards (€ € €!!!) • Satisfaction and pleasure the behaviour or task itself may not provide • Intrensic Motivation • Internal to in individual • Pleasure from the task itself • Altruism • Signalling Motivation (social esteem) • From individual’s concern with how they are perceived by others

7. Incentive Scheme • € 5000 towards funeral expenses paid to the estate of deceased or family • Extrinsicly motivated • Part of or all may be diverted as a donation to a reputable charity • Intrinsicly motivated • The donation should be publicly recognized • signaling motivation • Several field studies have demonstrated that donations to charity increases when associated with a high degree of publicity

8. Priority setting ethical platform • Three explicit priority setting principles which represent the values of Swedish health and on which policy decisions should rest • Human dignity: • In heath care all individuals should have equal value and equal rights regardless of personal characteristics or role in society • Needs and Solidarity • Health care resources should be committed to the people or activities representing the greatest need. Health outcomes should be as equal as possible • Cost effectiveness • When choosing between different medical interventions there should be a reasonable relationship between costs and effects measured as improvement in health and quality of life

9. Is an incentivized system in line with Swedish health care values? • Human Dignity • More people will be transplanted saving more lives • Decrease reliance on living donation • Non medically relevant criteria will play a smaller role in access to transplantation • Social capital • Financial capital

10. Is an incentivized system in line with Swedish health care values? • Needs • More organs will better meet patient needs • Solidarity • Plays significant role in current transplantation system- Altruism • Altruism not sufficient to meet current need • Health outcomes more equitable- fulfilling the solidarity principle

11. Is an incentivized system in line with Swedish health care values? • Cost effectivness • Driving factor for this proposal, if it doesn’t make good financial sense it is difficult to discuss any further • Is a €5000 economically justifiable? • Mendeloff et.al (2004) demonstrate that $1.3 Million for each additional deceased donor is cost effective • multiple organs retrieved • gains in survival, quality of life • alternative treatments more expensive than transplantation

12. Concluding remarks • The incentives scheme is varied to appeal to individuals motivated by various factors • Should result in wide participation • Compatible with values of Swedish health care • It will save and improve lives while being cost effective • Need studies which measure the impact particular incentives will have on willingness to donate • Studies must be carfully designed • Highest degree on transparency, this is a very important and potnetially controversial issue