Incentives For Organ Donation After Citizens' Death:Ethics And Policy

Incentives for organ donation after citizens' death(IODCD)could be viewed as a social institution which aims to minimize the gap between the need for clinical organ transplants and the number of organs available for transplantation.IODCD can be summarized as financial incentives,rights incentives(priority incentives),and spiritual incentives.A current controversy focuses on the incentives for organ donation,including direct financial incentives and indirect financial incentives.International organizations prohibit any form of direct or disguised payment,whether the indirect financial incentive can be justified by ethical arguments depends on whether the form of specific incentive constitutes a disguised payment or inducement.This paper first analyzes the terminology of IODCD to avoid conceptual confusion and logic errors and focuses on the ethical and policy issues of IODCD.Combined with the main ethical controversies currently involved in this issue,ethical issues are summarized as four issues:autonomy,effectiveness,motivation compatibility,and social justice.For autonomy,this paper discusses the conceems over undue inducement that may arrive from incentives and analyze the controversial issues of maximizing autonomy.The effectiveness section combines relevant statistical data and experimental analysis to consider the effectiveness of incentives and suggests that public willingness and public acceptance are critical to motivating interventions.Motivation compatibility,the third section,will be based on a discussion of altruism,mixed motivation,and gift relationships and rewards in an attempt to explore specific,acceptable incentive paradigms.The last section focuses on the impact of incentives of social equity and raises concerns about the gap between the rich and the poor,as well as the protection for vulnerable groups.The policy issues of IODCD mainly involve the definition and distinction between medical arrears,humanitarian assistance(difficulty assistance),financial compensation,and financial incentives.This paper proposes that direct or disguised forms of financial incentives should be explicitly prohibited,medical arrears and humanitarian assistance should be accurately defined,and attention should be paid to the distinction among medical expenses,humanitarian assistance and financial incentives in the practice of organ donation,especially the distinction among incentive interventions,medical assistance and humanitarian assistance system in civil affairs.Secondly,considering that a certain form of indirect financial incentives with limited amount may not improve the donation rate in organ donation efifectively,the formulation of policies should maximize the avoidance of social inequality and the further aggravation of the gap between the rich and the poor.In addition,based on the national conditions and the national funeral reform system,the payment of basic funeral services for organ donors is reasonable and defensible in our practice,but ought to be standardized.Finally,in view of the ethical and policy issues in academic research and medical practice governance,an ethical framework is proposed.Suggestions on the governance of organ donation incentive strategies are provided along the dimensions of policy formulation,terminology use,organ utilization rate,public trust,and public will.