Could a lottery solve the shortage of organ donors?

Health - Could a lottery solve the shortage of organ donors?

Two economists believe that a lottery could encourage more people to register as organ donors. Hanno Beck from Pforzheim University and Aloys Prinz from the University of Münster suggest that every holder of an organ donor card could automatically take part in an annual lottery with prizes of ten, five and one million euros, for example. The prizes would be financed by the state or health insurance companies. Reactions to the proposal have been rather cautious and critical. The current legal situation does not even permit such a lottery.

"Lotteries as an instrument of economic policy are quite common in other countries," explain the professors. In countries such as Taiwan, Malaysia, Chile, Puerto Rico, Brazil and the Philippines, every invoice with its registration number takes part in a lottery - this is intended to prevent tax evasion at the checkout. The two also argue that the public attention that such a lottery is likely to receive each year would be helpful in trying to increase the number of organ donors.

Proposal currently not feasible

The German Transplantation Society (DTG) has stated that it is generally in favor of all proposals to improve the number of organ donations. "However, there is no donor register in Germany. It is therefore not possible to organize a raffle among holders of organ donor cards," said the board.

The Federal Ministry of Health explained that the researchers' proposal contradicts the Transplantation Act. "Any kind of consideration for an organ donation conflicts with the legally enshrined and punishable ban on organ trading." Any incentive to declare a willingness to donate would also contradict the principle of voluntariness. "The personal decision to donate organs should always be voluntary," it said. "This means that there should be no legal compulsion, nor should the decision be made for non-altruistic reasons." Altruism means as much as unselfishness.

Giessen law professor Steffen Augsberg, who is a member of the German Ethics Council, also believes that commercialization cannot be the solution. It is not a matter of course that people donate organs. It is even an imposition for potential donors. Nevertheless, the appreciation of such a decision must be immaterial, he emphasized.

Otherwise, it could happen that people with money worries in particular have an organ donor card issued for this reason - and not out of actual conviction. "We also don't want anyone to sell a kidney out of financial need. That's why it's forbidden," said Augsberg. Once the path has been taken and does not immediately lead to the hoped-for success, there is also a risk of driving the price ever higher.

A lottery is a playful approach that could perhaps even increase the number of organ donor cards. "From a normative point of view, however, it is doubtful that this is appropriate for a difficult, complex situation," explained the professor.

Shortage of donor organs and possible solutions

There has been a glaring shortage of donor organs in Germany for years. The number of post-mortem organ donors has risen by eleven percent to 788 in the current year, as the German Organ Transplantation Foundation (DSO) announced last week. However, Federal Health Minister Karl Lauterbach (SPD) made it clear that Germany still performs very poorly in an international comparison. "This is shameful and life-threatening for the patients concerned."

There are repeated discussions about other models or procedures for organ donation. The main issue here is an opt-out solution. This would mean that everyone is automatically considered an organ donor if they do not object.

Other options for making more donor organs available include organizational improvements and, for example, changes to the guidelines for organ donations, said Augsberg. For example, the removal of organs after cardiac arrest, which is already possible in other countries, is currently being discussed. In Germany, doctors have to determine the brain death of the person concerned. "Such approaches are less striking, but ultimately more promising."

Beck and Prinz do see potential problems with their idea - for example, that people with unhealthy lifestyles could also register as organ donors. However, this is also the case with all other efforts to find organ donors. According to the proposal, the condition for participating in the lottery should be that you must have been registered for at least one year, so that nobody collects an organ donor card shortly before the draw and then returns it afterwards.

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