Investigating Public Opinions on Financial (Dis)Incentives for Organ Donation in Europe
Our newest project, funded by NWO/The Dutch Research Council under the XS Pilot Scheme, cross-nationally surveys European citizens’ opinions on removing financial disincentives and allowing incentives for deceased and living organ donation. As the incidence of organ failure continues to grow, the dialogue around removing/allowing (dis)incentives for organ donation is becoming increasingly relevant.
The objective of our project is to:
- investigate and compare the opinions of German, Dutch and Spanish citizens on removing disincentives and allowing different types of financial incentives for deceased and living organ donation;
- examine the influence of transplants outcomes (i.e., number of lives saved) and cultural factors (including moral values) on these citizens' opinions towards incentives and disincentives for deceased and living organ donation.
This project was inspired by the work of Julio J. Elias, Nicola Lacetera and Mario Macis. They conducted a randomized survey experiment in the United States which examined the preferences of US citizens for the compensation (payment) of living kidney donors. Their study is the first, and to date only study that has sought to understand public willingness to make tradeoffs between competing values and to study under what specific conditions they might consider such tradeoffs acceptable. It is crucial to approach this issue with nuance, as the debate surrounding payments for organs is often framed in simplistic, black-or-white terms. In reality, there are potentially numerous policy solutions that fall between a complete prohibition of payment for organs and a free market for human body parts, allowing for a more balanced consideration of ethical concerns and practical outcomes. Thus, acquiring knowledge on public support towards (dis)incentives for organ donation critically relies on what is asked and how.
We will partly replicate the US study and partly add new innovating elements in designing a randomized survey to recruit respondents constructed to match each country’s population on sex, age, ethnicity, religion, education, and other sociodemographic characteristics. Respondents will also be asked to respond in open text to questions about the moral values underlying their opinions.
The project starts in September 2023.
research team and collaborators
Our multidisciplinary team consists of:
- Frederike Ambagtsheer (PI), Erasmus MC Transplant Institute, Nephrology and Kidney Transplantation
- Saja Abusulttan (RA), Erasmus MC Transplant Institute, Nephrology and Kidney Transplantation
- Eline Bunnik, Department of Medical Ethics, Erasmus MC
- Mario Macis, Johns Hopkins Carey Business School, USA
- Liset Pengel, Erasmus MC Transplant Institute
- Julio Elias, Universidad del CEMA, Argentina
- Nico Lacetera, University of Toronto, Canada
- Alberto Molina Perez, Instituto de Estudios Sociales Avanzados, Spain
- Sabine Wöhlke, Department Gesundheitswissenschaften, University of Hamburg, Germany
expected impact and outcome
This proposed study is one of few to comprehensively and cross-nationally survey European citizens’ opinions on (dis)incentives for both deceased and living organ donation. As the incidence of organ failure and especially kidney failure continues to grow, the dialogue around (dis)incentives for organ donation will become increasingly relevant. On the one hand, payments for organs have been banned almost universally since the 1980s. On the other hand, research has found that laws prohibiting activities that are considered ‘repugnant’ do not always reflect the opinion of the majority of the population and resistance may not be as widespread as assumed.
By knowing the potential impact and public acceptability of different (dis)incentivized systems for organ donation, policymakers can make decisions that are in line with the preferences and values of the populations they serve.
This proposal can thus potentially lead to scientific and policy breakthroughs: if the broader public supports (dis)incentives for deceased and/or living donation, findings and recommendations may lead to willingness amongst politicians, law- and policymakers to change legislation and allow trials that test whether removing disincentives/allowing incentives may lead to higher deceased and living organ donation rates. This, in turn, can reduce the number of patients that die while waiting for an organ.