April PF Topic Overview

Resolved: The United States federal government should permit the use of financial incentives to encourage organ donation.


This topic will give you a nice break from the legal topics NFL has used for the past several months. The idea of offering financial incentives to increase organ donation has been around for quite a while. Although many of you may think that this topic has come out of left field, it is actually something the health community has been grappling with for decades.

The National Organ Transplant Act, passed in 1984, forbids citizens from selling their organs. It says specifically that people cannot exchange human organs “for valuable consideration.” However, states regularly offer tax breaks for organ donors.

This topic may have a tendency to devolve into emotional, sensitive debates. The affirmative may make the case that children are dying world over due to a shortage of donor organs, and the negative may make the case that the poor will be taken advantage of by those seeking a quick liver. Try to avoid using emotional language when you make your arguments so that you can focus on clash.

The definition of “financial incentives” will most likely become a huge part of the debate. The affirmative will have the burden of defining financial incentives; although, the negative can present an alternate definition if they disagree with the affirmative’s definition. You may think that the definition of financial incentive is pretty straightforward – money in exchange for organs. But actually, it’s a lot deeper than that. Financial incentives have been proposed that come in the form of health insurance premium discounts for those that sign up to be organ donors, helping the family of the deceased with funeral expenses if they donate their loved one’s organs, and offers to defray medical costs.

The affirmative probably has an upper hand in this debate. Given the intense amount of calls for creative ways to increase organ donations, the affirmative will generally have more material with which to work. The negative will probably have to do some creative research into the ethics of organ donation.


First, the affirmative can press the need for an increase in organ donations. An editorial in USA Today reads, “More than 6,000 patients die each year while on waiting lists. Demanding patience, when the price of delay is death, is no answer. It’s time to try new ideas.”[i]

To put the issue into perspective, “Over the years, the number of people waiting for an organ in the U.S. has soared upward, increasing from 31,000 people in 1993 to over 101,000 today.”

Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidney-transplant operations in the entire world. In the U.S. alone, 83,000 people wait on the official kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost 5,000 died waiting for one.[ii]

Affirmative debaters can argue that financial incentives will dramatically increase the availability of organs and decrease the price. Consider these examples in Singapore, Iran and Israel.[iii]

  • Singapore is preparing to pay donors as much as 50,000 Singapore dollars (almost US$36,000) for their organs.
  • Iran has eliminated waiting lists for kidneys entirely by paying its citizens to donate.
  • Israel is implementing a “no give, no take” system that puts people who opt out of the donor system at the bottom of the transplant waiting list should they ever need an organ.

The Iranian system and the black market demonstrate one important fact: The organ shortage can be solved by paying living donors.[iv] The Iranian system began in 1988 and eliminated the shortage of kidneys by 1999.

While affirmative debaters can defend financial incentives in general, they can also offer a specific proposal. Nobel Laureate economist Gary Becker and Julio Elias estimated that a payment of $15,000 for living donors would alleviate the shortage of kidneys in the United States. Payment could be made by the federal government. Moreover, this proposal would save the government money since even with a significant payment, transplant is cheaper than the dialysis that is now paid for by Medicare’s End Stage Renal Disease program.

Next, it is important that the affirmative preclude the arguments the negative will likely make regarding the manipulation of the poor. G. van Dijk and Dr. M.T. Hilhorst argue that financial incentives don’t have to mean cash at all, and that our system can ensure that people are not manipulated. They say, “Our regulated system is also able to guarantee that the voluntary nature of the act is not compromised. Under these conditions, payment can be a strong encouragement to this form of donation, which is becoming increasingly important. Life-long exemption from health insurance premiums is the most suitable method in this case. It would show how committed the government is to reducing the organ deficit, demonstrate that the effort of donors is highly appreciated, and that the government is prepared to cover any health risks.”

Further, the affirmative can argue that the negative’s assertion that the poor will be manipulated is problematic. Peter A. Clark says, “to deny financial incentives for fear of exploiting low income individuals and minorities implies that they are incapable of making voluntary decisions. Prohibiting low income people from receiving financial incentives for donating their organs for fear of abuses doesn’t really help them, it just leaves them poor. With the proper educational safeguards in place and with government regulation of the financial incentives for donation the informed consent of all people would be protected.”[v]

Additionally, the affirmative can propose a system where the donors would be compensated, and their organs would go into a donor bank to be doled out to those in need – like it is now. But, instead of waiting on goodwill to be the motivating factor for organ donation, it becomes the much more convincing incentive of money. This way, the rich are unable to buy up organs while the poor wait.


Some topics lend themselves to “counterplan” NCs, meaning that the negative would offer alternatives to the prescribed affirmative advocacy. On this topic, the 1NC would offer alternatives to financial incentives for organ donations. This allows the negative to agree that we need more organ donors. The negative agrees this is a problem but just offer a different solution. For example, the 1NC could advocate putting people higher up on the waiting list should they ever need an organ if they donate—an incentive, just not a financial one. [vi]

This might be a system of “presumed consent.” In this system, you are automatically assumed to be an organ donor upon your death unless you opt out of the system. Spain and Belgium already have this system in place, and Britain is heavily considering such a policy. According to the British Medical Journal (BMJ), Spain currently has the highest rate of organ donation in the world at 35.1 donors per million population. The BMJ says, “over a decade the number of transplant coordinator teams increased from 25 to 139. This combination of a system of presumed consent, which portrays a positive attitude towards donation, major financial investment, and good organization, seems to be the way forward.”[vii]

Additionally, the negative can argue for a system that gives organ preference to those that are declared organ donors. Right now, the system operates on who needs the organ the most. This might seem like the right thing to do, it provides no incentive for people to become organ donors. A system that gave preference to organ donors instead might provide more incentive for people to sign up. David J. Undis, speaking at a Cato Institute policy forum titled “Remedying the Organ Shortage: The Ethics of Market Incentives,” said, “There is a simple, effective, ethical, and already legal way to reduce the organ shortage in America and make the organ allocation system fairer in the process. You can donate your organs to people who will do the same for you. You can tell everyone: ‘If you don’t agree to donate your organs when you die, then you will go to the back of the transplant waiting list if you ever need one of my organs to live. When it’s time to decide who gets my organs, I am putting organ donors first.'” He said that LifeSharers is a non-profit organization that is doing just that. Members agree to donate their organs to other members when they die.[viii] In fact, Israel has already instituted this system in order to increase their low rate of organ donors. They continue to keep those who need organs the most at the top of the list, but when patients who are more or less equal in need are up for an organ, those who are already donors are given preference.[ix]

The negative should keep in mind that they have no obligation to provide an alternative to solving the problem of organ donation shortages. They can instead refute the affirmative case point by point and make a number of arguments.

First, the negative can argue that the ability to pay for organs decreases the dignity of the donor. The National Kidney Foundation is adamantly opposed to financial incentives for organ donation. They say, “Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society. Any attempt to assign a monetary value to the human body, or body parts, either arbitrarily, or through market forces, diminishes human dignity. By treating the body as property, in the hope of increasing organ supply, we risk devaluating the very human life we seek to save.”

The National Kidney Foundation maintains that offering financial incentives devalues the gift of life that donors have provided out of altruism, and leave out families who are unable to donate organs but consent to tissue donation

Second, the negative can argue that people would not be motivated by financial incentives any way. The National Kidney Foundation reports, “In a recent survey of families who refused to donate organs of their loved ones who have died, 92 percent said that payment would not have persuaded them to donate. Public opinion polls and focus groups have disclosed that many Americans are not inclined to be organ donors because they distrust the U. S. health care system, in general, and, in particular, because they are concerned that the health care of potential organ donors might be compromised if their donor status were known.”

So, if financial incentives will not increase the amount of donors, why embark on what promises to be a costly, unethical venture? The negative can argue that the costs of offering financial incentives will not be outweighed by lives saved.

Finally, the negative can argue that financial incentives exploit the poor. Dr. Francis L. Delmonico, a transplant surgeon and medical director of the New England Organ Bank in Newton, Massachusetts says, “Once you insert monetary gain into the equation of organ donation, now you have a market. Once you have a market, markets are not controllable; markets are not something you can regulate. The problem with markets is that rich people would descend upon poor people to buy their organs, and the poor don’t have any choice about it.”

[i] “Organ donations fall short; financial incentives can help,” USA Today, June 25, 2006. http://www.usatoday.com/news/opinion/editorials/2006-06-25-our-view_x.htm

[ii]John Goodman, “What We Can Learn from Iran about Organ Donation,” Health Policy Blog, National Center for Policy Analysis, April 13, 2010. http://healthblog.ncpathinktank.org/what-we-can-learn-from-iran-about-organ-donation/

[iii] Alex Tabarrok, “The Meat Market,” Wall Street Journal, January 8, 2010. http://online.wsj.com/article/SB10001424052748703481004574646233272990474.html

[iv] John Goodman, “What We Can Learn from Iran about Organ Donation,” Health Policy Blog, National Center for Policy Analysis, April 13, 2010.


[v] Financial Incentives For Cadaveric Organ Donation: An Ethical Analysis. By: Clark, Peter A. Clark, Internet Journal of Law, Healthcare & Ethics, 15288250, 2006, Vol. 4, Issue 1

[vi] “Financial incentives for organ donation: An investigation of the ethical issues,” by G. van Dijk Dr. M.T. Hilhorst. The Hague: Centre for Ethics and Health, 2007.


[vii] “Is presumed consent the answer to organ shortages? Yes.” By Veronica English, British Medical Journal. May 24, 2007. http://www.bmj.com/content/334/7603/1088.full

[viii] “Putting Organ Donors First,” David J. Undis, May 13, 2004. http://www.wellsphere.com/general-medicine-article/putting-organ-donors-first/726644

[ix] “Israeli organ donors to get transplant priority,” BBC News, Dec. 17, 2009. http://news.bbc.co.uk/2/hi/8416443.stm

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