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The US system asks for ALL of us to care for others by being an organ donor, but then does not reciprocate that care without enormous financial barriers. (Photo: Elvert Barnes/flickr/cc)

The US system asks for ALL of us to care for others by being an organ donor, but then does not reciprocate that care without enormous financial barriers. (Photo: Elvert Barnes/flickr/cc)

Do You Have a Heart? On Organ Donation, Poverty, and For-Profit Healthcare

Despite the efforts encouraging Americans to be organ donors and to “Give the Gift of Life,” we rarely hear about those who don't meet the financial criteria

Mary O’Connor Mack

Is there a difference between someone who dies on a transplant list—waiting for an organ and someone who dies in need of an organ, but was never listed because of their inability to pay? Is it more devastating when someone dies waiting on the list? Does it matter that one group never had a chance? Is the USA’s organ transplant system acceptable?

The reality is, that the “Gift of Life” is a privilege reserved for those who can pay—and the expenses are staggering.

Despite the efforts encouraging Americans to be organ donors and to “Give the Gift of Life,” we rarely hear about those who don't meet the financial criteria. However, the reality is, that the “Gift of Life” is a privilege reserved for those who can pay—and the expenses are staggering. The average liver transplant costs $813,000; the average heart transplant, 1.4 million, with anti-rejection drugs totaling approximately $30,000 to $40,000 per year for the rest of a transplant recipient's life.

Is it ethical that a healthy person can always be an organ donor, if they were to die in the “right” way, but this same individual might not have been able to receive, if the situation had been reversed? It’s unthinkable, and yet this is the graphic reality in our for-profit US healthcare model; it is estimated that 25% of donated organs come from folks of modest means.

There are organizations in the USA dedicated to helping remove financial barriers by raising money for patients needing a transplant, and they do help some. Nevertheless, many patients are not helped or are simply helped too late. Healthcare is big business and if you can’t pay, you can’t receive.  What can we do about this egregious injustice?

It is—without question—clearly and egregiously outrageous of the organ donation industry to ask everyone to donate altruistically, and then create financial barriers, so only some can receive. The worldwide need for donor organs far exceeds their availability and so deciding to donate seems like the right thing to do. However, what if the citizens of the USA decided to no longer be organ donors, unless and until our system changes? What if we all revolted in a display of collective nonparticipation? Would this be more wrong than the USA’s transplant system, as it exists now? It would certainly challenge the system’s long standing expectation that citizens should be altruistic for the good of all, despite little reciprocity, without barriers, from the system itself.  It would also feel wrong, because more people would die on the transplant list. The death rates of patients that don’t meet the financial criteria for transplant would remain unchanged.

 What is fair and ethical and just? We all have power in our health care decisions; the decision not to donate can highlight the immorality of the USA’s transplant and medical system. The question is: is this how far we have to go to get the attention of those in power to change our for-profit model into a model that cares for everyone?  The US system asks for ALL of us to care for others by being an organ donor, but then does not reciprocate that care without enormous financial barriers. Other wealthy countries—such as Spain for example— have universal healthcare. Moreover, they have an opt out system for organ donation, which has been very successful; there are no financial barriers to transplant.

Is it fair to potentially alter the outcome of an organ failure patient on the US transplant list by not being an organ donor? I don’t know. It is though—without question—clearly and egregiously outrageous of the organ donation industry to ask everyone to donate altruistically, and then create financial barriers, so only some can receive. 

Not donating is a bold action—an ultimatum really—demanding change. It feels uncaring, but above all it says: we won’t allow the USA’s political, pharmaceutical, corporate—For-Profit—industrial triangle to financially use and abuse us any longer. Either the system changes to universal care or we stop participating in a system that is fundamentally immoral, in the only ways that we can.


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Mary O’Connor Mack

Mary O’Connor Mack

Mary O’Connor Mack is living with heart failure and volunteers in Boston, MA as an advocate for safe affordable healthcare.

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