'Be an organ donor, get a free funeral!'
'Hey mister, wanna buy a kidney?'
These were just some of the UK and international headlines reporting on the launch last week of the Nuffield Council on Bioethics' consultation on donation of human bodily material for medical treatment and research. Even raising the question of whether people should be incentivised for providing organs, eggs, sperm and other tissue clearly provokes strong reactions. But incentives are just one part of a complicated ethical picture that the Nuffield Council is hoping to tackle over the next 18 months.
The starting point is that we have a problem: demand for human tissue currently significantly exceeds supply in the UK. Focusing on gamete donation, there is a waiting list for roughly 1200 egg donors and 500 sperm donors.
Demand for sperm has actually gone down over the past decade owing to new infertility treatments, and the number of new sperm donors registered is increasing, even though many people think that lifting anonymity for donors in 2005 led to a drop in numbers. Despite this, there is a demand for still more sperm donors.
Demand for eggs has increased owing to relatively recent medical advances that mean conception by egg donation is now possible. But it is easy to see why women are reluctant go through risky and unpleasant egg donation procedures unless they have a strong incentive.
So the first question we are asking is: should more people be expected to donate human tissue to meet the demand in this country? The purpose for which the tissue will be used is likely to provoke different opinions - saving or prolonging a life by donating blood or an organ may be viewed differently from creating a life through the donation of gametes.
If we do want to do more to meet the demand, there are a number of ways in which we might try to increase the number of donors, which is when we get to the issue of incentives. So, another important question is: how far can we ethically go in encouraging people to donate?
Currently, differences in UK law mean that it is legal to provide incentives to encourage people to donate some kinds of human tissue, but not others. For example, people cannot be paid to donate organs, tissue and blood for medical treatment, although living organ donors, such as those donating a kidney, can claim expenses. It is the same for sperm donors, with expenses restricted to a maximum payment of about £60 per day with a cap of £250 per course of sperm donation.
However, women can get free or reduced-cost IVF treatment in return for egg donation - so-called 'egg sharing' - which can be worth several thousand pounds. And, in an interesting contrast, healthy people who 'donate' their bodies by taking part in clinical trials to test new medicines can be paid significant sums of money for their trouble.
We will be looking closely at these differences and would like to know if people think other kinds of measures would be acceptable. For live donation, proposed incentives include more generous reimbursement of expenses, priority for medical treatment in future, a Government-run system for buying and selling human material and, at the extreme end, a fully-fledged free market. In trying to extend the circumstances in which donations can be made, there has also been talk of allowing egg donation after death.
We need to think about, not just the people who need the tissue, but also the people supplying them. Is it wrong to press people to donate their bodily material? Offering payment or other incentives may encourage people to take risks or go against their beliefs in a way they would not have otherwise done. Altruism is itself a huge incentive. Or perhaps donating parts of our bodies simply should be seen as a moral obligation for all of us.
The Council will also be looking at the potential effect of incentives on the validity of the consent given by people and their families, and the control people should have over future uses of their bodily material.To find out more about these issues, and to contribute to the public consultation, go to the website.