Should the families of organ donors be compensated?

Summary

---

The Indicator from Planet Money:

Should the Families of Organ Donors be Compensated?

Air Date: March 2, 2026
Hosts: Adrienne Ma & Waylon Wong
Guests: Kurt Sweat (Economics Researcher), Alex Chan (Harvard Economist), Shelly Snyder (Donate Life Kentucky Trust)

---

Overview

This episode explores the provocative question: Should the families of organ donors be compensated? Hosts Adrienne Ma and Waylon Wong discuss the economic, legal, and ethical aspects of compensating organ donors' families with researchers Kurt Sweat and Alex Chan. The conversation also features insights from Shelly Snyder, a leader in organ donation advocacy. The episode examines the proposal to reimburse funeral and related expenses, its potential benefits, the legal barriers, and concerns about maintaining public trust.

---

Key Discussion Points & Insights

1. The Human Side of Organ Donation

• Kurt Sweat’s Experience in the OR
  Kurt Sweat, an economics grad student, recalls his first direct experience with organ donation, highlighting its emotional and visceral impact.
  • Quote:

    “I'm very queasy with blood and there's obviously a lot of blood... There's obviously a very bad stench in the operating room. Things like that, that kind of you don't expect.”
    — Kurt Sweat (00:17)

  • Kurt recounts the moving moment when he knew a donated heart would save a young boy’s life.

    “It was just amazing.”
    — Kurt Sweat (01:00)

2. The Economics of Organ Donation

• Market Inefficiency and the Cost of Waitlists
  Alex Chan outlines the dire shortage in the organ market and the massive human and fiscal toll.
  • Over 100,000 people are on transplant waitlists; 5,000+ die waiting annually (03:17).
  • Medicare and healthcare systems spend $30–45 billion/year for people with chronic kidney disease.
  • Quote:

    “This is not just a life and death decision, but also a decision that is a huge amount of implication on our fiscal stability as a country.”
    — Alex Chan (03:42)

3. The Proposal: Compensate Donor Families

• How Would It Work?
  • When a deceased organ donor’s family consents (or if the deceased was registered), the government would reimburse funeral expenses and offer support (e.g., travel costs).
  • Estimated cap: $6,000–$8,000.
  • Modeled impact: Potential 9–35% increase in organ donations annually (04:59).
  • Quote:

    “Other things that might be covered are things like support for the donor family.”
    — Kurt Sweat (04:23)

  • Quote:

    “Even the low end of the range, 9%, seems very significant.”
    — Waylon Wong (04:59)

4. Major Barriers: Legality and “Ick Factor”

• Legal Roadblock:

  • The National Organ Transplant Act (1984) prohibits “valuable consideration” for organ donation, a direct response to commercialized and exploitative schemes in the early 1980s.
  • Quote:

    “Under the current law, this whole proposal is illegal.”
    — Adrienne Ma (05:20)

  • Historic context: Dr. H. Barry Jacobs' notorious attempt to buy and import organs (06:18).

• Ethical Concerns and Precedents

  • Plasma donation and whole body donation already allow for compensation or funeral costs (07:02).
  • Quote:

    “Whole body, you could pay; the blood plasma, you could pay; but sort of somewhere in between the organs—not.”
    — Alex Chan (07:27)

5. The Ethics of Financial Incentives

• Do Financial Incentives Corrupt the ‘Gift of Life’?
  • Alex Chan argues that most other parties (surgeons, organizations) are compensated; only donor families are not.
  • Compensation could increase equity, allowing less-affluent families to participate.
  • Quote:

    “People worry that financial incentives will corrupt... But if you think about the process more holistically... a lot of players already have incentives.”
    — Alex Chan (07:50)

  • Quote:

    “If you are a family of donors who are less well resourced, you are not allowed to be there with your loved ones, even though you have both made a heroic decision.”
    — Alex Chan (08:31)

6. Safeguards and Maintaining Public Trust

• Shelly Snyder’s Perspective

  • Financial strain for donor families is real, but maintaining trust is paramount.

  • Any compensation policy must ensure clear separation between the donation decision and reimbursement process to avoid undue influence.

  • Quotes:

    “Any policy would need really clear guardrails and separation from the decision to donate in order to protect that public trust.”
    — Shelly Snyder (09:05) “The people who say yes to donation are doing it because they want to save another human's life. And that always needs to remain at the forefront...”
    — Shelly Snyder (09:57)

  • Suggestions: Public awareness campaigns; administrative separation between donation consent and compensation (09:32).

---

Notable Quotes & Memorable Moments

• On the “Ick Factor” of Buying Organs:

  “That's just...That's terrible. That's icky.”
  — Kurt Sweat (06:18)

• On Saving Lives and Equity:

  “They are the true heroes of a story.”
  — Alex Chan (08:12)

• On the Need for Guardrails:

  “Any policy would need really clear guardrails...to protect that public trust.”
  — Shelly Snyder (09:05)

---

Important Segment Timestamps

• 00:17 — Kurt Sweat’s experience in the operating room
• 03:17 — Alex Chan lays out the numbers: shortage and deaths
• 04:06 — The researchers' compensation proposal
• 05:20 — Legal hurdles and “valuable consideration” law
• 06:18 — The story behind the National Organ Transplant Act
• 07:27 — Existing precedents for compensating donors
• 07:50 — Discussion on the ethics and equity of compensation
• 09:05 — Shelly Snyder on financial strain and preserving trust
• 09:32 — Practical ideas for maintaining ethics in implementation

---

Summary

This episode deftly unpacks a complex issue at the intersection of ethics, economics, and policy: whether families of organ donors should be compensated by the government. With deep empathy for donor families and a frank look at the law and historic pitfalls, the hosts and guests illuminate both the life-saving potential and the risks of changing long-standing donation policy. The episode highlights that increasing donations could yield large societal and fiscal benefits, but public trust and the principle of altruism must not be undermined.

A must-listen for anyone interested in healthcare policy, economics, ethics, or the future of organ donation in America.

Transcript

[Narrator/Host]

Npr.

[Adrienne Ma]

Kurt Sweat remembers one of the first times he watched a surgeon remove the heart from a deceased patient.

[Kurt Sweat]

I'm very queasy with blood and there's obviously a lot of blood. There's obviously a very bad stench in the operating room. Things like that, that kind of you don't expect.

[Waylon Wong]

It was 2021, and at the time, Kurt was a grad student at Stanford studying economics, although most of the people in the operating room did not know that.

[Kurt Sweat]

Someone mentioned, I'm a student and they assume I'm a med student or something. I remember they asked me to tie knots on the gown and I don't know how to do that. So, you know, I was just like, you know, I'm the wrong kind of student.

[Adrienne Ma]

Afterwards, Curt tagged along with the transplant team as they transported the heart from this operating room in New Mexico to an OR in California. There, another patient was waiting.

[Kurt Sweat]

Knowing that this person's heart was going to a young boy at the pediatric hospital at Stanford. I mean, it was just, it was just amazing.

[Adrienne Ma]

It's been a few years since Kurt first witnessed how organ donation can save a life. And the experience stuck with him because in his own nerdy econ brain way, Kurt wants to help save lives too. This is the indicator for Planet Money. I'm Adrienne Ma.

[Waylon Wong]

And I'm Waylon Wong. Today on the show, Kurt and his colleague Alex Chan get into the economics of organ donation. And they argue why the government should financially compensate donors and their families.

[Sponsor/Advertisement Voice]

Support for NPR and the following message come from Edward Jones. A rich life isn't always a straight line. A unexpected turns can bring new possibilities. With a hundred years of experience navigating ups and downs, Edward Jones can help guide you. Let's find your rich together. Edward Jones Member SIPC this message comes from Charles Schwab.

[Narrator/Host]

When it comes to managing your wealth, Schwab gives you more choices like full service, wealth management and advice when you need it. You can also invest on your own and trade on thinkorswim. Visit schwab.com to learn more.

[Sponsor/Advertisement Voice]

This message comes from Capella University. You know that feeling when there's a spark building inside you that you were meant for more? That's your own drive pushing you towards what's next. Capella University gets that with their flexpath learning format, you can set the pace and earn your degree without putting life on pause. You've built experience and know what you're capable of. Now this is your time to turn that momentum into more. The only real question is what can't you do learn more at capella. Edu.

[Adrienne Ma]

Whenever you have a demand for something and a limited supply, you've got a market. And when it comes to the market for human organs, Harvard economist Alex Chan says the stakes are brutally clear. With more than 100,000 people on the national organ transplant waiting list, the consequences of market inefficiency are the difference between life and death.

[Alex Chan]

So the level of inefficiency is also staggering. Right in this market, more than 5,000 people every year die waiting for organs.

[Adrienne Ma]

They're waiting for kidneys, livers, hearts, and lungs. The government spends billions of dollars a year on healthcare for people on the waiting list. For example, in recent years, it's spent between 30 to 45 billion dollars a year on dialysis and other treatments for people dealing with chronic kidney disease.

[Alex Chan]

That accounts for actually a huge part of our national budget through Medicare and other sources. So this is not just a life and death decision, but also a decision that is a huge amount of implication on our fiscal stability as a country.

[Waylon Wong]

Recently, Alex and his colleague Kurt Sweat came up with a proposal they say could help increase the number of organ donations, would save lives and save the government money in the process.

[Adrienne Ma]

And here's their idea in a. When a person dies in the hospital, their organs might be donated if they're a registered organ donor or the family gives consent. In either situation, Kurt says the government should reimburse donors families for their funeral expenses. But that's not all.

[Kurt Sweat]

Other things that might be covered are things like support for the donor family.

[Adrienne Ma]

Think travel and hotel rooms for family that want to be near their loved one throughout the donation process. The amount of compensation might be capped at 6,000 to $8,000, the typical cost of funeral services. And by offering this incentive to everybody, Alex and Kurt believe more families would consent to their loved ones organs being donated, and more people would choose to become registered donors in the first place. And the result, they estimate, would be a 9 to 35% increase in the number of organ donations each year.

[Waylon Wong]

Wow. I mean, that's a really big range, obviously, but even the low end of the range, 9%, seems very significant. Significant to me.

[Adrienne Ma]

Yeah.

[Waylon Wong]

And as a result, they say thousands more lives would be saved and the government would save money as there would be fewer people on the wait list in need of expensive long term medical treatment. So on paper, seems like a pretty good idea, right?

[Adrienne Ma]

Right. Except for a few potentially glaring issues. The first being that under the current law, this whole proposal is illegal.

[Waylon Wong]

Oh, minor detail, minor detail.

[Adrienne Ma]

And the backstory to why is Actually pretty interesting.

[Kurt Sweat]

The story sort of goes that there was someone who wanted to go to other countries and pay people to donate one of their kidneys, because kidneys, you have two, so you could do a living donation. They wanted to basically go pay people elsewhere to do that and then bring the kidneys back to the United States.

[Waylon Wong]

This is like getting into urban legend territory for me.

[Adrienne Ma]

Right?

[Waylon Wong]

Yeah. And when we first heard this, we had a hard time believing it, but indeed, in 1983, a. A Virginia doctor named H. Barry Jacobs formed a company called International Kidney Exchange. According to an article in the Washington Post, he talked about sourcing organs from, quote, U.S. citizens and third world indigents.

[Kurt Sweat]

This is a great way to make money. I go somewhere, I get the kidneys cheap, I bring them back to the U.S. i transplant them, and I charge a bunch of money. And everyone thought, that's just. That's terrible. That's icky.

[Waylon Wong]

It is terrible.

[Adrienne Ma]

Yeah. I think I understand the ick factor is pretty strong here.

[Waylon Wong]

Off the charts. Yeah. Shortly after this, Congress passed the National Organ Transplant act, which, among other things, outlawed the exchange of any human organs for, quote, valuable consideration. And on the one hand, this obviously makes sense. Like, imagine if the market for organs revolved around wealthy people paying for the organs of poor people. That would be incredibly dystopian. Like an episode of Black Mirror.

[Adrienne Ma]

Absolutely. On the other hand, though, what Alex and Kurt are proposing here is far from that. And Alex argues that tweaking the law to allow compensation for donation has some existing precedent. Like, after all, he points out that people can get paid for donating blood plasma, and a person who donates their whole body to medical research is actually allowed to have their funeral costs covered.

[Alex Chan]

It's like an interesting dilemma, right? Like, whole body, you could pay the blood plasma, you could pay, but sort of somewhere in between the organs.

[Kurt Sweat]

Not.

[Alex Chan]

Okay.

[Waylon Wong]

But let's put aside the legal issues for a moment and talk about another potential issue with their proposal, the ethics. Is it even right to offer this sort of incentive to people in exchange for their decision to donate? Here is how Alex sees it.

[Alex Chan]

People worry that financial incentives will corrupt sort of this gift of life. That is a pristine thing, the whole transplant process. But if you think about the process more holistically. Right. A lot of players already have incentives.

[Adrienne Ma]

He says the transplant surgeon is paid to do the surgery. The organizations that procure organs are paid for that work. But the donors and their families, they

[Alex Chan]

are the true heroes of a story. They are the folks who actually are left out of the system. Where incentives are embedded, he says, allowing

[Waylon Wong]

them to be compensated for funerals, hotel and travel costs. That would actually make the system more particularly for people who might struggle to afford those things.

[Alex Chan]

When you're well off, you can afford to hang out in the hospital nearby and you could skip work where if you are a family of donors who you know are less well resourced now, you are not allowed to be there with your loved ones, even though you have both make a heroic decision.

[Adrienne Ma]

So after hearing Alex and Kurt make their case, we wanted to get a sort of second opinion from someone who works with people who've actually made that heroic decision. And so we reached out to Shelly Snyder. Shelley is an executive director for Donate Life Kentucky Trust, which is a nonprofit that provides education and financial support to donors and their families.

[Narrator/Host]

Financial strain is very real for families. I think we also have to consider, though, that any policy would need really clear guardrails and separation from the decision to donate in order to protect that public trust.

[Adrienne Ma]

She says people are often making this decision at an emotionally vulnerable time and she doesn't want them to feel like their decision is being influenced by money.

[Waylon Wong]

One way of avoiding this might be through raising public awareness, running ad campaigns, letting people know that compensation for donation is a thing long before they ever have to actually make the decision. Another might be making sure the people responsible for discussing donation with families are separate from those who would handle reimbursements. In the end, Shelley says, it should be about honoring people's generosity.

[Narrator/Host]

And the people who say yes to donation are doing it because they want to save another human's life. And that always needs to remain at the forefront of the reason for making that decision to donate their organs as a registered donor or to donate their loved ones organs. And that's what organ donation has always been built on.

[Adrienne Ma]

This episode was produced by Angel Carreras and engineered by Kwesi Lee. It was fact checked by Sierra Juarez Cake and Cannon is our editor and the indicators production of npr.

[Sponsor/Advertisement Voice]

This message comes from BetterHelp International Women's Day is this March time to celebrate all women. The leaders, the caregivers, the hype friends, the how do you do it? All types. Women deserve to be reminded how much they matter and that therapy offers a space to care for themselves. BetterHelp makes it simple by matching you with a qualified therapist based on your needs and preferences. Visit betterhelp.com NPR for 10% off this message comes from Rosetta Stone. If you have travel coming up, like a spring break or summer vacation, imagine arriving actually understanding the language Rosetta Stone has been the trusted leader in language for over 30 years, with millions of users and 25 languages to choose from. Ready to start learning a new language this spring? Visit rosettastone.com NPR today to explore Rosetta Stone and choose the language that's right for you. This message comes from the BBC with its new podcast, the Interface. Every Thursday, three leading tech journalists explore how tech is rewiring your week and your world. Listen to the interface on BBC.com or wherever you get your podcasts.