Living Organ Donation and Valuable Consideration

Erin D. Williams
Specialist in Public Health and Bioethics

Bernice Reyes-Akinbileje
Analyst in Health Resources and Services

Kathleen S. Swendiman
Legislative Attorney

The central issue before Congress with respect to living organ donation is how to balance the needs of people seeking organs with one another, and with the needs of potential organ donors. While the majority of organs are harvested from deceased donors, an increasing number of donations are made by living donors each year. As new types of programs are developed to help encourage the practice of living donation, both legal and ethical issues may arise. 

The primary federal law governing organ donation in the United States is the National Organ Transplantation Act (NOTA, P.L. 98-507). It permits living and deceased organ donation, and prohibits the sale of organs. Specifically, section 301 of NOTA prohibits the exchange of valuable consideration (money or the equivalent) for organs. 

Congress specified in the Charlie W. Norwood Living Organ Donation Act (H.R. 710; S. 487; P.L. 110-144) that NOTA's prohibition on the exchange of valuable consideration for organs does not extend to paired organ donation (also known as paired donation, or human organ paired donation). Paired organ donation arises when two or more willing living donors are incompatible with their intended recipients, but compatible with one another's recipients. The donors give their organs to one another's intended recipients so that each recipient receives a compatible organ. 

Living organ donation generally, and paired and other similar types of organ donation arrangements specifically, raise or at least touch upon a range of issues. These include some related to evolving transplantation systems, the directive that physicians do no harm, risk-benefit ratios, informed consent, type O recipients, resource allocation, parity, and the possibility of paying for organs. 

Over time, Congress has considered several other types of measures intended to increase organ donation by amending NOTA's prohibition on the exchange of organs for valuable consideration. These would have specified that some combination of familial, emotional, psychological, and physical benefit, and another type of organ exchange known as list donation, were exempt from the prohibition. The impact, if any, of P.L. 110-144 on the legality of these exchanges is unclear. 

This report contains background regarding how living donation is included within the larger organ donation construct, the likely impact that paired organ donation will have, and that list donation programs would have, on organ supply, the legislative history and legal interpretation of the term valuable consideration as it is defined by NOTA, and the various ethical and policy issues related to living donation, paired donation and list donation.


Date of Report: March 25, 2010
Number of Pages: 20
Order Number: RL33902
Price: $29.95

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