State incentives to promote organ donation: honoring the principles of reciprocity and solidarity inherent in the gift relationship

Organ transplantation saves the lives of thousands of patients worldwide every year. However, a chronic organ shortage overshadows this success. We define the organ shortage as a public health problem due to its serious consequences on patients and society. This definition raises the question of the state's role in transplantation medicine. It leads us to formulate a public policy promoting organ donation through state incentives, ie regulatory instruments to reward individuals’ willingness to donate. Incentives allow the state to express gratitude for the solidary act of the donor toward the recipient and society. In an original approach, we integrate sociological findings as to the act of donation—the concept of reciprocity most importantly—into the core attributes of such a public policy. Addressing regulatory design questions, we present incentives such as allocation priority, tax benefits, health insurance discounts, and coverage of funeral costs. We also examine the unique non-financial incentive successfully implemented in Israel. We then discuss the legal and ethical framework in which state incentives have to operate, concluding that normative constraints can be addressed through law reform. Finally, we focus on aspects neglected so far in public information campaigns and discuss the interaction between state policy and public opinion.