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Original article

Vol. 141 No. 4950 (2011)

Financial incentives to improve organ donation: what is the opinion of the Vaud French-speaking population?

  • F Bosisio
  • M Santiago
  • L Benaroyo
Cite this as:
Swiss Med Wkly. 2011;141:w13312


BACKGROUND: With the increase of the organ shortage, several authors assume that financial incentives would improve organ donation rates and fill the unbalance between the demand and the organs available for transplant medicine. This line of argument has been criticised with people arguing that an exchange of money for organs would violate the legal and the ethical principle of gratuity, decrease voluntarism and increase the body parts commodification phenomena.

PURPOSE: Switzerland is often highlighted as having under-average organ donation rates compared to other European countries. In this paper we investigate the opinions of the Vaud French-speaking population concerning direct, indirect and non financial incentives in order to assess their opinions and anticipate the further debate.

METHODS: As part of a broad survey about the organ donation decision-making process, questions about incentives for both living and deceased organ donation were addressed to Vaud inhabitants and physicians.

RESULTS: The data collected showed that respondents were opposed to rewarding both living and deceased organ donation. The analysis of positive answers showed that indirect and non financial incentives were the most likely choice to acknowledge the donor’s act. People in critical financial situations preferred direct financial incentives.

CONCLUSIONS: These results showed that altruism and gratuity were key-values in the organ donation and transplantation social perceptions of the respondents. Thus, we assume that introducing financial incentives could tarnish the image of transplant medicine. Nevertheless, further studies are needed to evaluate if their introduction would improve the organ donation rates or decrease voluntarism.


  1. Moloney G, Walker I. Messiahs, pariahs, and donors: The development of social representations of organ transplants. J Theo Soc Behaviour. 2000;30(2):203–27.
  2. Erin CA, Harris J. An ethical market in human organs. J Med Ethics. 2003;29(3):137–8.
  3. Matas A, Schnitzler M. Payment for living donor (vendor) kidneys: a cost effectiveness analysis. Am J Transplant. 2004;4(2):216–21.
  4. Matas A. The case for living kidney sales: rationale, objections and concerns. Am J Transplant. 2004;4(12):2007–17.
  5. Daar AS. Paid organ procurement: Pragmatic and ethical viewpoints. Transplant Proc. 2004;36(7):1876–7.
  6. Byrne MM, Thompson P. A positive analysis of financial incentives for organ donation. J Health Econ. 2001;20(1):69–83.
  7. Delmonico FL, Arnold R, Scheper-Hughes N, Siminoff LA, Kahn J, Youngner, SJ. Ethical Incentives – not Payment – for organ donation. N Engl J Med. 2002;346(25):2002–5.
  8. Joralemon D. Shifting ethics: Debating the incentives question in organ transplantation. J Med Ethics. 2001;27(1):30–5.
  9. Uehelinger NB, Beyeler F, Weiss, J, Marti HP, Immer, FF. Organ transplantation in Switzerland: impact of the new transplantation law on cold ischemia time and organ transport. Swiss Med Wkly. 2010;140(15-16):222–7.
  10. Otth M, Rödder S, Immer FF, Marti HP. Organ donation in Switzerland: a survey on marginal or extended criteria donors (ECD) from 1998 to 2009. Swiss Med Wkly. 2011;141:w13230. doi: 10.4414/smw.2011.13230.
  11. The STROBE checklist used in this paper is freely available on the websites of the Annals of Internal Medicine at
  12. Bowling A. Mode of questionnaire administration can have serious effects on data quality. J Public Health. 2005;27(3):281–91.
  13. Melkhop G, Becker R. Zur Wirkung monetärer Anreize auf die Rücklaufquote in postalischen Befragungen zu kriminellen Handlungen. Theoretische Überlegungen und empirische Befunde eines Methodenexperiments. Gesis. 2007;1(1):5–24.
  14. Mayrhofer-Reinhartshuber D, Fitzgerald A, Benetka G, Fitzgerald R. Effects of financial incentives on the intention to consent to organ donation: A questionnaire survey. Transplant Proc. 2006;38(9):2756–60.
  15. Schweda M, Schicktanz S. Public ideas and values concerning the commercialization of organ donation in European countries. Soc Sci Med. 2009;68(6):1129–36.
  16. Rothman DJ, Rose E, Awaya T, et al. The Bellagio Task Force report on transplantation, bodily integrity, and the international traffic in organs. Transplant Proc. 1997;29(6):2739–45.
  17. Brahams D. Kidney for sale by live donor. Lancet. 1989;1(8632):285–6.
  18. Boulware LE, Troll MU, Wang NY, Powe NR. Public attitudes toward incentives for organ donation: a national study of different racial/ethnic and income groups. Am J Transplant. 2006;6(11):2774–85.
  19. Kranenburg L, Schram A, Zuidema W, Weimar W, Hilhorst M, Hessing E, et al. Public survey of financial incentives for kidney donation. Nephrol Dial Transplant. 2008;23(3):1039–42.