United States Organ Procurement System

In order to help ensure that organs are equitably distributed, Congress passed the National Organ Transplant Act of 1984 (NOTA). 710 ; P.L. Over time, Congress has considered a range of legislation aimed at encouraging the practice of living organ donation. Others, such as H.R. Directed Living Donation and Valuable Consideration: Paired Donation and Other Types of Exchanges

As described above, in traditional living donation, a specific donor, who is biologically compatible with his or her intended recipient, donates an organ to that person. One is paired donation (also known as paired organ donation or human paired organ donation ). In paired donation, two or more donors whose kidneys are incompatible with their own intended recipients, but compatible with each other's, trade donations. Each recipient receives a compatible kidney from a living donor. 110 - 144 clarified that NOTA's prohibition on the exchange of valuable consideration for organs does not extend to paired donation. If so, these arrangements would have been illegal. 110 - 114 on the permissibility of list donation is unclear. The effect, if any, of the passage of P.L. It presents statistics related to the current system, and estimates the impact that paired and list donation programs would have on the supply of organs for transplantation, waiting lists, and deaths. Next, the report presents a legal analysis of NOTA's prohibition on valuable consideration as it relates to directed living donation exchange programs. The ethical dimensions of this issue are discussed further in the Ethical Issues section of this report. The legislative history of the 1984 NOTA did not discuss the meaning of the term valuable consideration. 110 - 144 , the Charlie W. Norwood Living Organ Donation Act, which clarifies that "human organ paired donation" is not a human organ transfer for valuable consideration and thus does not violate NOTA. Now that Congress has clarified that paired transplants of compatible living donors and recipients do not violate NOTA's prohibition of valuable consideration in return for organ donation, issues may still be raised regarding other kinds of living donation arrangements such as list donation, because Congress clarified only the legality of paired donation arrangements. Ethical and Policy Issues Related Living Organ Donation, and Paired and List Donation

The central ethical question involved in organ transplantation is how to balance the needs of people seeking organs with one another, and with the needs of potential organ donors. This question has given rise to many issues, discussed below, including those 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. Current law permits and defines paired organ donation ( P.L.
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.
This report will be updated as needed.