Paying for Tissue: Net Benefits

Science  14 Sep 2012:
Vol. 337, Issue 6100, pp. 1292-1293
DOI: 10.1126/science.337.6100.1292-b

In their Policy Forum “Paying patients for their tissue: The legacy of Henrietta Lacks” (6 July, p. 37), R. D. Truog et al. oppose sharing biomedical research revenues with the patients whose tissues enable that research. They argue that “reconceptualizing tissue acquisition as an economic exchange rather than as a gift relationship” might reduce tissue donation by “crowd[ing] out” altruistic motivations. We are skeptical of this argument.

The possibility of compensation might crowd out some individual donations, but other altruism-motivated donations would increase because of compensation, and nonaltruistic donations would also increase. It thus seems unlikely that net willingness to supply tissue would decline. Patients for whom compensation would truly decrease the enjoyment of donating tissues could pass on their compensation to nonprofits such as the American Cancer Society.

Truog et al. also argue that offering compensation proportional to tissue value would be “unjust” because patients whose tissues yield “financial blockbusters” would be paid more than the vast majority of donors. This argument, too, is unconvincing. “Blockbuster” cell lines make some researchers very rich, whereas other researchers do not benefit at all; is that unjust? Moreover, it is standard to tie compensation to the value of personal characteristics such as intelligence or athletic ability. How could such a system, if applied to compensation for tissue donation, be less fair to patients than the current system, under which all revenues from tissue lines—“blockbuster” or otherwise—accrue to the medical community?

Offering value-based compensation to tissue donors would likely boost tissue supply. The great majority of patients would likely be willing to donate waste tissue in exchange for either a fixed fee or a chance to share in the rewards of financially successful research.

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