Paying for Tissue: Net Benefits—Response

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Science  14 Sep 2012:
Vol. 337, Issue 6100, pp. 1293
DOI: 10.1126/science.337.6100.1293-a

Kominers and Becker argue that compensating patients for their tissue will increase the supply of tissue for research. But there is no evidence that lack of compensation, the current standard, is an impediment to procurement of tissue. This is tissue that will be discarded if it is not used for research, and we doubt that very many patients refuse to give permission for the use of such tissue or that those who do refuse would reconsider if offered compensation.

Kominers and Becker propose compensation mechanisms that would be complex and difficult to implement. Compensation to the patient could not be linked to the actual value of the tissue at the time of donation, because it is impossible to know the value of waste tissue at that point. It could be many years before it is known whether a sample has value. An alternative reimbursement scheme based on a future royalty interest would lead to substantial transaction costs and would favor patients whose identity, location, and relatives could be easily tracked over time, thereby unfairly disadvantaging those with less social stability and family integrity.

Even the suggestion to consider a compensation scheme based on a fixed fee for all samples is problematic. If we are correct that the number of tissue samples that have little or no value dwarfs the number of those that do (an empirically testable question), the actual amount of the fixed fee would likely be quite small. While it is difficult to predict the effect that a small amount of compensation would have on the willingness of patients to donate, some empirical evidence does suggest that small payments can decrease altruistic behavior in comparison with no payments at all (1). The complexity and costs to the research enterprise of any of these mechanisms would need to be justified by a positive argument about why those who donate waste tissue deserve financial compensation, an argument that Kominers and Becker do not provide.

Finally, on the question of fairness, we disagree with the authors that there is anything unfair about rewarding medical researchers for their ingenuity, talents, hard work, and willingness to take risks and to absorb opportunity costs in transforming medical waste into products that have scientific value.

We want to be clear that our Policy Forum only analyzed whether donors of waste tissue should receive financial compensation. Other forms of compensation, such as recognition or commitments to use a portion of the proceeds for other worthwhile purposes, are commendable and entirely appropriate. Indeed, when the research is federally funded, all proceeds retained by the academic institution, net of expenses such as the costs of protecting intellectual property, must be used for research and educational purposes, both important public goods. The question we addressed, however, focused only on the propriety of payments to the individual and family for the use of the original discarded specimen.


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