Everyone involved with organ donation profits, except for the donor. In fact, living organ donors and their families can incur thousands of dollars in related costs not covered by insurance. Experts now urge Americans to remove financial barriers to organ donation.

The 38-member Incentives Workshop Group says removing the financial burden from donors and families is fair and may even lead to an increase in organs available for transplant. The Incentives Workshop Group, which includes representatives of the American Society of Transplant Surgeons and the American Society of Transplantation, published its recommendations online in the American Journal of Transplantation on March 31.

In addition to getting rid of financial disincentives, the group also suggests carefully considering economic incentives for donating organs. Any changes to current practices, however, must meet efficacy and ethics standards.

More than 123,000 people in the United States need a lifesaving organ transplant, according to the U.S. Organ Procurement and Transplantation Network. About 4,000 Americans die each year waiting for an organ. Better than half of all organ transplants are kidney transplants.

But the number of living kidney donors is declining. While there are a variety of reasons for the decline in living donors, money prevents many donors from making it to the operating room.

The average living donor incurs $5,000 in out-of-pocket expenses. The recipient's insurance usually covers the donor's medical expenses, but these policies do not pay for the donor's lost wages, lodging and transportation, childcare and other nonmedical expenses. Families of donors who die may struggle with hospital bills and funeral costs associated with the donation.

While most experts agree that financial obstacles stop many potential donors from going forward with surgery, the concept of providing economic incentives for organ donation is ethically charged. Donor compensation is illegal under the 1984 National Organ Transplant Act to prevent exploitation or inducement.

The authors of the Incentives Workshop Group say it may be possible to offer other effective incentives that do not interfere with donors' altruistic intents. The incentives could cover the costs of donation-related funerals, for example. Salomon says that donors should receive lifetime health coverage, but other members of the group suggest limited time coverage for donors.

Proponents of change say donors should not bear these economic burdens and that the cost of the transplant should include these donor costs. The Incentives Workshop Group says providing such coverage would facilitate organ donation in a way that results in substantial and long-lasting savings among insurers.

"From every single patient that stays on dialysis, the payer is losing $60,000 a year if they are not transplanted," writes Daniel Salomon, author of the paper and the medical director of the kidney and pancreas transplant program at Scripps Health in San Diego.

Opponents worry that these offers, especially lifetime care, may create a perverse incentive to donate organs. Proponents argue that it is possible to establish a balance between donation costs and compensation.