Surgeon Perception That Opioids Are Not Needed for Young Children Postoperatively—Reply

Abstract

plant program adds another recipient, not selected by the donor, who lacks a donor.Besides such standard voucher cases, conversations with prospective altruistic donors revealed an additional use for vouchers; some people wanted to help others by providing a kidney but held back from doing so because they worried that a relative might need a transplant in the future and they would be unable to help, having already given a kidney as a nondirected donor. By providing them with a family voucher, one of a group of up to 5 people designated by the donor who are not then awaiting a transplant could later receive a kidney should that become necessary.Matas's separation of the 3 overlapping categories of kidney donation allows him to claim that vouchers uniquely raise ethical concerns. Yet, one ought to be more concerned about the factual as well as the ethical basis for a system of financial incentives to kidney donors that Matas recommended recently, when the ground for his proposal is that the attempts made in the past 2 decades "to increase the number of both living donors . . . and deceased donors" have produced "little change in the number of donated kidneys." 4 In fact, between 2000 and 2020, the number of deceased donor kidney transplants more than doubled (from 8126 to 17 583), which is hardly "little change." Anyone who wants to see an increase in kidney transplants from living donors, which rose from 5505 in 2000 to a record 7397 in 2019 before the COVID-19 pandemic reduced donations in 2020, should support an expansion of the voucher system rather a trial of paying donors. The ethical concerns raised by paying financial incentives, a radical departure from the norms that have guided organ donation for more than half a century, far exceed any implicated by voucher programs.