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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 June 2; 334(7604): 1131.
PMCID: PMC1885312

Undertakers offer cash incentive for organ donation

One of the largest firms of undertakers in the Netherlands is offering a reduction in the cost of funerals to the relatives of dead people who have had an organ removed for donation. The initiative follows a call from the Dutch Kidney Foundation for new ideas to boost donation.

The foundation recently commissioned a study by the Dutch Institute for Health Services Research (Nivel), which found attitudes to donation changing, with more people against it (

Since 1998 the Netherlands has had a voluntary national register on which people can record their wish for or against donation. But only five million out of 12 million adults have done so.

And the Nivel study indicates that the proportion of people who have not registered but who would refuse to donate if asked has almost doubled in three years to 29%. At the same time the percentage of relatives who would agree to donation, if the dead person's wishes were not known, has fallen from 40% to 30%.

The Nivel researcher Roland Friele described this as a “worrying development, considering the large number of people on the waiting list for a donated organ.” The director of the foundation, Paul Beerkens, has called for incentives such as financial rewards or reductions in health insurance premiums to promote donation.

The undertakers, Monuta, have responded by offering a reduction of €150 (£100; $200) from the cost of a funeral for people who have donated organs. Because this benefits relatives or third parties it does not break a law that bans financial transactions between a donor and recipient. Monuta's director, Cors Hage, said that the company wanted to “take its responsibility” and that the reduction is “a small incentive” that “draws attention to this matter.”

About 1400 people are waiting for donated organs, and the rate of donation is about 200 a year, a drop of 28 since 2004. Although the number of people registering to donate their organs has gradually increased to 2.9 million, there is still a four year wait for a kidney transplant.

Mr Beerkens said that because the chances of becoming a donor are still one in 20 000, an extra two million people need to register to donate to ensure a substantial reduction in waiting times.

He said that after nine years the current law was not working properly. The worrying prospect of more people refusing to donate in future meant that a new “comprehensive master plan” was now called for. “All options, from financial incentives to a change in the law, should be studied and nothing excluded.”

Dr Friele argues that evidence in the Netherlands and abroad shows that there is no magic solution but that better communication among doctors, nurses, and relatives in intensive care wards is “a solution that has not been properly explored.” He argues that relatives have a decisive influence but that their wishes often remain unknown, and therefore opportunities for donation may be lost.

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