Imagine a car wreck has fatally injured a family member. The person is an organ donor but does not have insurance. Now, on top of the trauma of a family member dying, the procedural costs of donating your loved one’s organs has put the entire bill on your shoulders.

This could happen if an organ donor’s family does not have the appropriate health insurance to cover the costs incurred during organ donation. While this has angered some, there is a new movement towards a market for organs where some agency or group would pay a family or person to donate their organs.

“Once a person or family consents to donation, all of the costs associated with donation are paid for by the transplant recipient’s private insurance or Medicare, said John D. Pirsch, a professor of medicine and surgery at the University of Wisconsin. “This is true whether a person is a live donor or if the family consents to donating after brain death.”

If an organ is donated and the contributor remains alive, then the donor must have insurance. Without insurance, the story is different.

“In case of living donation, all costs are carried by the recipient’s insurance. There are now employers who award paid vacation to employees who are [donating] an organ,” said Hans Sollinger, chairman of the organ transplantation department at the University of Wisconsin. “The donor will have to pay absolutely nothing for any health-care issues related to organ donation.”

The cost of giving is also at the center of another debate. According to the United Network for Organ Sharing, 65,907 individuals needed transplants in 1998. Only 21,812 transplants were performed. This has led some to call for a pay system to those who donate organs. The goal would be to promote organ donation through cash or educational benefits.

“Over the years, there have been many proposals to provide some compensation to donor families. This is somewhat a difficult issue, as one does not want to remove the altruistic motive,” Sollinger said. “Therefore, the compensation which has been discussed is modest and perhaps should include funeral expenses or a contribution to a college fund.”

The costs of transplantation can also be “very cost effective” over time. When compared to long-term dialysis, the sheer amount of savings involved in transplantation is not only beneficial to the recipient but also to the general public, which often has to foot some of the bills in the form of taxes contributed towards Medicare.

“Transplantation is very cost effective compared to life-long dialysis. The average dialysis patient costs you and I [pay] — most patients on dialysis are on Medicare no matter what the age, so the government pays for most of the costs — is at least $50,000 per year,” Pirsch said. “The first-year cost of a transplant is about $120,000, and the per-year cost is about $10,000 to 15,000. It doesn’t take much math to figure out that a successful transplant is very cost effective over the long run.”

The concept seems to be catching on. In 1999, Pennsylvania started a pilot program that would contribute $300 from the state towards the donor’s funeral expenses. Currently, it is illegal to provide payment for organs, but the Pennsylvania system is different for a number of reasons.

Jeffrey P. Kahn, director for bioethics at the University of Minnesota, told CNN a number of reasons why this system would work.

First, the plan would only affect the supply and distribution of donor organs and would not change access by making the number of organs available increase. Also, the donor’s family would receive no monetary benefit besides funds to offset funeral costs. This would make the process unprofitable to families wishing to make quick cash out of donating organs.

Still, the attempt at providing some compensation for those contributing organs has not succeeded on a large scale. As a result, the government and individuals continue to search for a way to solve the organ shortage.

“As far as live donors are concerned, secretary of [Department of Health and Human Services] Tommy Thompson is considering proposals to assist live donors with travel expenses and compensation for lost salaries where applicable,” Sollinger said.