title: Donor organ shortage crisis: a case study review of a financial incentive-based system.
abstract: BACKGROUND
  Current organ supply system depends on altruistic noncoercive donation, which has failed to meet the demand of organ transplantation. Providing financial incentives to donors is one of several approaches to address organ shortage. However, its feasibility is debatable as it relates to medical, ethical, and economic dimensions. An incentive-based procurement system (IBPS) applied by the Mobile Donor Action Team (MDAT) was instituted in Riyadh, Saudi Arabia, resulting in a 3-fold increase in donation rate. The goal of this study was to provide a qualitative review of a 7-year experience with IBPS.
  
  
  METHODS
  A qualitative approach was used. Documents were reviewed to create a chronological audit and shape interview questions. Sampling was purposeful and inclusive of MDAT members. Semi-structured interviews were conducted, and findings were subjected to thematic analysis.
  
  
  RESULTS
  Documents reflected the evolution of MDAT. The essence of MDAT is field work and liberal use of financial incentives, which resulted in a 3-fold increase in the donation rate. MDAT members believed that IBPS is the main reason behind this increase. Moreover, IBPS is viewed as acceptable from a moral, ethical, and religious standpoint, with a high degree of professional satisfaction.
  
  
  CONCLUSIONS
  Theoretical assumptions doubted the feasibility of IBPS. This real-life experience with IBPS proved the contrary. The findings may be applicable only to the setting in Riyadh, Saudi Arabia, however; further research is thus needed to explore its transferability to other settings. IBPS may be an alternative to altruistic noncoercive donation and should be piloted in different settings.
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation and HBP Surgery, Riyadh, Saudi Arabia. Electronic address: mohammed@alsebayel.com.
authors.forename: M
authors.initials: M
authors.lastname: Al Sebayel
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation and HBP Surgery, Riyadh, Saudi Arabia.
authors.forename: A M
authors.initials: AM
authors.lastname: Alenazi
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation and HBP Surgery, Riyadh, Saudi Arabia.
authors.forename: R
authors.initials: R
authors.lastname: Sabbagh
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation and HBP Surgery, Riyadh, Saudi Arabia.
authors.forename: T
authors.initials: T
authors.lastname: Al Ageel
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation and HBP Surgery, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Al Enazi
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation and HBP Surgery, Riyadh, Saudi Arabia.
authors.forename: H
authors.initials: H
authors.lastname: Al Bahili
authors.affiliation: King Faisal Specialist Hospital and Research Centre, Department of Liver and SB Transplantation and HBP Surgery, Riyadh, Saudi Arabia.
authors.forename: H
authors.initials: H
authors.lastname: Elsiesy
mesh_terms: D005240:Feasibility Studies; D005376:Financial Management / Q000458:organization & administration*; D006801:Humans; D009042:Motivation; D019982:Organizational Case Studies; D036301:Qualitative Research; D012052:Reimbursement, Incentive / Q000458:organization & administration; D012189:Retrospective Studies; D012529:Saudi Arabia; D014019:Tissue Donors / Q000523:psychology / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000458:organization & administration*