How do you get more Americans to bequeath their organs?

Currently 80,269 critically ill people are waiting for organ transplants, according to the United Network for Organ Sharing, a nonprofit, federally funded organ procurement group. But last year, only 6,081 organs came from cadavers -- a number that has remained essentially flat for a decade, despite attempts to increase public awareness.

The issue is "whether we can identify a noncoercive technique for increasing the number” of such donated organs, said Dr. Frank Riddick, chairman of the American Medical Association's council on ethical and judicial affairs.

Under consideration are such proposals as paying small fees to donors' survivors, awarding a congressional medal of honor -- or even presuming someone is a donor unless he or she has stated otherwise.

In New York and most other states, an eligible donor must be declared brain-dead in a hospital and his or her organs viable and free of disease. In the New York Organ Donor Network -- New York City and six counties, including Nassau and Suffolk -- there were about 62,000 deaths last year. Of those, only about 600 were potential organ donors, according to Martin Woolf, a spokesman for New York Organ Donor Network. And only 199 ended up being donors, Woolf said.

In the past two years, several bills in Congress have tried to address ways to increase donations, including a bill by Sen. Charles Schumer (D-N.Y.) to create a database encompassing donor information from state registries to speed the donor-recipient matchup.

Sen. Bill Frist (R-Tenn.) is a former lung and heart transplant surgeon whose 1996 legislation required information about organ donation on tax return envelopes. He has sponsored a bill that would honor donors with congressional medals of honor and has introduced another to allocate $18 million aimed at increasing donations.

Two bills call for giving a donor's family a $10,000 tax credit or a $2,500 tax refund. But in a recent issue of the New England Journal of Medicine, Dr. Frank Delmonico, a member of the Health and Human Services advisory panel on transplantation, argues that those "are in reality merely forms of payment.” And the National Organ Donation Act of 1985 forbids any form of payment for an organ.

Nevertheless, Delmonico supported studying whether covering funeral expenses might increase donations. And in its June meeting, the AMA's House of Delegates approved a report calling for studies aimed at identifying what motivates families, including "the use of modest financial incentives,” according to the AMA's Riddick.

One approach that hasn't seemed to gain congressional support is "presumed consent.” Several countries, including Spain, Belgium and Austria, have laws that presume someone is a donor unless that person has stated otherwise. But such an approach "stands to contradict a profound respect a majority of Americans reserve for the value of individualism,” according to a UNOS document -- a view supported in the New England Journal article.

In Sweden and Denmark, citizen must state whether they will or won't be organ donors, a practice called "mandated choice” or "required response.” The UNOS document found that feasible, but Delmonico said it ran counter to "the expectation of autonomy on the part of most families” and said it hasn't been studied in this country.

Others argue that not knowing what Americans want is no reason to reject it out of hand. "The presumption is that Americans want their choices. They don't want to be told what to do,” said Alan Berger, a fierce xenotransplantation critic and advocate of mandated choice. "But you've never given them a chance.”