Jeff Jacoby’s opinion piece on organ donation highlights a debate that has gone on in the United States for decades (“Reward organ donors, and thousands of lives will be saved,” Opinion, Aug. 4). It must be understood that this issue is not quite as simple as presented. Incentive programs, such as payment for a kidney, will ultimately prey upon those who need the money most. The poor will ultimately pay the price.

It is also important to note that transplantation is not a cure. It is merely a treatment, albeit a good one, for renal failure. The key to solving the problem is not necessarily in transplantation, but rather prevention. The government pays the outlay it does, roughly 6 percent of the Medicare budget for under 1 percent of the Medicare population, because patients do not seek treatment for obesity, hypertension, and diabetes before it is too late. it seems we are at a crossroads, and the simple solution is to prevent, as opposed to fighting disease from the back end.

John D. Sullivan

The writer is a professor at Boston University.