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WORKING WITH an organ-transplant team, I recently treated two patients who helped change my thinking about efforts to obtain organ donations.

The first patient had contracted hepatitis in a blood transfusion. When I last saw him, three days had passed since his liver transplant.He was weak and had not yet gotten out of bed. He said he had one goal for the day: to sit up in bed.

He wanted to write a thank-you note to the family of the person whose donated liver saved his life. That afternoon, I found him in a chair, writing.

The second patient was not even able to write a note. At 39, she lay dying in the intensive-care unit, waiting for a donated liver. When I last saw her, she had a couple of days left, at best. Later I learned she had been given a new liver and was alive and well.

Liver, heart and kidney transplants are no longer experimental procedures. They are tried and true medical interventions - our closest thing to miracle cures. Most patients do very well for years after surgery and would have died without it.

Unfortunately, not enough donated organs are available. There are always twice as many people on waiting lists as there are organs. Every year, hundreds of patients on the lists die.

It is illegal to pay the families of organ donors. The 1984 federal ban on payment arose out of fear that a black market for organs would be created. The system for obtaining organs was just being started. Today, the source of every implanted organ is fully documented.

With transplants common, the law should be overturned. We should allow payments to families - strictly as an honorarium to pay for the donor's funeral.

Critics say payment would be unethical. Some fear that only the rich could buy organs and that the poor would not easily get them. That would not be the case. Organs would still be allocated based strictly on the severity of the patient's disease.

Suppose someone, for religious or personal reasons, does not want to donate an organ. That preference can be expressed in a document earlier in life or when entering the hospital or by rejecting the donors' option listed on drivers' licenses.

Unfortunately, an honorarium may feed greed. For many, the cost of a funeral is prohibitive, and they may wish to override the preference of the deceased.

In cases of family disagreement, who would decide? The next of kin or the person or people with a durable power of attorney. If the family simply cannot agree, the procedure should be avoided.

With more organs available, there would be more - and less-expensive - tranplants.

Who would pay the honorarium? Let the marketplace decide. The main candidates would be insurance companies, managed-care plans and hospitals, which want to keep costs down. Perhaps recipients could voluntarily pay into a pool that would be given to donor families.

The bottom line is that a funeral honorarium is better than a funeral.