There are roughly 96,000 people on the transplant list for kidneys in the United States. About 4,500 of them will die waiting for a match this year.
Kidney disease is on the rise in the nation. For patients nearing kidney failure, transplants are the best and often only methods of treatment. However, the rate of donations, from both living and deceased donors, has remained relatively unchanged in the last decade.
So how can the U.S. meet the demand for donors? Give people a couple thousand dollars in exchange for their kidneys, suggests a study published last week in the Clinical Journal of the American Society of Nephrology, which focuses on kidney-disease research and patient care.
The idea goes like this: Pay living kidney donors $10,000. The monetary incentive would then increase the number of transplants by 5 percent, which the researchers call a "very conservative estimate." More transplants would mean better patient outcomes. And hospitals and insurance companies would save money on dialysis and other care for now-healthier patients.
Last year, 16,812 kidney transplants were performed in the U.S. Of these, 5,769 came from living donors. A 5 percent increase, applied to these figures, would add about 288 kidney donations a year.
In the study, the researchers used average costs of dialysis and similar care, transplantation and survival rates, and time spent on transplant lists to compare a payment program with typical organ-donation systems. Some of the figures and databases were Canadian, but the researchers say the results hold for the U.S. A hypothetical government or third-party-administered program that paid donors, they argue, would be less costly and more effective than the current American system, which is managed by UNOS, a private, nonprofit organization.
In the U.S., it is illegal for "any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation," under the National Organ Transplant Act. While living donors don't get paid for their kidneys, Medicare or private health insurance does cover the process.
Proponents of legalizing payment for organs point to the generally accepted donation of hair, blood, sperm, and eggs. While these have minimal medical risk for the donor, "it is accepted that they are sold for financial gain," wrote surgeon Amy Friedman in a 2006 study in favor of legalizing payments for living organ donations. Many of these donations come from economically disadvantaged populations, and a hypothetical program that exchanges money for organs runs the same risk of exploiting the most needy.
There have been attempts to at least somewhat compensate living donors for their kidneys. In 2002, a former Sens. Chris Dodd, D-Conn., and Bill Frist, R-Tenn., introduced legislation that would have provided reimbursement for travel expenses for living donors. In 2009, the National Kidney Foundation, a New-York based nonprofit, recommended covering funeral expenses for families who donate a relative's organs. For some, however, even picking up the tab for travel and funeral expenses is going too far, nearing bribery. "You're edging towards financial incentives rather than compensation," one bioethicist told USA Today in 2009.
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