Would You Donate a Kidney for $10,000?

A program that pays people for their organs could help save lives and money. And it may work better than the current U.S. organ-transplant system.

National Journal
Marina Koren
Oct. 28, 2013, 9:38 a.m.

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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