Yesterday the Washington Post reported that under kidney transplant proposal, younger patients would get the best organs.  Several conservative talk show hosts and blogs were quick to jump on the article as an indication of a new system of rationing under ObamaCare.  Organs being prioritized to young healthy patients over older sicker patients was an indication that the death panels were on their way.

Like it or not, our current system requires rationing.  Today there are 93,637 people waiting for a kidney alone.  Only about 15,000 organs become available each year for transplant.  Each year around 4,500 patients die waiting for an organ.  And this really only scratches the surface, because it does not include all those who need a kidney, because theirs have failed, but are not listed because they have no chance of obtaining an organ with supplies so low.  Over 500,000 people are currently on dialysis in America today, and last year nearly 90,000 of them died.  That is the true cost of the organ shortage.  When we are talking about such massive loss of life, it seems ridiculous to talk about the financial cost, but with a country running on defecit spending, we are forced to ration our dollars as well.  Dialysis costs $35 Billion dollars a year, most of which is paid by medicare and medicaid.

Studies have shown that the best case scenario for a successful transplant is one that takes place early, before the recipient starts dialysis, and one that is from a living not dead donor.  Studies have shown that even if every potential decease donor who dies in a way that allows donation ends up donating, it is not enough to meet demand.

So to summarize our current system of organ donation:

  • Rationing is a reality.
  • 4500 die on wait list.
  • 90,000 die on dialysis, which would not be needed if kidneys were available.
  • 35 Billion dollars spent each year on dialysis.
  • People must wait years (average is 5 yrs), bodies becoming sicker and weaker, and if a kidney becomes available, the recipient may not have much time left.

Is there a solution?  Yes there is.  A regulated market on Living Kidney Donation.
There is one country that has tried it, and it has been highly successful.   That country is Iran, and it has completely wiped out its waiting list!

I know what your thinking, it just seems wrong, it is icky, makes you a bit queezy.  The question is, does it make you more queezy than the current system, where people are stuck connected to machines, slowly dying, hoping to hold on long enough to get a coveted kidney before their bodies have deteriorated to the point where the kidney is useless.

There are many objections that have been raise by such a system, but I assure you, each objection can be dispelled.

Many objections are to the black market that is present in many third world countries, such as donors not receiving proper care and rich recipients taking advantage of poor donors.  Yes, those are problems with the black market status quo, which could be prevented by a safeguards in a regulated market in a first world medical system.

Another objection is that offering compensation will incite people into taking undo risk that they would not normally take. A very good study done by the University of Pennsylvania has dispelled this concern.

Others say the risk is too high to allow such a thing.  But the risk is actually very low, about the same as having your appendix removed.  It is so low we allow this type of donation already between family members.  But it is true that there is some risk, and when someone does something that is risky, especially when that act saves a life, we tend to compensate them.  Soldiers, police officers, firefighters all face a certain amount of risk while serving to save lives…and they are compensated.  When a living donation does take place, the hospital gets paid, as does the surgeon, the nurses, the custodians, the recipient gets new life, everyone is compensated, except the donor, the person who has the most to lose.

Selling body parts is morbid.  But we already allow it in other situations.  Surrogate motherhood is essentially renting out the womb and poses its own risks as well.  Selling eggs remains legal.  Although the days of paying people for donating blood is over, people still receive compensation in many places for donating blood products such as plasma and platelets.

Another concern is donors developing kidney disease in their remaining kidney.  Kidney disease developing in former donors is actually less than in the general public, likely because they are overall healthier if they have made it through the screening to be a donor.  If they still had both kidenys, they would likely still be in the same position, since a majority of the causes of kidney failure affects both kidneys equally, it doesn’t matter if you have one or two at that point (exceptions would be trauma or rare tumors).  Also, if you are unluckily enough to need a kidney after donating most proposals include placing former donors at the head of the line.  Also remember under this system there is no waiting list, there is an ample supply, there are people waiting to give you a kidney.

The government could compensate donors up to $100,000 and still save money.  It is unlikely to require that amount to bring forward enough donors to completely wipe out the wait list, meaning the savings could be very substantial, while saving lives.

I’m sure there are other objections that can be brought up, but I am confident that each can be solved and such a system could be a huge success, saving billions of dollars and more importantly hundreds of thousands of lives.  I think it is time for a regulated market on living kidney donation.

4 comments
  1. A couple of points to ponder: Many people in kidney failure are already close to death related to other physical problems, making them unlikely to benefit from a transplant. Also, kidney failure can arise from preventable causes. Maybe we should focus more on preventing kidney disease, which is far cheaper than a kidney transplant.

    1. It is true that many people develop kidney failure in the last few days to months of life and would not be medically suitable to undergo a transplant and receiving a kidney would not substantially extend their life so it would be a poor “investment” to provide them a kidney. But I don’t think this describes the majority of those on dialysis.

      I agree that prevention is very important and more should be done on the prevention side of things. It would likely be much cheaper than a transplant. But we are still left with the problem of those who still end up with kidney disease, whether self induced through uncontrolled type two diabetes or hypertension, or those who end up with kidney failure after doing nothing wrong, such as kids with type one diabetes, or those who develop nephropathy from a long list of unpreventable causes. What I am suggesting is developing a system that increases the number of transplants and thereby decreasing the amount of dialysis. Transplant over dialysis provides better quality of life, longer life span, and significant cost savings.

      Vanessa, thanks for the comment and participating in the conversation.

  2. Saying Iran has completely cleared its waiting list is true, but did you find out why? Because they regulate who goes onto the kidney waiting list. There are thousands of people in outlaying areas of Iran who they never allow to go on the transplant list.

    So $100,000 to donors. Wow there will be a lovely long queue of drug addicts alcoholics, those almost bordering suicide because they are so much in debt, it will certainly bring a lot of the wrong people knocking on the door and at what cost to the health people having to vet them all and process them. How many people will try to lie to get through to the final stages?

    Then one of the donors dies or has major complications from the surgery … Oh I can just see the million dollar lawsuits.

    Yes surgeons get paid, I have heard that excuse so many times. If surgeons operated for free how are they going to live? put food on their table, pay their mortgage? Oh yes, they get another job somewhere else that does pay, then in their spare time do kidney operations for free.

    Spend the money on educating people. Getting them to understand how NOT to get diabetes which leads to kidney failure.

    Bit like closing the stable door by paying donors to encourage more. Gives the message to people, hey doesnt matter if we eat ourselves into kidney disease as someone up the road will give me their kidney and someone else will pay them to do that.

    I don’t think so.

    1. “Saying Iran has completely cleared its waiting list is true, but did you find out why? Because they regulate who goes onto the kidney waiting list. There are thousands of people in outlaying areas of Iran who they never allow to go on the transplant list.”

      Do you have a source for this claim? If so, I would love to see it. I’ve read much of the medical literature that has studied their system and have never run across this claim.

      “So $100,000 to donors. Wow there will be a lovely long queue of drug addicts alcoholics, those almost bordering suicide because they are so much in debt, it will certainly bring a lot of the wrong people knocking on the door and at what cost to the health people having to vet them all and process them. How many people will try to lie to get through to the final stages?”

      The 100K figure is the break even figure on making it cost effective, this is actually a low estimate for breaking even, the actual required amount to stimulate enough of supply would likely be much less, and that is were the cost savings come from. I’m sure it will attract both those who would be medically qualified as well as those who would not be. There are safeguards in place to make sure people are medically suitable in the current system when a family member seeks to give to a donor, as there would be in this system as well. The difference is the current system based solely on altruism (and a bit of family guilt as well) does not keep up with the demand, a regulated system with financial compensation could.

      “Then one of the donors dies or has major complications from the surgery … Oh I can just see the million dollar lawsuits.”

      Life is full of risks, as is surgical procedures. The job of the physician is to completely disclose the risks ahead of time, and this process of informed consent would be important under this system, just as it is with any medical procedure.

      “Yes surgeons get paid, I have heard that excuse so many times. If surgeons operated for free how are they going to live? put food on their table, pay their mortgage? Oh yes, they get another job somewhere else that does pay, then in their spare time do kidney operations for free.”

      I’m not suggesting that the surgeons work for free, they should be compensated for what they provide. I’m just arguing that the donor should be compensated for what they provide as well.

      “Spend the money on educating people. Getting them to understand how NOT to get diabetes which leads to kidney failure. Bit like closing the stable door by paying donors to encourage more. Gives the message to people, hey doesnt matter if we eat ourselves into kidney disease as someone up the road will give me their kidney and someone else will pay them to do that.”

      I agree that prevention is very important, but your not suggesting that it is the only thing, are you? We should no longer treat disease? We are already spending a lot of money treating end stage renal failure through dialysis, this would be treating it in a better way, while saving money. And suggesting that everyone who has kidney failure is in that position of their own accord is a pretty ignorant assumption to make.

      “I don’t think so.”

      Your on the record Martyn. Thanks for participating in the discussion, and have a good day.

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