Check Up: Time to consider paying for kidneys?

Posted: November 03, 2013

Paying people to give up their organs is unethical. That's why it's a crime under the National Organ Transplant Act.

Nonetheless, University of Pennsylvania kidney transplant specialist Peter Reese proposes conducting a small, careful test of financial incentives for living kidney donations.

In an editorial, he and Penn medical student Matthew Allen conclude that a real-life experiment is the only way to find out whether ethical concerns can be overcome.

"The time is ripe for new consideration of payments for living kidney donation," they wrote in the current Clinical Journal of the American Society of Nephrology.

Some experts agree. They cite federal data that shows 430,000 Americans are on kidney dialysis this year, 80,000 are awaiting transplants, and 50,000 will die waiting. And the yearly cost for dialysis is triple the cost of treating a transplant patient.

Reese's editorial accompanies a University of Calgary study of a theoretical model of financial incentives. The study found that if paying each kidney donor $10,000 would raise the number of transplants by just 5 percent, the approach would save money (about $340 per transplant) while improving the quality and quantity of life of patients with end-stage kidney disease.

Putting such a model to a real test is impossible without revising the 1984 national transplant law, the cornerstone of the U.S. organ transplant system, Reese said.

Surveys show the public and transplant doctors have little interest in lifting the ban on financial inducements.

But Reese believes that interest would grow if ethical concerns could be allayed.

The editorial laid out those concerns: Money would induce people, especially the poor, to take risks that are otherwise unacceptable. Payments would stifle altruistic motives. And it would degrade the human body, making it a commodity.

But the few studies of incentive impacts don't validate those fears. A study in a state that allows tax deductions for donor-related expenses found the write-offs did not make low-income groups more willing to donate - although it also found no rise in donations, he wrote.

Another study gave participants imaginary scenarios about varying payments and risks. Money for kidney donation did not boost their willingness to take risks or motivate poor donors more than wealthier ones.

"Of course, responses to survey scenarios may not reflect how people would actually behave," Reese wrote.

He stressed he is not advocating a payment system, but sees a need for new methods to increase kidney donations. He also sees inconsistencies in the legal system: young women are paid, often handsomely, to go through the physically and psychologically risky process of donating their eggs.

Kidney patients, he said, need to publicize their plight. Those waiting for transplants are "on average, some of poorest and most vulnerable people in the U.S.," he said. "I do worry that this group of patients and their physicians aren't as capable of lobbying for themselves as some other groups. I would love to see" that change.