Is it time to compensate kidney donors?

Kidney transplant surgery (Tareq Salahuddin)
Kidney transplant surgery (Tareq Salahuddin)

A recent New York Times blog entry editorialized on the worldwide shortage of transplant kidneys, raising the question of whether it’s time to compensate kidney donors to meet the growing need. The blog echoed the debate that is emerging in the United States among some doctors, medical societies, and groups that oversee organ transplants.

Taboos against paying for transplant organs are powerful. But these may be overcome by necessity, since the demand for transplant kidneys is growing at an alarming rate largely due to kidney failure from diabetes, high blood pressure and obesity-related diseases. According to the National Kidney Foundation, 450,000 Americans are on dialysis and the severe shortage of transplant kidneys in the U.S. results in 12 patient deaths each day.

Laying the groundwork for change, a collaboration of nephrology and finance experts, including Philip J. Held, PhD, a Stanford consulting professor of nephrology, performed a comprehensive cost-benefit analysis of a proposed government program for kidney donor compensation. In a study published last week in the American Journal of Transplantation, the authors estimate the shortage of transplant kidneys would be eliminated within five years if the government compensates living kidney donors $45,000 and the estates of deceased donors $10,000. The proposed compensation would also include an insurance policy against any health problems that might result from the donation.

The authors’ analysis shows that the benefits of a donor compensation program would greatly exceed the costs for society in general and taxpayers in particular. The researchers calculate the monetary value of a longer and healthier life for each kidney recipient at $1.3 million, with the added bonus of saving $1.5 million for not needing expensive dialysis treatments. After subtracting from these benefits the cost of transplants, society would enjoy a net welfare gain of $1.9 million over the lifetime of each kidney recipient. Since taxpayers currently pay about 75 percent of the cost of both dialysis and kidney transplants, this represents a taxpayer savings of about $400,000 per kidney recipient.

One of the main arguments against kidney donor compensation is that rich people would buy kidneys from poor people, exploiting them and causing them harm. The authors argue that the opposite is true because the poor, especially poor African Americans, are overrepresented on the kidney waiting list – so they would enjoy the greatest benefit.

The researchers summarized their findings in a press release supplied to our office:

“In sum, having the government compensate kidney donors would be a win-win-win situation. Kidney recipients would enjoy much longer and healthier lives. Kidney donors would receive compensation for their gift of life, whereas now they receive nothing. And taxpayers would save money because transplantation is not only a more effective treatment for kidney failure than dialysis, it is a much less expensive one.”

This is a repost of my Scope blog story, courtesy of Stanford School of Medicine.

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