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Paying Kidney Donors May Be Efficient, But is it Ethical?

Paying Kidney Donors May Be Efficient, But is it Ethical?

Organ donation is the gift of life, and in the case of living donors, it doesn’t have to come at the cost of life. Even with promotion of organ donation, though, shortages are a continuous problem and many patients develop serious complications while waiting for organs — or die before they have a second chance at life. The American Society of Nephrology, one of many medical associations that’s acutely aware of this problem, took a look at this issue and came up with a surprising finding: paying living donors might be the best solution, at least when it comes to kidneys.

The idea of compensating organ donors has long been taboo in the United States. While providing coverage for people during hospitalization is considered acceptable, as they wouldn’t be in the hospital and undergoing surgery if they weren’t offering an organ for someone who needed it, direct compensation is not allowed. The reasons behind this are sound: advocates worry about exploitation, people being pressured into “giving” organs, or the creation of an organ market where organs only went to those who could afford them.

What this study shows, though, is that the current system simply isn’t working. Too many people are living longer with more complex medical conditions, and they need organs. The expense of treating them while they wait and managing the transplant system is high, whereas getting organs where they’re needed improves outcomes and quality of life. Compensation might sound like it would cost the health care system more, even at the relatively low proposed sum of $10,000, but it would save money over the patient’s life. The cost savings represented by improved quality of life are trickier to calculate, but an important part of the equation.

This situation creates quite an ethical conundrum, and it’s sparking lively debate. For one thing, organ donation in the United States tends to be lower than in other nations, and for another, the United Network for Organ Sharing (UNOS) has worked very carefully to develop guidelines for managing organ donation and waiting lists. Some of those guidelines have included respectful collaboration with religious groups to ensure that people of faith can participate freely in donation without fearing that they’re violating religious precepts. Since some faiths bar selling organs (and some religious leaders interpret religious texts as doing so), UNOS could risk losing entire congregations by permitting the compensation of living donors, something that might feel too much like organ sales to some people.

Bioethicists have considerable concern about any donor compensation scheme, although it actually wouldn’t set a precedent: people can already receive funds for donating white blood cells and bone marrow extracted through apheresis. They’re calling for caution and a thorough review to determine if a compensation program would be cost-effective, and what kind of safeguards could be put in place to prevent exploitation and protect patients.

In the meantime, plans to boost organ donation overall in the United States are also important. One of the most obvious solutions is the creation of an opt-out system, like that used in several nations: instead of asking if people want to be donors, the government could presume everyone’s a donor unless informed otherwise. This tactic has radically increased the availability of organs in countries where it’s used, in addition to sparking a conversation about how to make people more aware of the value of organ donation.

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Photo credit: Army Medicine

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54 comments

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10:59AM PST on Nov 4, 2013

Not sure on this issue, appears that being a living donor is not a walk in the park, and no amount of money can be worth destroying your own health. What really bothers me though is that this opens the door to possible abuse, or desperate people selling their organs in order to live , without being aware of the consequences to their own health. Can we be sure that the doctors would tell the whole truth to the donor?




2:35AM PST on Nov 3, 2013

not sure

8:46PM PDT on Nov 2, 2013

I see nothing wrong with a person selling a kidney. If they are otherwise healthy and want to do this, it's their right. The government should not have a say in this. As long as the donor knows the risks involved and is a match it should be allowed. The donor should also have to be a person who is not looking for quick money, but one who just wants to help someone. No homeless or destitute people should be allowed to do this.

3:50PM PDT on Oct 30, 2013

ty

6:35AM PDT on Oct 30, 2013

Thanks.

2:05AM PDT on Oct 30, 2013

I don't know how much it would cost for a kidney in the US...50k, 100k? Then why shouldn't the donor get paid as much as the doctor doing the operation? It's disgusting to see that some people want everyone to get paid...except the donor!

12:58AM PDT on Oct 30, 2013

If someone wants to sell their kidney, to someone who needs it... LET them.
LIFE is what matters.

7:19PM PDT on Oct 29, 2013

noted

5:09PM PDT on Oct 29, 2013

My tattoo would make a nice phone cover. I don't care what all is used as long as I'm dead. Not only did Cheney the tin man get a heart, but Mickey Mantle jumped the line and got an organ that failed. I wonder if either bought their way into heaven? More likely Cheney got a ring side seat in hell. Or is taking over hell.
I didn't know kidney donation while living was so risky. I would chance it for a loved one...total stranger..probably not.

2:56PM PDT on Oct 29, 2013

All analysis from every country that has attempted a legal, illegal, or quasi-legal kidney market has found the paradigm to be beneficial to recipients, doctors, hospitals, and governments. It is however, incredibly detrimental to the person giving up the kidney.

Kidney donors/vendors have more physical problems, increased psychological difficulties, worse financial situations and a lower quality of life.

Secondly, it's been nearly 60 years since the first living kidney donor transplant and we still have no comprehensive short or long-term data on living donors' health and well-being. The US didn't even collect identifying info on living donors until 1993.

Thirdly, donating a kidney is not like a pint of blood.

- According to OPTN, 4.4 living kidney donors died every yr in the US between 2000-2009 in the first year after donation.

- 20% experience complications: hernia, pancreatitis, intestinal blockage, lymph leakage, nerve damage, etc.

- 20-30% experience depression, anxiety, anger, grief, or PTSD. There are no structured support services for living donors in the U.S.

- Since 1993, more than 300 living kidney donors have been wait listed in need of their own kidney transplant. NO, LKDs DO NO GO TO THE "TOP OF THE LIST".


Finally - According to USRDS, the average age of a person diagnosed with end-stage renal disease is 64.4 years old. Based on that alone, the number of folks with ESRD will continue to grow due to the US' aging population.

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