A Gift of Life Deserves Compensation: How to Increase Living Kidney Donation with Realistic Incentives

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Treatment for end‐​stage renal (kidney) disease(ESRD) is the only government‐​funded health carein the United States that has no financial need‐ orage‐​based criteria; inclusion in the program(Medicare) is solely based on diagnosis. If a personhas ESRD, treatment is covered by Medicare. Noother criteria must be met, but the best treatmentoption, a transplant, is not available for mostpatients. Compared with dialysis, a kidney transplantsignificantly prolongs life and improvesquality of life, but kidneys are scarce in large partbecause federal law prohibits the buying and sellingof organs. The average waiting time for a kidneytransplant in the United States approaches 5years; in some parts of the country, it is closer to 10years. A significant number of transplant candidatesdie while waiting for an altruistic donationthat never comes. Allowing the sale of kidneysfrom living donors would greatly increase the supplyof kidneys and thereby save lives and minimizethe number of patients suffering on dialysis.

The National Organ Transplant Act of 1984 waspassed to, among other things, prohibit the sale oforgans in the face of apprehension that the growingcommercialization of medicine would result inhuman beings being treated as commodities ratherthan individuals. Whether such concerns were wellfounded or not, the act was clearly overbroad in itsprohibition of the sale of organs. It’s time to loosenthose restrictions in order to save lives. The best wayto increase the supply of kidneys without drasticallychanging the existing allocation system is tolegalize a regulated system of compensation for livingkidney donors. Such a system could be establishedusing the infrastructure already in place forevaluating deceased donors and allocating theirorgans. The only change required to ease and probablyeven solve the organ shortage is some form ofpayment for donors.

The potential practical and theoretical concernswith compensated donation can be overcome,and alternative proposals will not doenough to solve the shortage. Upon careful analysis,it is clear that the benefits of a regulated systemof compensated donation (chiefly, increasing thenumber of donated kidneys) outweigh any risks.

Arthur J. Matas

Arthur J. Matas, MD, is professor of surgery and director of the kidney transplant program at the University of Minnesota. Dr. Matas has been a practicing transplant surgeon for more than 25 years and is the immediate past president of the American Society of Transplant Surgeons.