By John A. Schall

Today, the number of Americans in need of an organ transplant is approaching 100,000. Over 70,000 are in need of a kidney. Tragically, an average of seven Americans die every day waiting for an organ that never comes. Certainly, solving America’s organ shortage is taking on new urgency.

Thankfully, Congress passed legislation last December that gives hope to thousands of kidney patients: H.R. 710, the Charlie W. Norwood Living Organ Donation Act. The bill allows paired kidney donations. Success for this legislation is greatly due to the dedication of the late Rep. Charlie Norwood (R-GA) and Rep. Jay Inslee (D-WA), for sponsoring the bill, and Sen. Carl Levin (D-MI) for introducing the companion bill in the Senate. The bill was signed by the President just before Christmas, which was great news. Up to 1,500 additional organs will be available each year thanks to paired donations.

Another piece of legislation is the Living Organ Donor Tax Credit Act of 2007, introduced by Rep. Joe Wilson (R-SC). This bill would amend the Internal Revenue Code and permit a nonrefundable tax credit for a donation of a qualified life-saving organ for transplantation. To ease the price of costs and lost wages incurred by an organ donor, this Act would provide a tax credit of up to $5,000.

The Cato Institute in Washington, D.C., hosted an event this spring titled “Human Organs for Sale?” Featured guest speakers in favor of lifting the current United States’ prohibition on the sale of human organs, were Dr. Arthur Matas, professor of surgery and director of the Kidney Transplant Program at the University of Minnesota, and former president of the American Society of Transplant Surgeons, along with Dr. Benjamin Hippen, transplant nephrologists at the Carolinas Medical Center. They argued compensation for donation would solve the shortage of organs in this country.

Dr. Matas presented his current Cato study, “A Gift of Life Deserves Compensation,” where he described the current kidney shortage and provided a solution to the problem. He explained the solution would be a regulated organ market. This model would be created by using the existing models for living and deceased organ procurement and allocation, then adding a fixed payment to donors by the government or government-approved agency, according to Dr. Matas. Current bans on private sales would remain.

Dr. Matas explained compensation for the donor could be made in a variety of ways. Compensation may be in the form of fixed payment, long-term health insurance, college tuition, tax deductions and/or some combination of these. Dr. Matas notes the donor cannot come from other countries to be compensated. This would only be allowed if it were possible to make certain that if and when the donor returned to their country, they would receive long-term healthcare and follow-ups.

Dr. Matas claims there are only three options for patients with end-stage renal disease (ESRD): dialysis, kidney transplant or no treatment, which would lead to death. It is known dialysis is needed for patients who have developed ESRD. However, it is extremely expensive and more expensive than a transplant. So, the regulated organ market is deemed by Dr. Matas to save taxpayers money. In his study, Dr. Matas estimates kidney transplants save Medicare about $95,000 in addition to the health benefits to patients. To quote Dr. Matas, “compensated donation would increase the number of kidneys available for transplants, thereby shortening waiting time, improving patient survival rates and minimizing suffering on dialysis.”

To further support the argument of donation compensation, Dr. Benjamin E. Hippen presented his observations of why Iran is the sole country without an organ shortage. In contrast to the United States, where more than 70,000 people are on the waiting list for a kidney transplant, Iran has no waiting list. Iran has no waiting list due to the fact Iran legalized organ vending years ago.

According to Dr. Hippen, the procurement system in Iran is highly standardized. Organ vendors (donors) receive payment in two ways. The first is a fixed compensation to the vendor of roughly $1,200 plus limited health coverage. The limited healthcare would extend to one year after the transplant and covers only conditions deemed related to the surgery. The second way is a separate reward either from the recipient, or if the recipient is impoverished, payment from a series of designated charitable organizations, usually in an amount between $2,300 and $4,500. In contrast to Dr. Matas’ model, the Iranian model does not allow non-citizens to participate in the exchange, whether donor or recipient. For the past eight years, Iran has had no waiting list for kidneys.

The views of both Drs. Matas and Hippen are not without opposition. Dr. Francis L. Delmonico, professor of surgery at Harvard Medical School and director of Medical Affairs for the Transplant Society, spoke out against compensated donation. Dr. Matas, along with Dr. Delmonico were featured in the Wall Street Journal article, “Kidney Shortage Inspires a Radical Idea: Organ Sales.” The two friends are well known for their strong positions. To further dispute compensated donation, Samuel Crowe, senior policy analyst for the President’s Council on Bioethics, spoke. Dr. Delmonico and Crowe argued markets would cause more harm than good.

Dr. Delmonico argued research from a World Health Organization (WHO) report in 2007, showed most paid kidney donors were motivated by poverty, and the economic benefit after is limited or negative. This market would create a system in which the poor become the targeted donors. In “The Opposition of the Transplantation Society and the World Health Organization to Organ Trafficking and Markets of Organ Sales,” Dr. Delmonico writes, “it is the use of the vendor source that is not benefited in the long term by the sale. The destitute individual remains poor and with one less kidney.”

Another argument Dr. Delmonico offers is kidney sales will substantially reduce the number of deceased organ donors available. Instead of creating a market, Dr. Delmonico offered the proposal of comprehensive reimbursement or replacement of costs, which would be provided by governmental or other designated authorities. Also, this proposal would provide physical and psychological health for the donor. Samuel Crowe spoke against the idea of compensated donation. The strongest argument put forth by Crowe was the idea of a market inviting humans, “to see the body-and thus the self-as a mere thing, like any other commodity or natural resource.” He argued selling organs would hurt society and human “dignity.”

The Cato event was very illuminating for the future of organ donations. Sadly, the truth is people are dying while on the list awaiting a kidney. A call for action is a must. The idea of compensated donation is part of the policy debate on the future of kidney transplants and could bring hope to the tens of thousands of people currently on the waiting list.

John A. Schall, MPP, is a vice president at Jefferson Government Relations in Washington, D.C.

This article originally appeared in the May 2008 issue of aakpRENALIFE.

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