Financial Incentives for Kidney Donations?

Recently, the United States reached a grim medical milestone: over 100,000 Americans now wait for a new kidney, liver, heart or lungs. Sadly, this comes as no surprise. Ever since the first successful organ transplant took place half a century ago, there have never been enough organs available to those who need them.

Over three-fourths of those on the national list are people waiting for a kidney: that’s 75,000 patients in need of a kidney transplant today. Only one in four of those on the list will get a kidney transplant this year. The rest will languish on dialysis until their names crawl to the top of the list – an ordeal that can take five to eight years in some areas of the country. That means, tragically, every day 11 people die waiting for a kidney that never arrives. These patients were healthy enough to benefit from a transplant when they were first placed on the list. But because no friend or relative was ready, willing or able to donate a kidney (a healthy person can live a perfectly good life with just one of his two kidneys), the patients had to wait their turn for an organ from someone who died.

Last year 6,306 friends and relatives donated a kidney to a loved one – the lowest number since 2000. We all should be thankful for these wonderful donors, but unfortunately there are just not enough of them to go around.

And despite decades of public education about the virtues of donating organs after death, only half of all Americans have designated themselves as donors on their drivers’ licenses. Moreover, if family members are unaware of a loved one’s preference, they often deny permission for the organs to be taken. And so the waiting list grows ever longer.

That’s why some experts think we need to alter our thinking about organ donations and allow financial incentives to help increase the number of organ donors. Dr. Sally Satel of the American Enterprise Institute, a kidney transplant recipient herself, and Dr. Benjamin Hippen, a nephrologist who serves on the ethics committee of the United Network for Organ Sharing (UNOS), believe the government should devise a safe, regulated system in which would-be donors are offered incentives to donate a kidney.

The idea is admittedly not a new one, but it may be an idea whose time has come. Such a proposal allows for some creative solutions. A financial incentive need not necessarily be a cash payment, but a material reward of some kind that makes it easier for people to become organ donors. For example, a donor could receive something as simple as lifelong health insurance.

The most efficient plan would be for states to implement their own creative ways of giving a combination of incentives to donors: tax credits, tuition vouchers or a contribution to a tax-free retirement account.

As Dr. Satel emphasizes, it would not be the sick person who reaches into his own bank account to reward the donor, but the government who provides compensation. That way, everyone in need of a kidney would benefit. And in keeping with the current system for distribution of organs, the kidney would go to the next person in line – not just someone who happens to be wealthy enough to pay for it.

Potential donors would receive education, undergo careful medical and psychological screening, and receive quality follow-up care. This is important because many critics say such a system would merely exploit poor donors in desperate need of financial help. But a meticulous months-long screening process and a non-cash reward can greatly eliminate that danger.

Such an approach has attracted the interest of at least one major policymaker in Washington: Senator Arlen Specter (R-PA). Specter wants legislation to revise the 1984 National Organ Transplant Act so it is no longer a felony for donors to receive compensation. This would clear the way for pilot studies of incentives. In the 1990s, Specter’s home state of Pennsylvania tried to give funeral benefits to families of organ donors but ran afoul of the national 1984 law.

Financial incentives are certainly not the entire answer; and they will not guarantee an organ to every patient who needs one. But together with existing altruistic donations and paired kidney donations (allowed by law late last year), financial incentives could make a large difference in the lives of the 100,000 Americans on the waiting list today.

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

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

  • Written by: John Schall, MMP

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