Would you donate your kidney if you were paid $10,000? A new Canadian study says that people may be more likely to donate an organ if they were reimbursed financially, even though the transaction would no longer be considered a donation.
Dr. Braden Manns, a professor of nephrology at the University of Calgary and lead author of the study, told NBC News that there is a shortage of organ donors. “We need to figure out how to solve that problem," he said in an interview. "We shouldn’t throw out, out of hand, solutions that could increase donations.”
The solution in question is that of providing financial incentives, money that would be provided by an independent third party such as Canadian Blood Services. It’s currently a hotly debated issue: Is it ethical or even practical to offer money to living organ donors?
Is Paying For Kidneys Practical?
Manns and his team of researchers wanted to see if financial incentives could save money over the current system, which relies solely on altruism. Currently, people whose kidneys have failed are placed on dialysis, the artificial process of eliminating waste and water from the blood: a process that does what a healthy kidney normally does. Keeping a patient on dialysis long-term can be costly, for both payers and patients. According to the NIH’s National Kidney and Urologic Diseases Information Clearinghouse, costs for end stage renal disease (ESRD) patients were over $40 billion in public and private funds in 2009. Dialysis usually requires three sessions a week of being hooked up to a dialysis machine for hours. This time-consuming process must be done for the rest of a patient's life or, if they are lucky, until they get a new kidney.
Assuming that kidney donations were boosted by 5 percent due to the incentive, the researchers found that paying living kidney donors $10,000 each saved around $340 per patient when compared with the cost of long-term dialysis. They also analyzed it in terms of quality-adjusted life years, or QALY, which is a form of measurement used to define whether a medical intervention would improve a patient’s life by a lot or a little. They found that the QALY score would be boosted by 0.11.
However, if a financial incentive boosted donations up to 10 or 20 percent, the cost savings would be much higher, between $1,600 and $4,000 per patient. Thus they concluded that the practice could be a “substantial gain” for those getting the transplant, as well as an overall system-wide gain.
The Bigger Question: Is Paying For Kidneys Ethical?
There are some 98,000 people waiting for kidneys in the U.S., according to the Organ Procurement and Transplantation Network (OPTN), and last year more than 4,500 Americans died while waiting for a kidney. As the number of kidney donors has dropped in recent years, researchers have searched for ways to increase donations. This isn’t the first time they have turned to the market in the hopes of money solving the problem; doctors, ethical experts, lawyers, and economists have debated the issue for decades.
A 2012 survey revealed that the general population in Canada would be more likely to provide a kidney if they were paid. But adding financial incentives would cause an upheaval in the current system based on altruism, which has been in place since the 1960s and 70s. “Because the concept of financial incentives fundamentally changes the process of organ procurement,” a 1993 report by OPTN and the United Network for Organ Sharing stated, “it has been argued that the term ‘donor’ is no longer applicable and would need to be replaced by a term such as ‘vendor.’”
There are a number of people who oppose the idea of selling body parts. “Sometimes these things have unintended consequences,” Dr. Stephen Pastan, a board member for the National Kidney Foundation, told NBC News. “If we paid $10,000, a lot of altruistic donors would say that it’s just a cash transaction. Donations could go down.”
Art Caplan, director of the Division of Medical Ethics at New York University Langone Medical Center, wrote on NBC News Opinion that paying someone for their kidneys may not work, because $10,000 would probably not be enough to spur someone to go through the dangerous process of having their kidney removed. “Kidney surgery is still major surgery, living with one kidney is a bit risky and there is a very real danger of various complications,” he wrote. “While they won’t kill you, the problems could keep you in the hospital for days or weeks.”
A 2010 study completed by a University of Pennsylvania bioethics expert named Scott Halpern, however, claimed that the offer of money “did not cloud a person’s judgment” with regard to the risks involved with a kidney removal. Financial incentives also did not necessarily boost the number of poorer people to sell a kidney, which has been a concern in the debate, and it didn’t overcome people’s altruistic motivation to donate, the study said.
For an idea of what a kidney market would look like, one can turn to international examples. Iran is the only country in the world where organ sales are legal, and resultantly hospitals have been described as "kidney eBays." Despite a ban on organ sales in India, many indigent people are desperate to sell their kidneys for cash. Among live donors, women outnumber men, since they are traditionally expected to sacrifice their organs.
“There is more than money involved when it comes to body parts, and until proponents of payment can engage those concerns, it is not likely that we will see a shift from academic talk to political action,” Caplan writes.