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Will you need a kidney transplant?

Posted Jan 09 2010 7:51am

Kidney Millions of people suffer from kidney disease, but in 2007 there were just 64,606 kidney-transplant operations in the entire world.

In the U.S. alone, 83,000 people wait on the official kidney-transplant list. But just 16,500 people received a kidney transplant in 2008, while almost 5,000 died waiting for one.  Last year, 3,363 Americans died waiting for a kidney transplant from January to October 2009.

The shortage of organs has increased the use of so-called expanded-criteria organs, or organs that used to be considered unsuitable for transplant. Kidneys donated from people over the age of 60 or from people who had various medical problems are more likely to fail than organs from younger, healthier donors, but they are now being used under the pressure.

Writing in the Journal of Economic Perspectives in 2007, Nobel Laureate economist Gary Becker and Julio Elias estimated that a payment of $15,000 for living donors would alleviate the shortage of kidneys in the U.S. Payment could be made by the federal government to avoid any hint of inequality in kidney allocation.  Moreover, this proposal would save the government money since even with a significant payment, transplant is cheaper than the dialysis that is now paid for by Medicare's End Stage Renal Disease program.

The body can function perfectly well with one kidney so with proper care, kidney donation is a low-risk procedure.  In another sense, it's an ugly failure. Why must we harvest kidneys from the living, when kidneys that could save lives are routinely being buried and burned? A payment of funeral expenses for the gift of life or a discount on driver's license fees for those who sign their organ donor card could increase the supply of organs from deceased donors, saving lives and also alleviating some of the necessity for living donors.

Many people find the idea of paying for organs repugnant but they do accept the ethical foundation of no give, no take—that those who are willing to give should be the first to receive. In addition to satisfying ethical constraints, no give, no take increases the incentive to sign one's organ donor card thereby reducing the shortage. In the U.S.,, a nonprofit network of potential organ donors, is working to implement a similar system.

The world-wide shortage of organs is going to get worse before it gets better, but we do have options. Presumed consent, financial compensation for living and deceased donors and point systems would all increase the supply of transplant organs. Too many people have died already but pressure is mounting for innovation that will save lives.

Source:  The Meat Market by Alex Tabarrok, professor of economics at George Mason University, in The Wall Street Journal, January 9, 2010


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