...With Functioning Kidneys for All

[Clark]

http://www.theatlantic.com/magazine/archive/2009/07/with-functioning-kidneys-for-all/7587/

...With Functioning Kidneys for All
Surely we can find enough kidney donors for those who need transplants. But doing so will require creativity, boldness, and a sense of urgency—and experimenting with controversial ideas like donor chains and financial incentives.

By VIRGINIA POSTREL

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Eliminating the waiting list would thus save taxpayers $8 billion, or $4 billion if each living donor received a lump-sum payment of $50,000.

That purely financial estimate ignores the enormous benefits for the patients’ quality of life, of course. It also excludes the economic gains from returning to productive work—only about 10 percent of dialysis patients are employed even part-time—and the fiscal effects of paying taxes rather than receiving disability payments.

Registries and chains provide a model for how an above-board market in kidneys might develop, protecting the interests of both donors and recipients. Just as the National Kidney Registry initially screens nondirected altruistic donors, a central organization could do the same for prospective kidney vendors. Those who qualified would be referred to local transplant centers for full medical and psychological testing, after which they could be matched with the recipients—and possibly chains—for whom they were best suited. Unlike volunteers, vendors would not get to choose their recipients, giving everyone in need of a kidney a fair shot. Payment would come not from individual recipients but, as for the rest of the transplant process, through normal insurance (including Medicare) at standard rates.

Such proposals, of course, attract vehement opposition from people who fear that financial incentives would squeeze out unpaid donors, entice the poor into bad medical choices, or “cheapen the gift.” Some volunteers would undoubtedly drop out, relieved to let someone else provide their loved one’s new kidney. But real incentives, rather than token rewards, would produce a net increase in the number of transplants. Giving a kidney to a relative or friend could still speed up the process, providing an incentive to do so but relieving such donors of any sense of emotional blackmail.

A well-designed system could address the concerns about donor welfare by including educational programs, waiting periods, and follow-up care for donors, and possibly by allocating the payments over time rather than offering immediate cash. As for “cheapening” donation, Matas notes the importance of attitude. “We need to create a culture of dignity. There are many people who want to do this, and the incentive would push them over the edge,” he says. “The message should be, ‘We can compensate you but never repay you.’”

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