Need a Kidney? Not Iranian? You’ll Wait.

[Clark]

http://opinionator.blogs.nytimes.com/2015/07/31/need-a-kidney-not-iranian-youll-wait/?&_r=0


Need a Kidney? Not Iranian? You’ll Wait.
By TINA ROSENBERG

First of two articles

Last year in the United States, more than 4,000 people died while on the waiting list for a new kidney. An additional 3,600 people left the list when they became too sick for a transplant.The kidney shortage is a global problem. The world’s need for kidneys is growing alarmingly — largely because kidney failure is one consequence of diabetes and high blood pressure. Yet the supply has barely increased. In 2014, there were 17,106 kidney transplants in the United States, but more than twice that many people went on the waiting list.

In every country that does transplants — except one — patients have two legal ways to get a new kidney. One is to have a friend or relative who is a blood and tissue match donate a kidney. The other is to get on the waiting list for a deceased donor. In America, the average time on that list varies from 3 years to 10, depending on geography, blood type and other factors. Patients can’t even get on the list until they are about to start dialysis, and the average life span of someone who starts dialysis is only 5 to 10 years. Six years ago, the list had 77,000 names. Now it has more than 100,000. Other issues: Dialysis in America costs $80,000 per year. And the longer a patient spends on dialysis before getting a transplant, the greater the chances of complications and death with a new kidney.“If you’re looking at a country that offers dialysis that has a well-supported, sophisticated health care system, in all those countries there’s a significant wait for a kidney,” said Philip O’Connell, the president of the Transplantation Society, a global organization affiliated with the World Health Organization. “That will always be the case, unfortunately.”It is not the case, however, in Iran. There, people wait to donate a kidney. That’s because donors are paid.

...

[Clark]

How many times must we say it? Donors give, sellers sell.

[Clark]

http://opinionator.blogs.nytimes.com/2015/08/07/its-time-to-compensate-kidney-donors/?_r=0


It’s Time to Compensate Kidney Donors
By TINA ROSENBERG


[Singing the same old song. Staggering ignorance.]

[KidneyHelpPLEASE]

They compensate blood plasma donors and used to compensate bone marrow donors so why not kidney donors?

[Clark]

The nominal compensation for plasma donors is for manufacture of a product category that is not for transplantation/transfusion. Even so, it skates close to the edge of acceptability as nominal compensation for time, inconvenience and discomfort, not for the donated plasma. This is the argument for nominal compensation for egg donors, too, that it's for their time and discomfort, not the egg(s). This thin legal fig leaf rises to be challenged from time to time when procurers make the valuable consideration valuable instead of nominal.


Marrow donors are not compensated, even nominally. A recent court decision distinguished peripheral blood stem cell donors as not marrow donors, and therefore not necessarily covered by the NOTA. This transplantable tissue is still regulated by the FDA, CDC, and the CBER, so nominal compensation for time and discomfort is the maximum allowed.


Propose an institutional framework of compensation with unambiguous professional financial incentives to improve the dignified treatment of donor candidates and donors, and remove the extant structures that incentivize volume over all, with neither true informed consent nor statistically valid long term longitudinal followup studies and care, and we have the merest beginning of a potential conversation. Without that minimal basis, you're singing the old song, and sellers are sellers, not donors.

[KidneyHelpPLEASE]

I've even spoken to doctors and they agree it could work if you offered a flat fee of let's say $5K to donate a kidney. There are TENS of millions of people below the poverty line so $5K is very enticing for many people.

You would still have the same rigorous testing and no one is paid till after the transplant. You could even strengthen the qualification standards to make sure people don't lie. But it's a win-win situation that would reduce the waiting list from 100,000 to almost ZERO!

[Fr Pat]

     One possible problem if people in need of money were paid $5,000 to sell their kidney: Would this cause a decrease in the number of family members and friends who offer to donate a kidney? If I were in need of a kidney I might tell a willing family member NOT to donate to me, because rather than put a loved one at risk from the surgery and complications I would prefer to buy one from a stranger. An increase in people selling their kidneys might result in a decrease in people willing to give a kidney to a loved one.
     Fr. Pat

[KidneyHelpPLEASE]

Maybe but as long as they get a healthy kidney why does it matter? It's NOT a huge advantage. I was a perfect match from my sister but it only lasted 5 years. Even cadavers last longer!

[Clark]

You don't provide what I said was a prerequisite for even considering this. Saying unnamed doctors say a given number of dollars will coerce enough poverty stricken people to come forward to provide a viable organ to every patient in need, when in need, is specious. This doesn't address these sellers' well being in any particular. As Fr Pat noted, multiple studies, and the evidence of the changes in the lung allocation algorithm suggest that significant increases in supply from other sources depresses supply from living donors. This is ample evidence to demonstrate that becoming a living donor candidate and successfully donating is a significant hurdle for us all, a cup we would let pass if we did feel compelled to drink. Finally, the number of donor candidates coming forward is not even the most significant constraint on volume. Why else are we scheduled for test and surgery dates so far beyond even a generous cooling off period? There aren't enough surgical suites or teams of surgeons to respond to a substantial increase in the number of candidates for transplant surgery, be they donors or sellers. This is not the simple problem so often argued.