Would you give up a kidney for $50,000? Proposed law sparks debate.

[Clark]

https://www.today.com/health/news/kidney-donation-compensation-rcna173782

Would you give up a kidney for $50,000? Proposed law sparks debate
A person can donate one of their kidneys and live a normal life, but not enough people do it. Would compensation change their mind, and is it ethical?

By A. Pawlowski

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Unlike most other organs, a healthy person can donate one of their kidneys and live a normal life. About one-third of kidney transplants are from living donors.
But not enough people are willing to do it, so there’s an organ shortage. Between 2010 and 2021, more than 100,000 people died while waiting for a kidney or became too sick to receive a transplant, doctors reported in JAMA Surgery.
“It’s a horror that we’ve allowed this to happen,” says Elaine Perlman, executive director of Waitlist Zero, an advocacy group that wants to increase living kidney donation.
“If you’re just repeating the same thing again and again and expecting a different result, that’s nuts.”
The number of Americans who agree to donate a kidney while alive consistently stays at about 6,000 a year, and most give it to someone they love, Perlman says. Only about 300 agree to give it to a stranger.
She’s one of them, donating a kidney in 2020 and calling it an “incredibly rewarding” experience, but also “unpaid work.” Medical expenses are paid by the recipient’s insurance, but the donor must spend time going through tests, surgery and recovery, and deal with out-of-pocket costs.

To get more people to donate, Perlman is urging lawmakers to pass the End Kidney Deaths Act.
The 10-year pilot program would provide an annual $10,000 refundable tax credit for five years — for a total of $50,000 — to living donors who donate a kidney to strangers who’ve been on the waitlist the longest. That means if you owe $10,000 in federal taxes each year, with this tax credit, you’d owe $0.
People who don’t make enough money to pay $10,000 in federal taxes a year would get a check in the amount of the difference over the same time period, Perlman says.
The proposed bipartisan legislation was introduced in the House in August.
“It will work very beautifully for kidney donation. It would just make it easier for people to say yes to donation,” Perlman says.
“The End Kidney Deaths Act is a game changer. It will lead us to a place where no American will die while waiting for a kidney.”
‘Ethically suspicious’
But critics are skeptical it would lead to more kidney donations and are concerned about the ethical implications.
The National Organ Transplant Act of 1984 makes it illegal for living donors to be paid for their organs, other than being reimbursed for expenses.
Tax credits are basically the equivalent of payment — it’s just paying in a way that “raises fewer ethical eyebrows,” says Arthur Caplan, Ph.D., founding head of the division of medical ethics at NYU Grossman School of Medicine.
“It gets to be a little ethically suspicious when somebody says, ‘You can get this tax break and all you have to do is undergo surgery and give up a kidney,’” Caplan tells TODAY.com.
Most people wouldn’t be willing to get an operation and remove an organ for a stranger even for a $50,000 tax break, he adds. Caplan is particularly concerned that low-income Americans would be most tempted.
“So there is an issue about: Are you going to exploit the poor to give up a body part and undergo surgery for money?” Caplan asks.
Perlman calls the notion that low-income Americans would donate against their better judgment if there’s a tax credit “unscientific and paternalistic.” The donation process screens out people who don’t understand the risk and don’t have the support they need, she says.
Perlman also points out compensation already works for people who donate plasma, sperm and eggs, or become pregnancy surrogates.
But a healthy person giving up an organ is a different category because it’s permanent, Caplan says.
“When your kidney comes out, you’re left with one kidney,” he notes, which puts the donor at risk if something goes wrong with it down the road.
In a statement to TODAY.com, the National Kidney Foundation says it has traditionally had “very strong reservations about direct financial incentives that go beyond" reimbursing kidney donors for their expenses, which is what the proposed law would do.
“The potential for unintended consequences is high, such as the exploitation of people who are financially desperate and the potential to turn kidney donation into a profit opportunity,” the foundation says.
It’s monitoring the End Kidney Deaths Act, but hasn't taken a direct position on it for now.
When asked for comment, the American Association of Kidney Patients pointed to a 2023 statement, which expresses concern about any new policies that would involve large financial incentives for organ transplants.
Caplan doesn’t think the proposed law will pass. He believes a better way is to pass a law that would automatically consider everyone an organ donor when they die, unless they opt out.
Meanwhile, Perlman’s dream is to get the End Kidney Deaths Act passed by Thanksgiving.
“It baffles me why we haven’t solved this issue. It’s overdue,” she says.