Compensation for kidneys would help the poor

A government program that would provide market-value, noncash compensation to living kidney donors would benefit low-income people and not be exploitative, according to a new study by researchers at Stanford Medicine and other institutions.

Such a program could also end the national shortage of kidneys for transplantation. Each year, about 9,000 people are removed from the kidney transplant waiting list because they die before they are matched with a donor or become too sick to undergo the operation.

“There are lots and lots of people dying whose lives could be saved by increasing the supply of kidneys,” Philip Held, PhD, an adjunct lecturer in nephrology at Stanford, told me. “And many of the people who could be saved are poor.”

Held shares lead authorship of the study, published today in PLOS ONE, with Frank McCormick, PhD, a former vice president and director of U.S. economic research with Bank of America. Together, they’ve spent much time exploring the economics and implications of the U.S. system for kidney donation, including in an editorial about the shortage that recently appeared in the Journal of the American Society of Nephrology.

The United States currently prohibits the sale of kidneys, and a major concern about changing the law is that people with low incomes would be more likely to sell their organs. Poor people are under-represented as kidney transplant recipients: they account for 34 percent of patients newly diagnosed with end-stage kidney disease, but they receive just 6 percent of the nation’s kidney transplants, according to the study. Some ethicists worry that with compensation for kidneys, poor people would donate kidneys in disproportionate numbers and affluent people would receive them disproportionately.

To determine whether people with low incomes would be exploited by such a system, Held and McCormick’s new study compared estimates of the total fair-market value of kidneys that would be donated by the poor with the value poor people would receive through transplants.

They estimated the market value of a donated kidney to be $75,000, based on the price that Medicare pays organ-procurement organizations and adjusting for factors, such as the longer duration of a transplant from a living donor. The total value of kidney transplantation to a single recipient was estimated to be $1.3 million, accounting for additional years of healthy life and assuming recipients would be able to obtain two transplants on average, replacing a donated kidney with a second one if the first stops functioning.

The study’s calculations showed a positive net benefit, in monetary terms, of $12.4 billion for low-income people overall.

The researchers also calculated that the number of transplants per year would increase from 17,500 to 31,000 — enough to supply kidneys for yearly additions to the wait list. With the increased supply, the proportion of transplant recipients who are poor — defined in this study as adults without a high school diploma — would rise from 6 percent to 30 percent.

“It’s not only valuable to that person who is so fortunate to receive the transplant,” Held told me, “but it’s also valuable in a lot of ways to our society, in terms of equalizing access for the poor.”

Currently, poor people are less likely to be added to the transplant waiting list, in part because they tend to be less healthy and have worse prospects for a successful transplant. It is also more difficult for poor people to find living donors because their friends and relatives would struggle more with lost wages and other issues associated with organ donation. These problems would be less severe if more kidneys were available, the authors said.

“Today, if you’re a dialysis patient and you’re thinking about a transplant, in most places you’re going to be told you’re going to wait five years, which is longer than most of these people’s life expectancy,” Held said. “The economics in favor of compensation are convincing.”

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