A group of medical, legal, economics and ethics specialists is proposing a program of limited financial support for kidney donors as a solution to the organ shortage in the United States, where the offer of valuable consideration for a human organ is strictly forbidden.
While the U.S. system of organ donation is beset by an increasing reliance on living donors, expanding waiting lists and longer waiting times, the mortality rates of those waiting increased almost by one-quarter in a recent four-year period, said Robert S. Gaston, M.D., director of medical evaluation and patient treatment for the kidney transplant program at UAB and lead author of the proposal published in the American Journal of Transplantation.
Gaston, who describes the debate over paying for organs as “heated” and “polarized,” expects the compromise proposal will not entirely please advocates of either position but “spark much needed discussion of the issue” between opponents and proponents.
“While offering a financial incentive may be unacceptable, at least we can limit financial disincentives that inhibit many people’s altruistic tendencies to help a friend or relative by donating a kidney,” he said.
Sources estimate out-of-pocket expenses associated with living donation range from $550 to $20,000 and potential donors are concerned about lost time from work, child-care expenses, job security and future health-insurance coverage. The article cites a recent survey that indicates that as many as 40 percent of potential kidney donors ultimately decide not to donate due to financial concerns.
Cost, risk, benefits
The proposal recommends a package of benefits for a live donor that would cost the government between $23,525 and $32,800 per donor and include:
• A one-year, $1 million term-life-insurance policy
• Long-term health insurance to be integrated with other forms of coverage individuals may possess
• Reimbursement of travel expenses and lost wages from missed work, during both evaluation and perioperative phases
• Either a tax deduction of $10,000 or a nontaxable lump-sum payment of $5,000
“Our proposal would expand compensation beyond what is currently accepted by many, but we also would cap the total amount at levels far below what open market advocates would prefer,” Gaston said. “By directly linking compensation to risk, we believe our proposal preserves the essence of kidney donation as a gift and would be implementable in the United States without altering current legal statutes.”
Increased costs of delivering these benefits would be more than offset by savings from decreased use of long-term dialysis, the article stated.
This package would minimize hazards and ensure donor interests are protected before and after the kidney is removed. “Similar programs now are being developed piecemeal in some states, but we maintain that the program should be universal and national in scope, with costs to be assumed by the federal Center for Medicare and Medicaid Services (CMS),” Gaston said.
The proposal also would fund medical follow-up and enable data collection so that long-term risk, until now only estimated, could be accurately assessed. Most donors look back favorably on their choice to donate, Gaston said, but some do not, “especially when perioperative complications occur or the recipient had a bad clinical outcome.”