How Much is your Kidney Worth? How about $14,200

June 18,2011 (republished from 2/26/08)

how Much is Your Kidney Worth ? How About $14,200                                      

Should Selling of Kidneys Be Allowed?

John Schieszer

Economic analysis supports the idea, but critics say the practice would exploit low-income people

THE ABILITY to purchase organs from live donors could largely eliminate transplant waiting times and only modestly increase total transplantation costs, according to a newly published economic analysis.

The analysis suggests that healthy young donors in an economy like that in the United States—which place them at low-risk for post-surgical death—would sell a kidney or a portion of a liver at prices that would drastically increase the number of those organs available for transplantation and increase transplantation costs by only 12%.

In a study published in the Journal of Economic Perspectives (2007;21:3-24), economists Julio Elias, PhD, of the State University of New York at Buffalo (SUNY Buffalo) and Gary Becker, PhD, of the University of Chicago argue that the use of monetary incentives could increase the supply of organs for transplant sufficiently to eliminate the very long waiting times. They say this approach could eliminate the suffering and deaths of many of those individuals waiting for a kidney without increasing the total costs of transplant surgery by a large percentage.

Putting kidneys and other organs on the market may seem like a proposal straight from the cold heart of a free-market economist, but Dr. Elias does not see it that way. He notes that 18 Americans die every day—more than 6,500 a year—awaiting transplants, according to the United Network for Organ Sharing. “When an economist sees a persistent gap between supply and demand, as in the demand for and supply of organs for transplant, the next step is usually to look for the obstacles to market equilibrium,” said Dr. Elias, an assistant professor of economics. “In the case of the market for transplantable organs, the obstacles are obvious. Very few countries allow the use of monetary incentives to acquire organs from either living donors or cadavers.” Those few countries include Iran, starting in 1988. India had allowed payment for organs in the 1980s and early 1990s, but today it is not legal, Dr. Elias observes.

Although previous authors have discussed using monetary incentives to increase cadaveric organ do-nations, Drs. Elias and Becker stress the potential for obtaining more kidneys from living persons. This approach, they argue, would in several respects be less subject to abuse and corruption than harvesting cadaveric organs.

The researchers say donating an organ for transplantation may affect a person's quality of life, risk of mortality and the ability “to perform market and non-market activities for some period of time after the surgery.” Building on the value of statistical life, a measure that summarizes tradeoffs between monetary wealth and fatal safety risks, and other parts of economic analysis, the authors compute how much additional income or market consumption a person will require to be indifferent as to the question of selling an organ or not.

Their analysis suggests that in the united states , a payment of $15,200 per kidney, as a case in point, to a healthy live donor would significantly increase the pool of transplantable kidneys and eliminate the large numbers of people on waiting lists. In the United States, nearly 74,000 people were on a kidney transplant wait list by the end of 2007, up from about 17,000 in 1990, Dr. Elias notes.

Payment for organs—whether from the living or cadavers—has been widely criticized on several grounds, among them the immorality of commodifying body parts, the likelihood that the poor would be the most likely people to step forward to sell an organ, and the possibility of reckless or impulsive donations. The au-thors argue, however, that paying for organs that save lives is no less moral than paying surrogate mothers for the use of their wombs or paying market wages to attract an army, which they note commodifies a recruit's entire body.

The economists say the organs of low-income persons who are sick are likely to be rejected, so live donors would likely come from among the healthy poor and middle classes. They argue that poor individuals should not be deprived of revenue that could be highly useful to them, especially when their organs might save the lives of persons who are in desperate need. Drs. Elias and Becker say reckless or impulsive donations can be mitigated by requiring that donors be given written and verbal information about the risks posed by the surgery as well as afterwards. They also should be given a “cooling off” period that is long enough for potential donors to seriously consider their decisions, according to the authors.

Based on reactions to their paper, Dr. Elias says his impression is that older physicians disfavor the idea of allowing payments for organs, but younger physicians seem to be more amenable to the concept. “We have this problem of too many people waiting [for organs] and a lot of people dying while on the waiting list. And the problem is increasing. I think at some point this idea will be accepted.”

Not so fast

James DuBois, PhD, professor of health-care ethics at St. Louis University School of Medicine, is against any kind of direct payment for any living donation for several reasons. Dr. DuBois served on an Institute of Medicine committee that studied the dollars-for-donors idea and voted against any selling of organs. The committee issued a report in 2006.



“When you start paying living donors you see significant decrease in deceased donation, which is a shame because deceased donation poses no risk to donors,” Dr. DuBois said. In Iran, where payments for living organ donation are legal and common, deceased donation of kidneys was less than 1% in 2002, he noted.



His other major concern is exploitation. In Iran and India, it is almost exclusively the poor and unemployed who donate. In China, as in the United States, a disproportionate number of living women donate organs, and men are far more likely to be organ recipients than women.



A study of kidney donors in Iran, which was published in 2001, found that of 100 donors interviewed, 84% lacked full-time work, 93% had no health insurance, and 83% did it just for the money. In addition, 85% of donors said they would not do it again. “These data reinforce my fear that payments for living donation would become exploitative,” Dr. DuBois said.

Rocco Venuto, MD, professor of medicine at SUNY Buffalo and medical director of transplantation at an affiliated hospital, agrees with Dr. DuBois. “When [organ donation] is driven by money and not altruism then there is a problem that it is never going to be fair for people with less money,” Dr. Venuto said. “The human cost of giving up an organ has no price. A certain number of donors are going to die.”

However, both Dr. Venuto and Dr. DuBois support the idea of compensating living donors for their costs. They say a better way of addressing this problem is not direct payment to donors, but instead eliminating barriers to donation. They advocate tax deductions and compensation for travel and lost work.

“Tax breaks are good. I don't think the person should end up a nickel richer, but they should also not have to pay all the bills,” Dr. Venuto said. “The system is set up so that your insurance covers your sister's testing, but there is no system to help her with lost wages or travel costs and lost time. Some people have lost their insurance after becoming kidney donors, so we have a series of practical issues that we need to address to enhance the system in connecting people who are motivated to donate out of altruism and not money.”
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