A perfect Rx: Sell a kidney

A perfect Rx: Sell a kidney

BY DR. ARTHUR MATAS

Monday, November 26th 2007, 4:00 AM

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For the first time, a significant number of patients in this country are dying while still waiting for a kidney transplant. Last year, 4,476 patients died while waiting. There were another 1,350 removed from the list because they became too sick. There are currently 75,000 patients waiting.

This is happening because each year there are more new kidney transplant candidates for the waiting list than there are available kidneys. As a consequence, the waiting list, and the resulting wait time for a transplant from a deceased donor, has continued to grow. The average waiting time for a kidney transplant in the United States is approaching five years; in some parts of the country, such as the East Coast, it is closer to 10 years.

It's time for a better plan.

Increasing the number of available kidneys would save lives and minimize the number of patients suffering on dialysis. One way to do this is to allow living donors to sell their kidneys.

Such a system could be established using the infrastructure already in place for deceased donor evaluation and allocation. Critical to such a system would be:

# Payment by the government or private insurance company (no brokers involved)

# A fixed price to the donor

# Allocation of the kidneys by a predefined algorithm similar to that used for deceased donor organs (so that everyone on the list has an opportunity)

# Thorough donor screening evaluation; informed consent; safeguards

# No other living donor commercialization would be legal.

The system would be limited to countries or geographic areas which are willing to provide long-term health care, long-term followup and appropriate oversight.

Compensation could include a choice of options: life insurance, health insurance (access to veterans benefits or Medicare), payment for time out of work, a tax deduction, college tuition and/or a direct payment.

Importantly, a kidney transplant is a cost-effective treatment for kidney failure: It is estimated that each kidney transplant saves more than $100,000 compared with keeping the patient on long-term dialysis. Since the government (Medicare) is the primary payer for treatment of kidney failure in the U.S., a system of compensation for donation could be developed without increasing health care costs.

So, if such a system benefits the patient and could be cost-neutral, why aren't we doing it? Under the National Organ Transplant Act (NOTA) enacted by Congress in 1984, compensation for donation is illegal. Before we can establish a system of compensation, or even a trial of such a system, the law must be changed.

In the U.S., we already accept kidney donations from a patient's family and friends. The only difference between these altruistic donations and a compensation plan is the receipt of the money (the donor evaluation, selection criteria and surgery [including the risks] would be the same).

Critics charge that similar systems have not worked elsewhere (for example, India and the Philippines). But it must be noted that these systems were free-market systems (with a broker involved) and without protections for either the seller or the buyer (transplant recipient). One major advantage of establishing a regulated system of compensation in this country is that we could eliminate demand for these unregulated markets (and for "transplant tourism," where patients go to another country to buy a kidney). It is also argued that a huge number of poor people would come forward for the chance to sell their organs. What's wrong with that? We do not prevent the poor from taking other risks for compensation (for example, miners). And it is not illegal for either the rich or poor to take risks that are much greater than kidney donation (smoking, skydiving).

Unless we make dramatic changes in our policies, the tremendous shortage of organs will persist and patients with kidney failure will continue to suffer and die while waiting for a transplant. The risks of establishing a regulated system of paid donation are clearly outweighed by the benefit to our patients.

Matas is director of the kidney transplant program at the University of Minnesota and surgical director of kidney transplants at the Transplant Center in Minneapolis.

http://www.nydailynews.com/opinions/2007/11/26/2007-11-26_a_perfect_rx_sell_a_kidney.html