Readers Not Against Paying for Kidneys

Readers Not Against Paying for Kidneys By Chris Kaiser, Cardiology Editor, MedPage Today
Published: August 12, 2011

Eight out of 10 of the respondents to a MedPage Today poll agreed that people should be paid for live-donor kidneys.

But those "Yes" votes did not indicate unqualified approval. One-third of the 1,616 respondents agreed that donors should be paid -- but the payment should only reimburse them for their expenses.

Our question was prompted by a commentary in BMJ arguing for such payments. Author Sue Rabbitt Roff, PhD, a social scientist at Dundee University in Scotland got strong rebukes for her views from the editors of BMJ, from the president of Dundee University, and from leading charities such as the National Kidney Foundation.

Only 19% of respondents to our poll replied with a strong 'No', donors should not be paid.

Riding the Slippery Slope

These types of ethical questions are not always easy to answer, and even respondents in favor of paying for live donations noted that it can be a slippery slope.

"We live in a very desperate world right now, and people will sell anything to have money to feed their families. This question has many levels," wrote one respondent.

"A sticky wicket," another commentator said.

A nurse who said people should be able to sell their own organs if they want expressed concern for an "influx of organs from other countries where organs may have been extracted from unwilling prisoners or victims of 'middle-men' who broker kidneys from the desperate and profit from the transaction."

To other respondents, no means no.

"I do not like the idea that someone gets paid for a body part. I think that is when you get into a real scary place," said one reader, who also worried that wealthier people would jump ahead of sicker people on the transplant list just because they can afford to pay more for a kidney.

"We should not cross the ethical lines, we must avoid organ traffic by all means," said one man.

Another Problem -- Who Will Pay?

Among the 42 voters who chose to comment, many wondered about how the payment process would work.

"If you donate your kidney, does the hospital charge the patient for that donation? The hospital will recoup its money through insurance. So why would it charge for a donation?" asked one reader.

She continued: "I know when my mother died and we donated her body, the hospital notified us of what the donation was used for. Now I wonder if those recipients were charged for our donation. Either way the ethics of charging is really in question here."

One reader said, "It was my understanding that the donor is not charged for medical costs," which could reflect a wider uncertainty about the issue that would first have to be clarified before moving forward with this discussion.

While payment could encourage higher organ donation rates, one reader wrote, "compensation should be in the form of a once-lifetime income tax credit rather than monetary payment. A deceased organ donor should be permitted a full credit and a live donor one-half credit, however the credit is computed. There should never be a direct monetary reimbursement, regardless of method used."

The recipient of a kidney donation said that this complex question "relies on how a paid program is handled and by whom."

Continuing, the recipient suggested the use of a kidney registry of "willing paid donors who are screened and available when their kidney is required. The payment is a tax-free charitable donation from a reliable kidney nonprofit."

One man compared it to the sale of blood, but insisted the government should not pay for live kidney donations.

And still another reader said that if the hospital charges the recipient for the kidney, then "the donor deserves reimbursement, if not, then the cost of the donor's bills should be paid for unless they opt out."

The Future

But what organ regeneration? Several readers mentioned that organ donation will become a "thing of the past" as the technology to commercially develop whole organs from cells advances.

But in the here and now, "what is the going rate on a healthy kidney these days?" asked one woman. She noted that black market kidneys in 2009 were going for $150,000.

And if "the black market for organs is alive and well, it makes good business and medical sense for the free market to be involved."

http://www.medpagetoday.com/PublicHealthPolicy/Ethics/28028