Kidney Transplants-Private Profits-Socialized Losses

[NDXUFan]

I see two issues being conflated in this thread.  One is the issue for compensating donors.  The other is the issue of exploitation of the poor in less developed countries.

So, to separate the two issues, what is the argument against compensating US donors who are not poor? Iran has eliminated their waiting list by officially compensating donors. No one's complaining about being exploited, there are no middlemen getting rich from the exchange, and the donors are honored and taken care of (free healthcare) afterwards.

What are the objections to that model?  Why should an altruistic donor be expected to bear all the financial burden (lost wages, possible followup care) of donating?

Exactly.......

[NDXUFan]

Not a simple issue my friend. Why compensate the rich? I thought you were against that sort of perk.

Secondly, what rich person will be motivated by a small compensation package? That would not be an incentive to them. Thirdly, there is a real concern that the current altruistic donation system would suffer despite great strides in increasing living donation especially with donation chains.

Thirdly, yes, even here in the US, it would be the poor who would step up to sell kidneys once again broaching the ethical issue of financial coercion of such a system. Whether here in the US or over seas, the same ethical constraints apply. If you are interested, Sally Satel has written extensively promoting this system of payment for organ donation. Fortunately, to date, her efforts have not born any fruit. The hypocrisy of Sally Satel's writings is that she HERSELF had a complete stranger donate a kidney to her. Well, rather a remote acquaintance to put it more correctly. Her donor became her friend when she donated. Yet, despite this amazing altruistic donation, Sally Satel paradoxically is one of the greatest critics of the altruistic donation system in the US.

As an aside, I wrote a critique of one of Satel's articles and the pair of articles became an English writing assignment by a college professor comparing and contrasting the arguments. The kids put their opinions online and it was quit interesting to see how well they understood or didn't understand the issues at hand.

http://www.billpeckham.com/from_the_sharp_end_of_the/2010/04/dsen-goes-to-college.html

Where the real problem exists in our ever increasing burden of renal disease each year. We are quite focussed on the transplant issue when in fact the real problem is the rate of growth in renal patients far outstrips the growing number of donors. Poorly controlled HTN and Diabetes, both potentially treatable or reversible conditions bolstered by our outrageous obesity rates are the real heart of the matter. What many of the proponents of payment for organ donation fail to truly grasp is that even their system could not keep up with the demand for kidneys. If we cannot stem the tide of new or incident patients entering ESRD, then no system we could ever devise will suffice.

For instance, looking at the Iranian system where they claim to have solved the wait list issue, what you don't hear is that it favors males vs females due to their culture and one of the exclusions the last time I looked was age over 50. In addition, Iran is a totalitarian dictatorship without full access to all of their data. Who knows what the real story is vs their propaganda.

In any case, there remain serious ethical obstacles against an organ vendor system in the US and that in my opinion is a good thing.

How can you blame Obesity when the cause of Type II Diabetes is unknown(Mayo and Cleveland Clinics, University of Cincinnati and Indiana University Nephrology). No, I do not trust Iran, it is a thuggish dictatorship of criminals.

[NDXUFan]

Hemodoc, I had been in favor of at least considering the idea of people being able to sell a kidney, but after reading your post, I have changed my mind.  Thank you for a very eloquent argument.

Oh, after 2 years on the list at a Chicago tx hospital, my neph insisted I get listed in Wisconsin which had a shorter waitlist.  I ended up getting my tx in Madison.  It's actually a shorter drive from my house to Madison than it is to Chicago, especially during rush hour.  I am certainly not rich, but it's probably an advantage that I don't live in California.  I didn't know that Steve Jobs went to Memphis.  I wonder how he chose Memphis.  Do they have the shortest wait time in the nation or something?

I guess as long as you have your transplant, who cares, about the other people who are suffering because of hypocrisy?

[NDXUFan]

Here is a recent review of the Iranian system http://www.nature.com/ki/journal/v82/n6/full/ki2012219a.html  the charity gets a donor and a recipient together, and provides them with a room where they can haggle about the price. That's not something I think most people in the US would welcome.

The Iranian system reports limiting donors to those between 18 and 35. It would make more sense to me that donors and recipients should be the same age + or - . A 65 year old should only be able to buy the kidney of another 65 year old. Part of the ick-factor in all this is the idea of an entitled elderly harvesting the kidneys of the desperate young, at least make it ones desperate peers.

But the main issue with the Iranian model is that it is happening in Iran. There is no way to know what is happening behind their theocratic vale. Their incidence rate suggests an age restriction - population ~90 million, ~2,300 transplants and of those transplants how many go to foreigners? It is acknowledged that there is some transplant tourism, that Iran is a Kidney exporter to the Gulf states, but that segment of the Iranian transplant industry is not ever described. Given the need in Iran for hard currency and the ability of Saudis and Kuwaitis to pay, the temptation to sell Iranian kidneys to the highest bidder would be significant. That’s not happening at all?

Each proponent of a kidney market has a very different idea of what it would look like – some imagine people receiving an honorarium and/or a lifetime benefit, some hold the idea that a person ought to be able to do whatever they want with their body – including selling their kidney to the highest bidder. There is a lot of money at stake, if the state limits the price paid to some nominal amount when in fact people are willing to pay hundreds of thousands of dollars there will be corruption. The fact that no corruption is described in the Iranian model suggests a problem with the reporting rather than the virtue of the system.

But really that is all navel gazing. It would be a disaster if we eliminated post mortem donation – or even negatively affected post mortem donation rates. The needs of people waiting for heart transplants, to take one example, come way before the needs of people waiting for a kidney. It isn’t some idle question, you have to know what will happen before it’s even worth thinking about what is being suggested.

Really?  So Obama should have known what was going to happen with his health care plan?  Bill, no one can see the future, not you or me.  The main problem is the needs of everyone else, is coming before someone who needs a kidney transplant, look around, if you have not noticed.

[MooseMom]

Hemodoc, I had been in favor of at least considering the idea of people being able to sell a kidney, but after reading your post, I have changed my mind.  Thank you for a very eloquent argument.

Oh, after 2 years on the list at a Chicago tx hospital, my neph insisted I get listed in Wisconsin which had a shorter waitlist.  I ended up getting my tx in Madison.  It's actually a shorter drive from my house to Madison than it is to Chicago, especially during rush hour.  I am certainly not rich, but it's probably an advantage that I don't live in California.  I didn't know that Steve Jobs went to Memphis.  I wonder how he chose Memphis.  Do they have the shortest wait time in the nation or something?

I guess as long as you have your transplant, who cares, about the other people who are suffering because of hypocrisy? 

Yeah,as long as I have mine, I no longer care about ethics.     So, what you are really saying is that those who may disagree with you are morally bankrupt.

[NDXUFan]

Hemodoc, I had been in favor of at least considering the idea of people being able to sell a kidney, but after reading your post, I have changed my mind.  Thank you for a very eloquent argument.

Oh, after 2 years on the list at a Chicago tx hospital, my neph insisted I get listed in Wisconsin which had a shorter waitlist.  I ended up getting my tx in Madison.  It's actually a shorter drive from my house to Madison than it is to Chicago, especially during rush hour.  I am certainly not rich, but it's probably an advantage that I don't live in California.  I didn't know that Steve Jobs went to Memphis.  I wonder how he chose Memphis.  Do they have the shortest wait time in the nation or something?

I guess as long as you have your transplant, who cares, about the other people who are suffering because of hypocrisy? 

Yeah,as long as I have mine, I no longer care about ethics.     So, what you are really saying is that those who may disagree with you are morally bankrupt.

That would be incorrect.  I am pointing out that the hypocrisy is incredible and breath taking. 

[cassandra]

And completely ignoring the simple, and only fair solution that actually benefits every one on any organ waiting list is even worse.
Introduction of the 'opt out' system is such a solution, and avoids the introduction of yet more capitalistic nonsense.

[NDXUFan]

And completely ignoring the simple, and only fair solution that actually benefits every one on any organ waiting list is even worse.
Introduction of the 'opt out' system is such a solution, and avoids the introduction of yet more capitalistic nonsense.

NDXUFan: 
Fairness is a matter of subjective opinion, compared to what?  How is it fair that almost 100,000 people are waiting for a kidney?  Does that seem like a great policy to you?  The Laws of Economics apply to everyone, including Obama, Clinton, Bush, Reagan, etc.....  How is it fair that people, instead of receiving a kidney because of reasonable compensation, are left to sit on a dialysis machine for hours on end, each week, is that truly fair?  It is "fair" that many people have died because of your preceived notion of "fairness?"  It is "fair" that you are able to impose your vision of fairness on everyone else?  How is your take on the morality of kidney transplants based on reasonable compensation superior to other viewpoints? What do you think would happen if there were 100,000 individuals waiting to purchase food?  What do you think the reaction would be if 100,000 people were waiting to buy a car or a house?  Do you or anyone you know work for free?  How much food, or how much of a house, car, or any other consumer good will you be able to own for the price of $0?  Basically, what you are proposing is that people should serve or help you and the transplant hospital for free.  In other words, you are taking something someone from that person, without compensating them in return.  The person who is giving you the gift of life, along with taking all of the risk, should get nothing in return?  I am not aware of any other field where someone takes all of the risk and receives nothing in return....  The donor could lose his or her life, but, they should get nothing for that risk?  When you are ready to live under Soviet system of socialism and leave the United States, let me know.  Even your pals, the Kennedys do not live as you proscribe, they have more money in oil stocks than the Bush family, along with owning two companies.  I hope you will remember those facts when they cry about "oil profits and greed."

[MooseMom]

So if it were entirely up to you, NDXUFan, what exactly would your plan be for compensating living kidney donors?  Give us a list of specifics proposals.  Define "compensation".  Would this be a cash compensation or would it be more in line of tax credits or other benefits?  How would these be paid for?  Who would decide what the compensation should look like?  Have there been any studies done on how many people would become donors if they were paid for their kidney?  Should patients on the transplant list help fund the "compensation pot"?  If you are on the list, would you be willing to pay, say, an annual fee, the aggregate of which could go toward compensation?

I'm interested in what you have in mind.

[NDXUFan]

So if it were entirely up to you, NDXUFan, what exactly would your plan be for compensating living kidney donors?  Give us a list of specifics proposals.  Define "compensation".  Would this be a cash compensation or would it be more in line of tax credits or other benefits?  How would these be paid for?  Who would decide what the compensation should look like?  Have there been any studies done on how many people would become donors if they were paid for their kidney?  Should patients on the transplant list help fund the "compensation pot"?  If you are on the list, would you be willing to pay, say, an annual fee, the aggregate of which could go toward compensation?

I'm interested in what you have in mind.

   


According to the laws of Economics, individuals will be more willing to donate at a higher level of compensation than at a lower level of compensation.  In Rome, individuals who served in the Roman military, would be able to live tax-free, after their release from the service.  Reasonable compensation could be anything from cash payments, tax credits, free life time health insurance, free college tuition, as individuals(My Dad went to school on the GI Bill) receive the GI bill for serving in the U.S. Military.  Yes, I would be willing to pay an annual fee to fund compensation for kidney donors, it would be very cost effective.  Yes, patients on the transplant list should help fund the compensation pot, if they have the financial means to do so......  I do not expect someone only receiving $600 per month on disability to help with funding.  I am not for forcing anyone to donate a kidney, it must be a free exchange....  I am not for dealing with the thuggish dictatorships in Iran or China to receive kidneys.  In an article in the Wall Street Journal, the government could pay $100,000 per donor and still come out ahead.  I would also put the sickest dialysis patients in the front of the line, not me, I do not fall in that category.  I have many years to wait, many of them only have days or months to wait..... 

For example, a individual who is dying with high functioning kidneys could have the incentive to take care of themselves, so the money could be used to help their child with special needs, so they would not have to rely on the state or taxpayers.  I worked with individuals with special needs, both mental and physical needs for many years.  Many of those parents are terrified to die because they are afraid to what will happen to their children.  The kidney donation will be a way to help the child with special needs and the individual who needs a kidney.    My goal is to rehab kidney patients and to help other people in society at large.  I want special needs children to have a great life, be a part of the community and to help kidney patients to rehab and have productive lives.  The current policy is ineffective and it is not working, we need a change.  Under the current system, the special needs child does not have money to help themselves and has to depend on the taxpayer, along with the kidney patient.  Under my system, the special needs child wins, the donor wins, the kidney patient wins, and the taxpayer wins with much lower costs.    My ideas and plans are designed to help the sick, the working and middle class, and individuals who need a helping hand.  The medical system needs to become "consumer or patient centered."  I do not care if Thiry makes alot of money, acts like an idiot, or acts like a drunk, as long as dialysis patients are being well taken care of, in the clinics.  Unlike many dialysis individuals, he has no control over my life, money, care, or otherwise......   The time has long passed where excuses need to be made for the crappy and subpar care that is being given by the large dialysis corporations. 

[MooseMom]

I have a child with special needs, AND I needed a kidney.  How would your plan work for someone like me?

[noahvale]

*

 

[MooseMom]

Thank you, noahvale, for those links.  Yes, I was able to zoom in on Professor Kaserman's obituary, and I read the forward and introduction to his book.  It looks fascinating, and I'm going to see if I can download it onto my Nook.  I have to admit that I flop back and forth on this issue.  I read thoughtful arguments put forth by thoughtful people who come down on both sides of this issue, and just when I think I'm convinced, I see another viewpoint that I can't summarily dismiss.

Again, thank you for your post. 

[NDXUFan]

I have a child with special needs, AND I needed a kidney.  How would your plan work for someone like me?

I have a special needs child, who is 16, my stepdaughter, her mom died of a heart condition.  My RN sister said that the cause was unknown.  I would put you in the front of the line so you could make a living for that child.  Per the IU Dialysis Clinic philosophy, "Dialysis patients need to be rehabbed, not treated as infants."  The current policy is very, very expensive and it is not working. 

[cassandra]

[/quote]

NDXUFan: 
Fairness is a matter of subjective opinion, compared to what?  How is it fair that almost 100,000 people are waiting for a kidney?  Does that seem like a great policy to you?  The Laws of Economics apply to everyone, including Obama, Clinton, Bush, Reagan, etc.....  How is it fair that people, instead of receiving a kidney because of reasonable compensation, are left to sit on a dialysis machine for hours on end, each week, is that truly fair?  It is "fair" that many people have died because of your preceived notion of "fairness?"  It is "fair" that you are able to impose your vision of fairness on everyone else?  How is your take on the morality of kidney transplants based on reasonable compensation superior to other viewpoints? What do you think would happen if there were 100,000 individuals waiting to purchase food?  What do you think the reaction would be if 100,000 people were waiting to buy a car or a house?  Do you or anyone you know work for free?  How much food, or how much of a house, car, or any other consumer good will you be able to own for the price of $0?  Basically, what you are proposing is that people should serve or help you and the transplant hospital for free.  In other words, you are taking something someone from that person, without compensating them in return.  The person who is giving you the gift of life, along with taking all of the risk, should get nothing in return?  I am not aware of any other field where someone takes all of the risk and receives nothing in return....  The donor could lose his or her life, but, they should get nothing for that risk?  When you are ready to live under Soviet system of socialism and leave the United States, let me know.  Even your pals, the Kennedys do not live as you proscribe, they have more money in oil stocks than the Bush family, along with owning two companies.  I hope you will remember those facts when they cry about "oil profits and greed."
[/quote]

People who are dead don't need compensating for organs they don't need anymore.
The opt out system means that everyone who dies will leave their body (including their useful organs) to people waiting on such an organ to stay alive. If people do not want that they opt out. I see that as fair.
They do get their funeral expenses paid for. In the countries with that system is no waiting list for numerous amounts of years.
What's not fair about that? Rich or poor are treated the same

[NDXUFan]

NDXUFan: 
Fairness is a matter of subjective opinion, compared to what?  How is it fair that almost 100,000 people are waiting for a kidney?  Does that seem like a great policy to you?  The Laws of Economics apply to everyone, including Obama, Clinton, Bush, Reagan, etc.....  How is it fair that people, instead of receiving a kidney because of reasonable compensation, are left to sit on a dialysis machine for hours on end, each week, is that truly fair?  It is "fair" that many people have died because of your preceived notion of "fairness?"  It is "fair" that you are able to impose your vision of fairness on everyone else?  How is your take on the morality of kidney transplants based on reasonable compensation superior to other viewpoints? What do you think would happen if there were 100,000 individuals waiting to purchase food?  What do you think the reaction would be if 100,000 people were waiting to buy a car or a house?  Do you or anyone you know work for free?  How much food, or how much of a house, car, or any other consumer good will you be able to own for the price of $0?  Basically, what you are proposing is that people should serve or help you and the transplant hospital for free.  In other words, you are taking something someone from that person, without compensating them in return.  The person who is giving you the gift of life, along with taking all of the risk, should get nothing in return?  I am not aware of any other field where someone takes all of the risk and receives nothing in return....  The donor could lose his or her life, but, they should get nothing for that risk?  When you are ready to live under Soviet system of socialism and leave the United States, let me know.  Even your pals, the Kennedys do not live as you proscribe, they have more money in oil stocks than the Bush family, along with owning two companies.  I hope you will remember those facts when they cry about "oil profits and greed."
[/quote]

People who are dead don't need compensating for organs they don't need anymore.
The opt out system means that everyone who dies will leave their body (including their useful organs) to people waiting on such an organ to stay alive. If people do not want that they opt out. I see that as fair.
They do get their funeral expenses paid for. In the countries with that system is no waiting list for numerous amounts of years.
What's not fair about that? Rich or poor are treated the same
[/quote]

What is your obsession with your perceived notion of fairness?  Who are you to decide what someone "needs?"  So, the special needs child does not need money from a financially supporting parent?  I want to help everyone who needs a kidney, rich or poor......  I see incredible hypocrisy in the current system.....  Why does it upset you to see someone making money?  The Kennedy's make tons of money with their two oil companies and have not had to work a day in their lives, my Dad worked for JFK.    I think your plan is workable, but, living donors are the best.

[rocker]

People who are dead don't need compensating for organs they don't need anymore.
The opt out system means that everyone who dies will leave their body (including their useful organs) to people waiting on such an organ to stay alive. If people do not want that they opt out. I see that as fair.
They do get their funeral expenses paid for. In the countries with that system is no waiting list for numerous amounts of years.
What's not fair about that? Rich or poor are treated the same

   
I, too, am in favor of presumed consent, but the things you say simply are not true.

The US, with the "opt-in" system, ranks fourth in the world in donation rates.  The US has a higher donation rate than some opt-out countries.

The rates I have heard for donation eligibility range from 1-5%. The vast majority of deaths are due to something (cancer, infection, etc) that makes the deceased's organs unsuitable for donation.  One stat I read said that about 75% of eligible brain death patients end up donating in the US.

And it is definitely not true that presumed consent eliminates waiting lists. And in many presumed consent countries, the doctors still seek the permission of the family before taking organs.

In fact, one study said that the number one factor influencing donation rates was the training of the staff who approach the family.  I know that when my father died, the staff who approached my stepmother were unbelievably callous.

Opt-out is an idea I agree with, but it's not a magic solution.

[MooseMom]

Thank you, noahvale, for those links.  Yes, I was able to zoom in on Professor Kaserman's obituary, and I read the forward and introduction to his book.  It looks fascinating, and I'm going to see if I can download it onto my Nook.  I have to admit that I flop back and forth on this issue.  I read thoughtful arguments put forth by thoughtful people who come down on both sides of this issue, and just when I think I'm convinced, I see another viewpoint that I can't summarily dismiss.

Again, thank you for your post.

noahvale, I was able to download the book onto my Nook.  I've read through the introduction which outlines exactly how the authors will lay out their arguments.

[jeannea]

Erma Bombeck died waiting for her kidney transplant. She even registered in Arizona instead of California because the wait was less and I think she moved there. There may have been others I don't know about. Some of the celebs you mentioned were liver transplants not kidney. I don't know how that works. I know George Lopez got his transplant fast because he had a living donor.

[NDXUFan]

Erma Bombeck died waiting for her kidney transplant. She even registered in Arizona instead of California because the wait was less and I think she moved there. There may have been others I don't know about. Some of the celebs you mentioned were liver transplants not kidney. I don't know how that works. I know George Lopez got his transplant fast because he had a living donor.

Was her death worth it, for some people to feel good about themselves?

[jeannea]

I thought I read someone saying famous people never die before transplant. Maybe it was a different thread.

Where did I say she made people feel good by dying? You are a troll. You still haven't answered why you come here. You are derisive of anyone else's opinion not willing to discuss. We're supposed to believe you know everything. Or else your "brother" does.

[NDXUFan]

I thought I read someone saying famous people never die before transplant. Maybe it was a different thread.

Where did I say she made people feel good by dying? You are a troll. You still haven't answered why you come here. You are derisive of anyone else's opinion not willing to discuss. We're supposed to believe you know everything. Or else your "brother" does.

My point was, she died so other people could feel good about themselves.  In other words, IF MY SYSTEM WOULD HAVE BEEN IN PLACE, she might not have died.  YET, since other people enjoy imposing their value system on her and us, we are leading a miserable life because of them and their total hypocrisy.  I hate to inform you that I talk to many dialysis advocates all of the time.......  Individuals on dialysis are being used and abused, along with people on the transplant list.  In addition, I do not answer to you.....   If you do not like my posts, you have the freedom and liberty not to read them, quite simple....  I post what have been my experience and the total B.S. of the dialysis industry......  If you like being used by these hypocrites, that is your business, I do not and I do not take their garbage.  An insane amount of money is being spent on our "care" and we are treated like trash.  It is time for this abuse to end, if you do not stand up for yourselves, no one else will.

[amanda100wilson]

You have lost me somewhat.  Who are 'they'?

[NDXUFan]

You have lost me somewhat.  Who are 'they'?

They is people who adovcate for the current system of transplants because they are not paying the price for their decisions.