I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: NDXUFan on October 27, 2013, 02:33:11 AM
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http://www.nbcnews.com/health/kidney-10-000-paying-donors-actually-pays-new-study-finds-8C11459939
People starting to live in the real world. :)
Paying living kidney donors $10,000 to give up their organs would save money over the current system based solely on altruism — even if it only boosts donations by a conservative 5 percent.
That’s according to a new analysis by Canadian researchers that rekindles the ongoing debate about whether it’s practical — and ethical — to offer financial incentives for human body parts.
“We have a problem. We don’t have enough organ donors coming forward,” said Dr. Braden Manns, an associate professor and clinical professor in nephrology at the University of Calgary. He led the new study published Thursday in the Clinical Journal of the American Society of Nephrology.
“We need to figure out a way to solve that problem. We shouldn’t throw out, out of hand, solutions that could increase donations.”
But other kidney experts say that even if it’s cost-effective to pay people for organs, the moral issues the practice generates might backfire.
“Sometimes these things have unintended consequences,” said Dr. Stephen Pastan, a board member for the National Kidney Foundation and a transplant surgeon at Emory University in Atlanta. “If we paid $10,000, a lot of altruistic donors would say that it’s just a cash transaction. Donations could go down.”
Right now the question is theoretical. In the U.S., Canada and other countries — except Iran — paying people to donate organs is illegal.
Still, Manns and his team wanted to find out if offering financial incentives would save money over the current system of keeping people on kidney dialysis for years. They compared cost data from a cohort of kidney patients identified in 2004 and followed them for three years.
They determined that paying living kidney donors $10,000 apiece would save about $340 per patient, compared with the ongoing costs of dialysis, and would also provide a modest boost of .11 in quality-adjusted life years, or QALY scores, a measure of the quality and length of life. (The money would come from an independent third-party entity, like the Canadian Blood Services or perhaps through OPTN in the U.S., Manns said.)
Those figures are based on what Manns called a “very conservative” assumption that financial incentives would boost kidney donations by 5 percent. If donations actually rose by 10 percent or 20 percent, the cost savings would jump to $1,640 and $4,030 per patient, respectively.
“It’s a substantial gain for the people who get the individual transplant,” said Manns, and a system-wide gain when multiplied by the thousands of people on kidney transplant waiting lists.
In the U.S., for instance, more than 98,000 people are waiting for kidneys, according to the Organ Procurement and Transplantation Network, or OPTN. Last year, more than 4,500 people in the U.S. died waiting for kidneys. Meanwhile, the number of kidney donors has fallen steadily for the past several years, to 13,040 in 2012, despite the growing need, figures show.
In Canada, the issue is the same: Wait lists of two to three years, and about 30 percent of patients die while waiting, Manns said.
“The obvious question, the elephant in the room is, ‘Why don’t more people donate?’” Manns said.
Related: Opinion: Why selling kidneys won't work
The new research follows a recent survey of 3,000 Canadians by Manns and his colleagues. It found that about 70 percent of members of the general public thought that some form of compensation for organ donation would be OK, but that only 25 percent of transplant doctors agreed.
The same survey found that about half of people who said they wouldn’t be likely to donate an organ changed their minds if the deal included a $10,000 payment.
While Manns’ study focused on paying all donors directly, others have previously suggested offering incentives that might include compensation for health costs, a break on life and health insurance or even tax relief for kidney donors.
The idea of compensating people for their organs doesn’t sit well with Lora Wilson, 53, of Pittsburgh, Pa., who donated a kidney in 2006 to a 71-year-old grandmother in New Jersey.
“For me, I just don’t like the idea that body parts are for sale,” said Wilson, who is director of an orthopedic group. “You may start with a $10,000 incentive, but what’s to say someone of means wouldn’t say, ‘I’ll pay $100,000?’ I don’t feel very comfortable with it.”
There are also questions of whether financial incentives would coerce poor and vulnerable people into donating for money, despite medical risks, Pastan noted. But a 2010 study by Scott Halpern, a bioethics expert at the University of Pennsylvania, found that many of the fears that financial incentives could cloud a person's decision about donation weren't actually true.
All of these issues are part of a decades-long debate about paying for organs, a conversation that stalls because no one really knows what effect incentives would have, experts say. In the U.S., the National Organ Transplant Act of 1984 expressly prohibits selling organs and a Senate report that accompanied it warned that "human body parts should not be viewed as commodities."
In an editorial accompanying Manns’ study, two University of Pennsylvania researchers, Dr. Peter Reese and medical student Matthew Allen, argue that “the time is ripe” to at least consider studying the real-world impact of incentives.
They’re proposing a research agenda and a limited-scope trial that would finally answer lingering questions about paying for body parts.
“We really don’t know how big the opportunities are here and we really don’t know the risks,” Reese said.
ND:
I think Ms. Wilson and some of these hypocrites need some time on a dialysis machine, they would change their tune, quickly.
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So, I Love Soda should suffer so these hypocrites can feel good about themselves??? :Kit n Stik;
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Canada should just try it for 5 years so they have something real to study. Hmmmm I live 120 miles from Canada!
:flower;
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http://www.nbcnews.com/health/kidney-10-000-paying-donors-actually-pays-new-study-finds-8C11459939
ND:
I think Ms. Wilson and some of these hypocrites need some time on a dialysis machine, they would change their tune, quickly.
NDXUFan, to blanketly accuse those who disagree with your point of view as being hypocrites is inflammatory rhetoric. It does absolutely nothing to advance the discussion of the importance of organ donation and can quite possibly have a negative impact on the public's perception of kidney patients.
One of those so-called hypocrites you refer to in the article is Stephen Pastan, MD. Dr. Pastan was my nephrologist for 7 years before leaving private practice and taking the position of medical director of the kidney and pancreas transplant programs at Emory University School of Medicine (not surgeon as stated in the article).
Knowing Dr. Pastan's history as a thoughtful, caring physician with almost 30 years of treating esrd patients, I will not stand quiet and allow him to be denigrated for his view on this controversial topic. He is a tireless advocate for transplantation and home dialysis options, yet also has a firm grasp on the realities of esrd treatment and its shortcomings - from provider care to the patient population. Although not currently listed with Emory's transplant program, I still consult with Dr. Pastan when wanting his opinion on a certain treatment/medication or just needing a sympathetic/nonjudgmental ear to vent.
At this point in time, after living with esrd for 35+ years and awaiting a second transplant (B blood type and 99% antibody sensitized), I'm still on the fence if allowing monetary compensation for LIVING organ donation is good public policy. I see the positives and negatives from both sides of the issue. It is not a cut and dry, black or white decision.
Personally, I think a more important immediate goal would be to have Medicare begin paying for lifetime immunosuppressive drug coverage instead of dropping kidney transplant recipients after 3 years (if receiving coverage due to esrd only). This would be of tremendous financial benefit to patients and also create less of a burden on the donor list. I mean why expand the donor pool when funds are currently unavailable to keep a significant segment of those who already have transplants from losing them?
FYI - David Kaserman, PhD, a former professor of economics at Auburn University and kidney transplant recipient, was a firm believer in allowing for a market driven system to increase cadaver organ donation. Dr. Kaserman and I received our kidney transplants from the same donor at UAB in 1990. He lost his transplant due to rejection within a few months, but did get another one a little over a year later. Unfortunately, Dr. Kaserman passed away a few years ago due to complications/side effects from the transplant regimen.
http://www.independent.org/newsroom/article.asp?id=419
http://www.amazon.com/gp/reader/084474171X/ref=sib_fs_bod?ie=UTF8&p=S00L&checkSum=ENXLoBQp%2FlVXjEWtSS9rJmLFKoQI2%2FWqO3RQLUIh9HA%3D#reader-link
http://www.amazon.com/The-Global-Organ-Shortage-Consequences/dp/0804784094#reader_0804784094
ND:
If that is the way that you want to live, that is fine with me. Yet, do not force your opinions on other people. The physician has every right to his opinion, as I have a right to my opinion. So, how long has Wilson spent on a dialysis machine, would Wilson be willing to live the same way as she advocates that others should live? I highly doubt it. It is truly amazing to me how totally clueless people in this industry happen to be..... I have never heard so many stupid comments in my life and I have worked for the government, that should give you an idea. In the real world, people respond to incentives, not pie in the sky platitudes. I am tired of this attitude of these people who think they are the royal court and we are just a bunch of mindless feudal serfs. We do agree on transplant medication...... Kaserman made a lot of sense, unlike the majority of Yahoos in this industry.