You've Heard of Trump Steaks - Now Trump Kidneys

http://www.forbes.com/sites/sallysatel/2016/11/15/youve-heard-of-trump-steaks-now-trump-kidneys/#427d896c254e

You've Heard of Trump Steaks, now Trump Kidneys
As a new administration dawns, anyone with a beloved policy project starts to dream. Maybe this time the power brokers — now, president-elect Donald Trump and his appointees — will see the wisdom of our proposals.

For my part, I am optimistic that my goal — easing the nation’s organ shortage — might just gain traction. This is because my preferred solution — rewarding kidney donors – will yield a fiscal windfall for the federal government.

There are about 120,000 people waiting for a kidney, heart, liver, or lung. Roughly 101,000 of them need kidneys but donation rates from both living and deceased donors are basically flat. The death toll is about 22 per day among those waiting for any organ and 12 per day among those needing kidneys (and these numbers do not include people who are removed from the waiting list because they have become too sick to transplant and are likely die soon).

Our current transplant system, by law, mandates altruism as the sole legitimate motive for organ donation. It’s a lovely sentiment — and I mean that sincerely as one who has received two kidneys over the years from dear friends — but altruism isn’t enough. We need to give more healthy, young, and middle-age people an incentive — a tax credit, a tuition voucher, a contribution to one’s 401(k), and so on — to become living kidney donors. Unfortunately, the 1984 National Organ Transplant Act (NOTA) explicitly bans this approach of enriching donors.

Ultimately NOTA should be significantly changed — I’ve written here about what an ethical system of rewarded donation could look like. Yet, at the very least, we need the leeway to put such incentives to the test. A bill in Congress sponsored by Representative Matt Cartwright would do just that.

Sally Satel , CONTRIBUTOR
I write about issues at the intersection of medicine and culture.

Opinions expressed by Forbes Contributors are their own.
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As a new administration dawns, anyone with a beloved policy project starts to dream. Maybe this time the power brokers — now, president-elect Donald Trump and his appointees — will see the wisdom of our proposals.

For my part, I am optimistic that my goal — easing the nation’s organ shortage — might just gain traction. This is because my preferred solution — rewarding kidney donors – will yield a fiscal windfall for the federal government.

(Photo by Joe Raedle/Getty Images)

There are about 120,000 people waiting for a kidney, heart, liver, or lung. Roughly 101,000 of them need kidneys but donation rates from both living and deceased donors are basically flat. The death toll is about 22 per day among those waiting for any organ and 12 per day among those needing kidneys (and these numbers do not include people who are removed from the waiting list because they have become too sick to transplant and are likely die soon).

Our current transplant system, by law, mandates altruism as the sole legitimate motive for organ donation. It’s a lovely sentiment — and I mean that sincerely as one who has received two kidneys over the years from dear friends — but altruism isn’t enough. We need to give more healthy, young, and middle-age people an incentive — a tax credit, a tuition voucher, a contribution to one’s 401(k), and so on — to become living kidney donors. Unfortunately, the 1984 National Organ Transplant Act (NOTA) explicitly bans this approach of enriching donors.

Ultimately NOTA should be significantly changed — I’ve written here about what an ethical system of rewarded donation could look like. Yet, at the very least, we need the leeway to put such incentives to the test. A bill in Congress sponsored by Representative Matt Cartwright would do just that.

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Wait, you say, won’t this proposal cost money? Yes, but the immediate savings will be huge and more than enough to offset the cost. This is because a person with a transplant costs far less then a person on dialysis.

Dialysis for kidney failure — formally called end stage renal disease — costs Medicare about $90,000 per person per year. With a census of about 650,000 dialysis patients in the country, the total expenditure represents roughly seven percent — seven percent! — of the entire Medicare budget.

Now consider a powerful cost-benefit analysis that appeared last year in the American Journal of Transplantation. Choosing a value of $45,000 for living donors and $10,000 for deceased ones (material benefit to be provided by the federal government) the authors found that taxpayers would save about $12 billion each year. This is the savings from stopping dialysis for 35,000 needy patients minus the cost of $45,000 per transplant for each of those patients. (Note: 35,000 is the total number of people in need of a kidney that is added to list each year)

Dialysis is almost four times as expensive per quality-adjusted life-year gained as a transplant. It is also an inferior therapy for end stage renal disease. After one year on dialysis patients suffer a 20-25 percent mortality rate with a 5-year survival rate of 38 percent.

People who receive transplants, however, have a 5-year survival rate of 93 percent, if the kidney from a living donor, and 84 percent with a kidney from a deceased donor. Further, the twelve additional years of a much healthier life that come with a new kidney have a monetary value of about $1,300,000 over an individual’s lifetime.

All this is great news, if you can find a donor. Tragically, too many cannot. Only 17,000 -18,000 kidney transplant operations are performed each year (but, recall, twice as many are needed to clear the list each year). The deficit exists and accrues over the years because not enough people bequeath their organs at death; also relatively few people with end stage renal disease have friends or relatives who donate to them.

Under a plan of rewarded donation, the paper’s authors estimate that 5,000 to 10,000 premature deaths would be averted each year. Also, with a larger pool of kidneys available for transplant, the biological diversity would be enhanced, making it easier to match kidneys to patients. This is significant as the better the immunological compatibility, the longer the life of the transplant and the less anti-rejection medication patients must take. The latter matters greatly because immunosuppression — essential to guard against organ rejection — has the downside of making patients more susceptible to infection.

Minority patients would benefit the most from rewarding donors because they are overrepresented on the waiting list. African Americans, for example, are over three times as likely as whites to develop kidney failure, due to their greater rates of diabetes and hypertension – diseases accounting for most cases of kidney failure – as well as a tendency to progress more quickly to full blown kidney failure when diagnosed with poor kidney function.

In addition, African Americans are less likely than whites to get a living donor from a relative (in large part because those individuals are at risk for the same predisposing conditions), according to economists Philip Held and Frank McCormick whose article, “How the Prohibition on Compensating Kidney Donors Harms the Poor,” is forthcoming. Compared to college-educated blacks, whites are three times as likely to have a living donor.

Sally Satel , CONTRIBUTOR
I write about issues at the intersection of medicine and culture.

Opinions expressed by Forbes Contributors are their own.
Play Video
Continued from page 1

Dialysis is almost four times as expensive per quality-adjusted life-year gained as a transplant. It is also an inferior therapy for end stage renal disease. After one year on dialysis patients suffer a 20-25 percent mortality rate with a 5-year survival rate of 38 percent.

People who receive transplants, however, have a 5-year survival rate of 93 percent, if the kidney from a living donor, and 84 percent with a kidney from a deceased donor. Further, the twelve additional years of a much healthier life that come with a new kidney have a monetary value of about $1,300,000 over an individual’s lifetime.

All this is great news, if you can find a donor. Tragically, too many cannot. Only 17,000 -18,000 kidney transplant operations are performed each year (but, recall, twice as many are needed to clear the list each year). The deficit exists and accrues over the years because not enough people bequeath their organs at death; also relatively few people with end stage renal disease have friends or relatives who donate to them.

Under a plan of rewarded donation, the paper’s authors estimate that 5,000 to 10,000 premature deaths would be averted each year. Also, with a larger pool of kidneys available for transplant, the biological diversity would be enhanced, making it easier to match kidneys to patients. This is significant as the better the immunological compatibility, the longer the life of the transplant and the less anti-rejection medication patients must take. The latter matters greatly because immunosuppression — essential to guard against organ rejection — has the downside of making patients more susceptible to infection.

Minority patients would benefit the most from rewarding donors because they are overrepresented on the waiting list. African Americans, for example, are over three times as likely as whites to develop kidney failure, due to their greater rates of diabetes and hypertension – diseases accounting for most cases of kidney failure – as well as a tendency to progress more quickly to full blown kidney failure when diagnosed with poor kidney function.

In addition, African Americans are less likely than whites to get a living donor from a relative (in large part because those individuals are at risk for the same predisposing conditions), according to economists Philip Held and Frank McCormick whose article, “How the Prohibition on Compensating Kidney Donors Harms the Poor,” is forthcoming. Compared to college-educated blacks, whites are three times as likely to have a living donor.

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Poor patients would gain as well. Study after study shows that dialysis patients with lower household income are less likely to receive a kidney of any kind and to suffer higher rates of death while waiting. Rarely are their loved ones in a position to donate because they can’t afford to miss wage-work nor can they cover the expenses associated with pre-transplant work-up and subsequent recuperation.

Our organ transplant system fails thousands of patients per year. A regime of rewarded donation will almost surely generate more kidneys, so let’s confirm it with pilot projects.

The stakes for people needing organs is high. Trump Kidneys, with their vast life-saving potential, would be far more than a brand. They would rescue thousands of desperate patients while saving public funds that could be far better spent on a healthcare system that is more efficient and affordable.