Should the government consider paying people to be donors?

[The_Vincester]

With health care costs as they are and the high price of treating someone for dialysis, why doesn't the government consider paying donors?  I think $50,000 is a fair price. There is plenty need and the treatment and care is not getting cheaper.

This could include voluntary as well, and help cover out of pocket expenses like lost wages. It's going to cost my family several thousand to help cover expenses for my donor. It's not a payoff - she didn't ask, but we know she needs help.

I would think this would save the government several  billion dollars over several years in treatment savings.

The individuals would have to be healthy and pass all the tests, of course. Heck, it would be a stimulus as well!

[okarol]

You might want to search the forum and see some of the prior posts on this topic. It's come up in the past.

[Bill Peckham]

I don't think the needs of people who are using dialysis are the first priority. By paying for kidneys you change the system that has developed for the acquisition/transplant of other organs and tissues. I htin ka kidney market would impact the willingness of people to participate in altruistic donations of kidney and all other body parts.

If a kidney from a living donor is worth $20,000, what's a postmortem kidney worth? How much for a postmortem liver? Postmortem donation of hearts, livers, lungs and all manner of other useful tissues rely on altruistic donation. If body parts become commodities what will it mean for all the people waiting for postmortem donations? I think the needs of people waiting for irreplaceable body parts (e.g. hearts, lungs, liver (mostly)) should be considered before the needs of those waiting for a kidney.

[The_Vincester]

The idea is to mitigate the cost of treatment. It's a unique situation unlike the other organs where live donation is a possibility (and preferred). I think it would encourage altruistic donation.

I'm also not saying to kill the cadaver program either. Fact is, we need a LOT of kidneys and this is a unique and cost-saving opportunity.

[Bill Peckham]

If you want to make the argument on purely economic costs then you'd have to compare the total yearly medical costs of someone using dialysis that is also a candidate for transplant, compared to the total yearly cost of someone using a transplant. Usually advocates for a market compare the average yearly cost for everyone using dialysis (~$75k) to the yearly medication cost of someone using a transplant (~$20K). The average cost of someone who is eligible for a transplant is significantly lower since they are not using skilled nursing or spending 14 days a year in the hospital - averages that comprise the $75K number. Medicare pays about $30,000 a year to keep someone dialyzed incenter 3x week, and about $3,000 for physician services. Add in one off diagnostics, an ER visit, a hospital stay every few years and you get an average yearly cost of someone medically appropriate for a transplant in the $40,000 range.

On the transplant side you have the $20,000 for tx drugs and doctor fees and diagnostic testing and regular blood tests and even ER visits and an occasional hospitalization. $30k? $25K? The yearly difference is not very much and given the initial cost of a transplant (now with the kidney acquisition costs), how many years would it take before the scheme turned a profit 10 years? 5 years? It wouldn't be billions in savings any time soon.

But still the bigger problem isn't economic or the considerable legal/technical issues paid donation would raise (is there a warranty? Younger kidneys worth more than older?), the big problem is the impact of a live donor market on altruistic and post mortem donation of all organs/body parts. For instance I don't think you can simply wave away the potential impact on post mortem donation of hearts. If the change is made there will be no going back. There is no room to experiment or act without considering people with more acute needs.  I don't know for certain what the impact would be either, but these things are connected, they are part of the same system, I think there would be an impact. But more than that I have long been concerned that advocates for a market haven't even considered the question. Advocates are obliged to consider the wider impact of this large a change in the business of organ donation. They are obliged to consider the impact beyond the people receiving the kidney.

[Rerun]

Keep the Tax Payer out of it.  Just let the program continue and let people make their own deals or Have the government put a price.... but people would make their own deals anyway.

The point would be to get the rich people off the list and let us poor people have a chance at the road kill. 

      

[BattleScars]

I don't know the exact logistics of how a program like this would work but I read an interesting article recently that made a lot of sense and addressed the ethical side of one selling his/her kidney. If I can find the article I'll post it but this is my take. I know this is a different scale but we let people sell blood and plasma so why not healthy kidneys? Let's say the government set a price of $50,000. This would give healthy people that are having money trouble a huge intensive to donate. The funds would come from the government or insurance companies but all kidney patients would have a shot at a kidney regardless of income so that would solve the moral issue. The donor doesn't get paid until their kidney is removed and of course they would go through extensive testing just like anyone else to be considered. There would have to be a system that matches the donors with kidney patients but like I said income and social status cannot be a factor for this to work. Selling your organs privately would still be illegal.

In a perfect world healthy people would want to donate but that just isn't happening and can you blame people for being hesitant? There is no reward or incentive yet the donor is taking a risk and they are also taking time off work and being put through pain. People that donate and ask for nothing in return are truly angels from heaven but we just don't have enough of those people to go around. With over 95,000 people waiting for kidneys why not? I think people deserve to be compensated if they wish and I don't see anything unethical about it. We just need the doctors to think outside the box. I wonder sometimes if they are only using excuses because dialysis in this country is a big business. There are people that don't want this for their own greedy reasons. I mean there will always be people on dialysis that are too frail or sick or just don't want to go through a transplant, but having a system like this would shut a lot of dialysis centers down, that I guarantee. 

[Poppylicious]

I don't like the idea of people being paid to donate their organs.  I just don't feel comfortable with the fact that more people may come forward because they're having money troubles.  A donor isn't just giving away their prized childhood toy or a slice of homebaked cake; they're choosing to go through with elective surgery which has a 1 in 3,000 chance of killing them, and a higher risk of leaving them with lifelong complications, both mental and physical. 

The donor doesn't get paid until their kidney is removed ...

Do they still get paid if the transplant doesn't work?!

There is no reward or incentive ...

The reward is that someone is receiving a life-changing gift which enables them to continue living, hopefully feeling better and able to do more of the things they couldn't do on dialysis. Knowing that you've done something so amazing should be reward enough.

I do completely recognise that my world is probably tinged with pink and fluffiness though, and that makes my thoughts on the subject different to other people's.   

[KarenInWA]

Yes, the donor should still get paid if the kidney does not work because regardless - they still stepped up to donate and took a risk to go through the surgery. Nothing changes that, and to me, that is why they should be compensated. Maybe not by cash money, so to speak, but compensated in *some* way. I truly believe we would have more transplants if that was done.

KarenInWA

[Rerun]

Battlescars... I like it!

[BattleScars]

I don't like the idea of people being paid to donate their organs.  I just don't feel comfortable with the fact that more people may come forward because they're having money troubles.  A donor isn't just giving away their prized childhood toy or a slice of homebaked cake; they're choosing to go through with elective surgery which has a 1 in 3,000 chance of killing them, and a higher risk of leaving them with lifelong complications, both mental and physical. 

The donor doesn't get paid until their kidney is removed ...

Do they still get paid if the transplant doesn't work?!

There is no reward or incentive ...

The reward is that someone is receiving a life-changing gift which enables them to continue living, hopefully feeling better and able to do more of the things they couldn't do on dialysis. Knowing that you've done something so amazing should be reward enough.

I do completely recognise that my world is probably tinged with pink and fluffiness though, and that makes my thoughts on the subject different to other people's.   

Is there really a 1/3000 chance that a person will die donating a kidney? That seems really high given all the testing they put donors through. Just my opinion but if that's true then that's even more reason people should be compensated. Like I said, it would be nice if more people stepped up and donated for the right reasons but there's not enough people like that to fill the gap. I don't think the current system is working or maybe the government isn't doing enough to get the word out. But telling someone they have a 1/3000 chance of dying will probably scare a lot of people off.

As far as complications from removing a kidney in a healthy person I believe aside from the actual surgery most people do really well with just one kidney and are expected to live a full and normal life. Creatine might spike a bit to the upper one's but that's the only real complication I've heard of unless they develop kidney disease later in life themselves but that's why they screen for that.

[BattleScars]

Here's the link to that article. It's a little long but a really good read with a lot of good information in it. It opened my eyes to the thought of the government buying kidneys.
http://blog.priceonomics.com/post/50996688256/the-price-of-a-human-kidney

[BattleScars]

I don't like the idea of people being paid to donate their organs.  I just don't feel comfortable with the fact that more people may come forward because they're having money troubles.  A donor isn't just giving away their prized childhood toy or a slice of homebaked cake; they're choosing to go through with elective surgery which has a 1 in 3,000 chance of killing them, and a higher risk of leaving them with lifelong complications, both mental and physical. 

The donor doesn't get paid until their kidney is removed ...

Do they still get paid if the transplant doesn't work?!

There is no reward or incentive ...

The reward is that someone is receiving a life-changing gift which enables them to continue living, hopefully feeling better and able to do more of the things they couldn't do on dialysis. Knowing that you've done something so amazing should be reward enough.

I do completely recognise that my world is probably tinged with pink and fluffiness though, and that makes my thoughts on the subject different to other people's.   

My bad. Actually the death rate is higher than 1/3000, not lower. Kidney.org says the risk of death is 1/1700 procedures. That seems so high to me but I guess it isn't in the grand scheme of things. It still might scare a lot of people off. What's our normal risk of dying just living a normal healthy life? It's something to consider.

[Subeat]

http://cjasn.asnjournals.org/content/1/6/1136.full][url] http://cjasn.asnjournals.org/content/1/6/1136.full[/url].

Thoughts on the Iranian model?  Personally, I'd prefer to see the opt out system implemented before paying for organs.

[Bill Peckham]

http://cjasn.asnjournals.org/content/1/6/1136.full] http://cjasn.asnjournals.org/content/1/6/1136.full] http://cjasn.asnjournals.org/content/1/6/1136.full.

Thoughts on the Iranian model?  Personally, I'd prefer to see the opt out system implemented before paying for organs.

 


A theocratic dictatorship selling their citizen's kidneys to Saudis for their second, third, fourth transplant? What's not to like?

[okarol]

Everyone is paid, the transplant coordinator, the hospital, surgeon, anesthesiologist, pharmaceutical company, nurses, social worker, etc. The person taking the biggest risk, the donor, gets nothing. If there was a flat fee, paid via Medicare, then it wouldn't matter if the recipient was rich or poor, because it would be paid like every medical expense, directly to the donor. And all patients would qualify.
The problem I have, as Dr. House used to say, "People lie." A large part of the process of evaluating the potential donor is the personal health history and family history given to the transplant team by them. If a person is feeling financial pressure they might not mention that they have a family history of CKD or diabetes or high blood pressure. This would put the donor at risk in the future. There are just some things that will not be revealed through lab tests or a physical exam. And what if there's a pimp, sending his girls (or boys) in to donate a kidney so he can cash in? They would also be motivated to lie about their lifestyle and family history. How about someone in an abusive relationship, being pressured to give up a kidney? I am sure you can think of other scenarios where people would do something unethical. Ultimately this could lead to an outcome where the supposedly healthy donor ends up being a kidney patient themselves. The transplant team cannot interview the potential donor's family, boss, neighbors, personal physician, etc. And they don't have a way to track their health history. It's just not an easy solution. In other countries people have sold their kidney and then, after the money is gone, they are right back where they started, and if not throughly evaluated, perhaps now they've got health problems related to selling their kidney. Isn't this taking advantage of them? This topic has been discussed for years, but no one has come up with a scenario which would save lives and pay for the kidney while not harming the donor.

[Sydnee]

I agree

Everyone is paid, the transplant coordinator, the hospital, surgeon, anesthesiologist, pharmaceutical company, nurses, social worker, etc. The person taking the biggest risk, the donor, gets nothing. If there was a flat fee, paid via Medicare, then it wouldn't matter if the recipient was rich or poor, because it would be paid like every medical expense, directly to the donor. And all patients would qualify.
The problem I have, as Dr. House used to say, "People lie." A large part of the process of evaluating the potential donor is the personal health history and family history given to the transplant team by them. If a person is feeling financial pressure they might not mention that they have a family history of CKD or diabetes or high blood pressure. This would put the donor at risk in the future. There are just some things that will not be revealed through lab tests or a physical exam. And what if there's a pimp, sending his girls (or boys) in to donate a kidney so he can cash in? They would also be motivated to lie about their lifestyle and family history. How about someone in an abusive relationship, being pressured to give up a kidney? I am sure you can think of other scenarios where people would do something unethical. Ultimately this could lead to an outcome where the supposedly healthy donor ends up being a kidney patient themselves. The transplant team cannot interview the potential donor's family, boss, neighbors, personal physician, etc. And they don't have a way to track their health history. It's just not an easy solution. In other countries people have sold their kidney and then, after the money is gone, they are right back where they started, and if not throughly evaluated, perhaps now they've got health problems related to selling their kidney. Isn't this taking advantage of them? This topic has been discussed for years, but no one has come up with a scenario which would save lives and pay for the kidney while not harming the donor.

I think the opt out system would be a better start.
I also think that NOT enough people KNOW about the need for donors.  If you look at cancer you see everyone knows get how devastating cancer is how life changing and deadly it is. But kidney failure not so much. You here things like "when are you getting better?", "so you'll have to be on dialysis a few months?"  Only those close to someone with organ failure KNOW anything about what it's like.
A women on facebook that will be testing for me said to me"I didn't know there was anyone in my own town that needed a kidney" That is really sticking with me. It truly bothers me. This is from someone that tried to register as a altruistic donor.
There are at least 10 people in Cheyenne WY that need a donor. (50,000 town) Praying that I can, start a website and publicize our need. (Hoping our caring Neph will help pass on my letter.)
Really I think we need to make our need known (grassroots style) after all that's why everyone knows about cancer. I have a hard time believing there are not at least 97,000 people willing and able to donate in america. the problem is they don't know the need
   

[Zach]

Everyone is paid, the transplant coordinator, the hospital, surgeon, anesthesiologist, pharmaceutical company, nurses, social worker, etc.

Ain't that the truth!

Also included are the organizations which coordinate the cadaver organ donation, also known as Organ Procurement Organizations (OPO).
OPOs are usually not-for-profit, public charities.

In Los Angeles, it's OneLegacy.

Annual salaries:
Thomas Mone, CEO & EVP:  $631,964.00
Chowdary Garimella, COO & VP Operations:  $487,087.00
Davis Grafty, CFO & VP Finance: $290,498.00

The organization has a fund balance of over $30,000,000.00
Investment income:  $363,682.00

http://www.guidestar.org/FinDocuments/2011/953/138/2011-953138799-08aab7de-9.pdf

 

[Rerun]

I bet they all have their 2 working kidneys too.

I think all Nephrologists should donate 1 kidney.  That may get donation flowing.

Back on topic....  I wish Medicare which is for old people.... would not have to foot our bill.   

[MooseMom]

Back on topic....  I wish Medicare which is for old people.... would not have to foot our bill.   

I wish the same thing, but Corporate America won't foot the bill.  Who would pay?  There's a reason why insurance companies don't remain primary payers for very long.  Dialysis and the related bits and bobs are just so expensive as everyone wants their piece of the pie.  Should the government force insurance companies to pay for all dialysis/ESRD charges until a patient is 65?  What do you think, Rerun?  Would that be "government interference"?

[BattleScars]

Everyone is paid, the transplant coordinator, the hospital, surgeon, anesthesiologist, pharmaceutical company, nurses, social worker, etc. The person taking the biggest risk, the donor, gets nothing. If there was a flat fee, paid via Medicare, then it wouldn't matter if the recipient was rich or poor, because it would be paid like every medical expense, directly to the donor. And all patients would qualify.
The problem I have, as Dr. House used to say, "People lie." A large part of the process of evaluating the potential donor is the personal health history and family history given to the transplant team by them. If a person is feeling financial pressure they might not mention that they have a family history of CKD or diabetes or high blood pressure. This would put the donor at risk in the future. There are just some things that will not be revealed through lab tests or a physical exam. And what if there's a pimp, sending his girls (or boys) in to donate a kidney so he can cash in? They would also be motivated to lie about their lifestyle and family history. How about someone in an abusive relationship, being pressured to give up a kidney? I am sure you can think of other scenarios where people would do something unethical. Ultimately this could lead to an outcome where the supposedly healthy donor ends up being a kidney patient themselves. The transplant team cannot interview the potential donor's family, boss, neighbors, personal physician, etc. And they don't have a way to track their health history. It's just not an easy solution. In other countries people have sold their kidney and then, after the money is gone, they are right back where they started, and if not throughly evaluated, perhaps now they've got health problems related to selling their kidney. Isn't this taking advantage of them? This topic has been discussed for years, but no one has come up with a scenario which would save lives and pay for the kidney while not harming the donor.

Never looked at it this way. I could see it now, huge billboards in Las Vegas telling you where you can donate your kidney lol. There would be a lot of gamblers with one kidney running around. Seriously though, I know we have to protect the donor too but if they lie they are only harming themselves. The pimp thing is scary and I could see that happening. I guess there's always going to be someone trying to take advantage with any system we implement.

[BattleScars]

I have a hard time believing there are not at least 97,000 people willing and able to donate in america. the problem is they don't know the need
   

I think there are 97,000 people willing to donate but out of those 97,000 how many would actually be qualified? Still you are right, there needs to more awareness. My own mother thinks dialysis is a cure and we do fine on it no matter how many times I tell her she's wrong.

[okarol]

Everyone is paid, the transplant coordinator, the hospital, surgeon, anesthesiologist, pharmaceutical company, nurses, social worker, etc. The person taking the biggest risk, the donor, gets nothing. If there was a flat fee, paid via Medicare, then it wouldn't matter if the recipient was rich or poor, because it would be paid like every medical expense, directly to the donor. And all patients would qualify.
The problem I have, as Dr. House used to say, "People lie." A large part of the process of evaluating the potential donor is the personal health history and family history given to the transplant team by them. If a person is feeling financial pressure they might not mention that they have a family history of CKD or diabetes or high blood pressure. This would put the donor at risk in the future. There are just some things that will not be revealed through lab tests or a physical exam. And what if there's a pimp, sending his girls (or boys) in to donate a kidney so he can cash in? They would also be motivated to lie about their lifestyle and family history. How about someone in an abusive relationship, being pressured to give up a kidney? I am sure you can think of other scenarios where people would do something unethical. Ultimately this could lead to an outcome where the supposedly healthy donor ends up being a kidney patient themselves. The transplant team cannot interview the potential donor's family, boss, neighbors, personal physician, etc. And they don't have a way to track their health history. It's just not an easy solution. In other countries people have sold their kidney and then, after the money is gone, they are right back where they started, and if not throughly evaluated, perhaps now they've got health problems related to selling their kidney. Isn't this taking advantage of them? This topic has been discussed for years, but no one has come up with a scenario which would save lives and pay for the kidney while not harming the donor.

Never looked at it this way. I could see it now, huge billboards in Las Vegas telling you where you can donate your kidney lol. There would be a lot of gamblers with one kidney running around. Seriously though, I know we have to protect the donor too but if they lie they are only harming themselves. The pimp thing is scary and I could see that happening. I guess there's always going to be someone trying to take advantage with any system we implement.

Funny about Vegas, hadn't thought of that! 
The problem with people only hurting themselves is that ultimately they become everyone's responsibility.
It's been a lifesaver that dialysis patients are automatically covered by Medicare.
But we all are paying for it, and it could get much worse.