An organ shortage kills 30 Americans every day. Is it time to pay donors?

From Keith Humphreys of the Washington Post. Keith Humphreys is a Professor of Psychiatry and Mental Health Policy Director at Stanford University.Excerpts:

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Source: U.S. Health Resources and Services Administration

"Taxpayers also bear a significant burden in the case of kidneys because of the special status of renal dialysis within the Medicare program. In 1972, Congress mandated that Medicare cover the costs of care for end stage renal disease regardless of patient age. In 2011, over 500,000 people took advantage of this benefit at a cost of over $34 billion, which is more than 6% of Medicare’s entire budget.

"Tom Mone, chief executive of OneLegacy, the nation’s largest organ and tissue recovery organization, points out that “The recovery rate for deceased donors in the United States is actually better than that of European nations with presumed consent laws. The United States rigorously follows individual donor registrations whereas presumed consent countries actually defer to family objections.”"

"less than 1% of deceased individuals are medically eligible to donate organs, and 75% of this group in the United States in fact does so, there simply isn’t enough “there there” to remedy the shortage with improved recovery from deceased donors."

"Sally Satel (a resident scholar at the American Enterprise Institute):

Here is one model: a governmental entity, or a designated charity, would offer in-kind rewards, like a contribution to the donor’s retirement fund, an income tax credit or a tuition voucher, or a gift to a charity designated by the donor. Because a third party provides the reward, all patients, not just the financially secure, will benefit."

Meanwhile, imposing a waiting period of at least six months would ensure that donors didn’t act impulsively and that they were giving fully informed consent. Prospective compensated donors would be carefully screened for physical and emotional health, as is done for all donors now."

"all rewarded donors would be guaranteed follow-up medical care for any complications, which is not ensured now."

"KH: Some remarkable people altruistically donate kidneys to complete strangers. If the U.S. adopted a paid donor model, might such individuals stop donating, thereby making the shortage worse?

SS:Altruism – the “gift of life” narrative – is a beautiful virtue but, clearly, is not enough. Yet, for decades, the transplant establishment has embraced altruism as the only legitimate basis for giving an organ. If we keep thinking of organs solely as gifts, there will never be enough of them. Deaths will mount,"

"“crowding out” is unlikely. We have no shortages of blood plasma, eggs, sperm, and cadavers for medical school dissection. Why? Because donors are remunerated. Also, data suggest that voluntary activities in such contexts are not suppressed as long as the meaning is preserved'

 "I’ve also heard critics allege that increasing organ donation through donor benefits “cheapens the gift.” It is unlikely that the recipient of a lifesaving kidney would agree."

"the number of kidney transplants performed over the past several years has been basically flat."

"KH: How big an impact could your proposal make? Would we clear the waiting list or just shorten it?

SS: There is every reason to expect that it would. After all, persuasive data show that paying for blood leads to greater donation. The U.S. is the one of the very few countries that pays donors for their blood plasma and is, in fact, the supplier for the rest of the world."

"Did we honor the heroism of 9/11 firefighters who rushed into the World Trade Center towers any less because they got paid?"
"Some worry that that rewarded donation will attract only low-income people. This is possible, though only a trial project can provide the answer. But even if this turns out to be the case, why doubt the capacity of low income people to make decisions in their own interest"