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Best post I have read on how to pay donors for kidneys

If you want to start a fight among nephrologists, start talking about paying donors for their kidneys. This may be the most contentious issue in nephrology. I personally am a believer in the concept but trying to imagine a free market for organs makes me nauseous.

Rohin Dhar, at the Priceonomics Blog has put together a brilliant, straight-forward essay describing the problem, showing how current ideas for increasing the organ supply (make donating organs the default after death, paired kidney donation, improved donor-recipient matching) are not working and cannot hope to solve the problem and then goes on to describe a hypothetical organ purchasing system run by medicare. I’m convinced.
When discussing this on twitter, the always interesting Christos Argyropoulos talked a bit about the problem with Greece’s implementation of default organ donation:

@kidney_boy The Iranian system was covered last year in KI if I am not mistaken. Opt out can also backfire as it has in Greece
— ChristosArgyropoulos (@ChristosArgyrop) May 29, 2013

@kidney_boy Opt out legislated in 2011;hugely unpopular, a couple of high profile resignations from the Ntl Transplant body-> # of Txps down
— ChristosArgyropoulos (@ChristosArgyrop) May 29, 2013

@kidney_boy Public pushback makes ICUs reluctant to refer donors,even though almost everyone is. Opt out systems are embraced not imposed
— ChristosArgyropoulos (@ChristosArgyrop) May 29, 2013

An open access review of Iran’s transplant system can be found here (A non-systemic review from McGuil University? I grow feint.) Here is the Kidney International paper Dr. Argyropoulos was referring to.
Look at how the number of transplantations is growing in Iran:
Mitra Mahdavi-Mazdeh. Kidney International, 2012
While it is flat in the US:

USRDS

The current system of paired exchanges and campaigns for kidney donors has noble intentions, but it’s not working. People are needlessly dying as a result.

One Reply to “Best post I have read on how to pay donors for kidneys”

  1. Dhar’s article is frustrating to read from the perspective of someone who’s used hemodialysis for over 22 years, is working full time through the carpenter’s union and is booked to go down the Grand Canyon in a little over a month (I’ll dialyze four times using a generator).

    Organ thieves? That doesn’t happen in the US outside of TV shows, so a strawman. A stronger objection never addressed by proponents of a market is the impact of a kidney organ market on all organ and tissue donations and a market’s effect on existing kidney donation.

    If live donor kidneys are worth tens of thousands of dollars what is the worth of deceased donor kidneys? Does Dhar imagine that bereaved relatives will evince the same willingness to donate post mortem?

    However, aside from kidneys which can be imperfectly replaced, what would be the effect on the donation of irreplaceable tissues and organs?

    By paying for kidneys you change the system that has developed for the acquisition/transplant of other organs and tissues.

    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.

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