“It’s time to pay kidney donors”, writes Jeremiah Johnson in The Dispatch.
He’s wrong. It’s long since past time.
Six years ago, Mr Johnson altruistically donated one of his kidneys to someone who was at that time a stranger. That is admirable. It is also quite rare.
Despite donors like me, end-stage renal disease (ESRD) is still a huge problem in America. It’s a silent epidemic that kills more people than car crashes, breast cancer, homicide or suicide. There is no cure for ESRD—you either get a transplanted kidney or live the rest of your life on dialysis. As of September, there were almost 90,000 people on the kidney waiting list.
The worst part is that, for so many, these deaths are completely preventable.
While there are some ESRD patients who are too old for surgery or too sick to be helped, the majority of ESRD patients can easily extend their lifespan with a donated kidney. Our best estimates show that tens of thousands of people die every year, when they could have been saved by a donated kidney.
We simply don’t have enough kidneys, and people are dying by the tens of thousands because of it. We do, however, have another way to address the problem. We can pay people who choose to donate.
Mr Johnson outlines some of the objections to paying kidney donors:
I know that for some folks, paying for organs seems morally questionable. Perhaps it feels like a violation of the sacred nature of the human body. Or perhaps paying someone to do a good act seems like it inherently violates the altruistic nature of that act. Some folks might have concerns that this will lead to the commoditization of organs or will be used to exploit poor people. I understand and I sympathize with those concerns.
Probably more than I do, but even I acknowledge that the possibility of someone donating a kidney to get out of an immediate financial hole but regretting it later is real. But something similar is true of any consequential decision in life. The only way to make people safe from regretting their decisions would be to take away their control over their own lives. And, as Mr Johnson movingly describes in the next few paragraphs, the human beings currently desperately waiting for a kidney who would be given decades more life (and a life free of the constraints of dialysis) if the number of available kidneys was increased, are also real.
The “icky” thing I mentioned in the title to this post is not donating a kidney. It is allowing someone else to profit by selling one.
Better than being tricked into donating, at least: https://www.youtube.com/watch?v=5el171CKtv0
And the other thing is – the question of prolonging the life of the rich, who can pay for a kidney, but for the poor who can’t. Or, alternatively, burdening the public health care system with a big new expense, even for kidneys it now gets gratis (via donations)…
Another question is if this matter needs to be regulated by government at all.
During a kidney donation the surgeon, the scrub nurse, the circulating nurse, the pharmacist, the anesthesiologist, the ambulance driver, even the janitor who cleans up afterward, all get paid. Is that icky? What about the person at UNOS or your country’s equivalent, who decides where donated organs go. Icky? They get paid too. The only person who doesn’t get paid is the one person who makes it all possible.
And this is talking about live kidney donation. What is the argument against paying the loved ones of the recently deceased for the organs of that body? When you have just lost someone in your family you are often in significant financial need, especially here in the USA with the ridiculous medical bills you are likely to end up with. Allowing the sale of organs at that time can offer financial relief, save a dozen lives (depending on the viability of organs) and allow the deceased last act to be one of dignity and generosity to his family and strangers before his final remains are disposed of. There is nothing icky about that. It is rather generous and beautiful.
But as it stands today there is a massive shortage of organs causing huge mortality and morbidity. A massive shortage? If only economics had come up with a solution to massive shortages… they should totally work on that. Oh wait!! I’ve got an idea! Let’s have it managed by a government department. That should fix things!
Jacob, you write that allowing paid donations would be “burdening the public health care system with a big new expense, even for kidneys it now gets gratis (via donations)”
On the contrary, besides everything else to recommend the proposal, it would result in a net financial saving for the US public health care system. From the article:
Emphasis added. I was stunned by that figure of 1% of all federal spending being accounted for by dialysis. Can anyone confirm this?
A very quick Google gives a figure of 3.2% of the UK NHS budget so that 1% sounds about right.
Perhaps more interestingly is the cost per patient seems to be GBP34,000 p.a. So… depending on how long a patient lives either on dialysis or with a new kidney I think the economics of this are interesting and I suspect would favour the state paying for kidneys. Oddly enough that figure of GBP34,000 is quite similar to the USD50,000 tax credits mentioned.
Well the British government is encouraging euthanasia – so I might as well be paid to die. How much for two kidneys, and other organs?
It’s a bipartisan bill that would offer a $10,000 refundable tax credit…
So the Government would pay for the kidney… nice. I thought they would allow people to pay for the kidney they receive… the transaction to be concluded between donor and recipient.
Jacob,
I almost see your point BUT… Charging you less tax is not paying you. You are using the very same argument Greens us about the “subsidisation” of aviation fuel. A subsidy they utterly fail to see with “renewables”. My next door neighbour has just had an air heat-pump fitted because she got cash from HMG. I just hope she doesn’t wind-up like Jack Nicholson at the end of “The Shining” come November. Heat-pumps are an example of obeying the laws of thermodynamics as long as you throw the laws of economics under the electric bus…
Paul,
Depends on the years and the mileage. Just like a Ford Fiesta!
The concept of ‘my body my choice’ seems pretty convincing at face value. However there is the issue then of who picks up the tab if the remaining kidney subsequently has a problem. The existence of socialised healthcare would mean that the benefits of selling your kidney would be privatised while the costs would be socialised. And one suspects that those most incentivised to sell their organs would be precisely the people who aren’t that good at looking after themselves in the first place. I could easily see a scenario whereby the poor sell organs to gain extra cash, then fall back on the welfare and healthcare state to look after them if it goes t*ts up late on. Equally do payments for organs get taken into account when welfare payments are considered? Would such payments be taxed? Not so great if the State takes 20-30% of your kidney cash is it?
Fraser Orr:
There is no moral hazard attached to their participation.
There are numerous moral hazards and obvious potentials for corruption/abuse attached to paying organ donors.
Fraser Orr’s entire post – like many on threads like this – is just a series of poorly thought out sidestepping dodges of reality… especially the reality of human nature.
Nobody is opposing organ sales because they are “icky” – such attempts to belittle those opposed merely backfire by showing how little substance backs up the pitymongering and mau-mauing.
Ah, but it would be a “refundable tax credit” – which means, it comes right off the top of taxes you owe, and if you don’t owe taxes, turns into a government refund check.
One good thing about such an arrangement is the fact that it’s a slow process. The argument that some poor wretch who needs money to make rent will be frantically selling off a kidney is somewhat attenuated by the fact that it would take months – maybe a year – to get paid.
But get ready for the new industry of lawyers and social workers “helping” you through the process for a standard 30%-50% cut. Every governmental program that disburses money always triggers the middlemen and helpers who siphon off a chunk. They are as bad as the commodity traders.
Too late to edit . . . .
I can see that there will be a new “kidney season” – it will be far easier to get a kidney right before tax filing day (April 15th for most) in the USA.
Paid tax preparers will be educated in the process as one more tool in tax avoidance.
“Bring in all of your receipts and documents, and find out your blood type before we meet.”
@Ben David
There are numerous moral hazards and obvious potentials for corruption/abuse attached to paying organ donors…. sidestepping dodges of reality… especially the reality of human nature.
You mean the reality of human nature that some people might make the “wrong” choice and so need the government to rob them of their options to only choose from a menu of approved choices? Me? I think it is better to let people make their own choices and make their own mistakes about their own lives and bodies. My body, my choice just seems to me self evidently true. The idea that the government should take away people’s most basic right to control their own body is utterly repugnant to me. Give them an inch and next thing you know they will start doing really crazy shit like forcing everyone to take untested vaccines or banning people from drinking soda. But maybe I am arguing ad absurdum there. My apologies.
But let’s not forget the real moral hazard of tens of thousands of people who die every year waiting for an organ transplant. They don’t have any choices.
@Jim
The concept of ‘my body my choice’ seems pretty convincing at face value. However there is the issue then of who picks up the tab if the remaining kidney subsequently has a problem.
How many people get kidney disease after donating a kidney? I don’t know, but it surely isn’t very large — and in a world where the kidney shortage was alleviated surely this would be a much lesser issue. However, although I don’t know how many people suffer from kidney disease after donation, I do know that a VAST number of people die from lifestyle choice diseases as is the case in many heart attacks and cancers, COPD, alcohol related liver disease and so forth. If we really are concerned with people’s personal choices costing the NHS too much money I suggest you start shutting down McDonalds, or closing all the bars and ban smoking and vaping entirely. I don’t think the government should do that, in fact I don’t think the government has any right or moral authority to do any of those things. But that is where your argument leads. Taking away people’s choices to reduce the cost of socialized medicine is a very, very slippery slope.
Libertarians have been arguing about the case for commercialising organ sales for a long time. I sometimes think that what worries many is the “ick factor”, as well as the sheer irreversibility of something that can have potentially dangerous consequences for a donor if things go wrong. Sure, this applies to many other transactions we engage in.
A concern that many might have (to try and do a bit of Devil’s Advocacy here) is people who are acting under conditions of extreme financial pressure or even duress, and to ensure that decisions are made in the calmest, least pressured condition. I am not sure how this happens, to be honest.
This is one of those topics where I genuinely struggle to find a clear path forward, even though my libertarian worldview points towards it.
All sorts of short-term decisions can have negative long-term effects. I knew somebody who sold his computer to get out of a financial hole, which crippled his coding ability and employability.
A related issue is blood donation. For whatever reason, many countries still insist on unpaid blood donors instead of paying for it, despite substantial research on the topic.
Worse yet, many of these countries which rely on unpaid blood donation have shortfalls, which they make up by buying blood from countries which do pay their donors!
Utter hypocrites.
As a regular blood donor myself (unpaid in my country), I don’t need the money. But it’ll be a nice incentive for many, and for those of us inclined, we can always redirect that money to a charity of our choice. Two good deeds for the price of one.
@Johnathan Pearce (London)
Libertarians have been arguing about the case for commercialising organ sales for a long time.
Johnathan I am not arguing for the “commercialising organ sale”, what I am arguing for is stopping the government interfering in people’s private business. What I am saying is that people own their own bodies and so it really is none of the government’s business what they do with them. I guess I understand that some people feel an “ick factor” but I find prostitution pretty icky but I still support people’s right to do that if they want — even though it certainly has a chance of being explotitive to the poor — I also think driving a Formula 1 car is dangerous but I think if people want to take the risk then that is their business. As to irreversability? I mean obviously people make irreversable decisions all the time. And it is also worth pointing out that in a world with a free market in organs that organ donation is not necessarily irreversable.
And again, live organ transplants are perhaps 30% of all kidney transplants, and most of those occur because the shortage makes it extremely hard to match people. If we removed the bans of the sale of organs from the recently deceased I don’t doubt the great growth in supply would greatly reduce the need for live kidney transplants. And what exactly is the argument against this?
But I think what gets lost in all this pearl clutching is that every day in the United States about 13 people die waiting for a kidney, 5 people die each day waiting for a liver transplant, and 16 people die each day waiting for a heart transplant, and that is just people on the list. Many, many people don’t even qualify for the list. It is a tragedy of epic proportions and there is absolutely no need for it.
@The Wobbly Guy
As a regular blood donor myself (unpaid in my country), I don’t need the money. But it’ll be a nice incentive for many, and for those of us inclined, we can always redirect that money to a charity of our choice. Two good deeds for the price of one.
In the US it varies by state, but another common thing is the donation of blood plasma (they remove the blood, spin off the cells, mix them with saline and inject them back, just keeping the plasma.) The advantage of this is that you can give plasma two or three times a week, whereas blood you can only give every 6-8 weeks. Last time I checked, they pay about $80 a donation. Blood plasma is, of course, rich in many medically useful substances. Many students supplement their income doing this, again though, it is only legal in some states. $80 an hour is pretty good money. FWIW, I wrote some of the software on those machines — I hope I got it right 😊
The idea that this could be banned? I mean it is just the ick factor gone wild. Nobody is hurt and everybody gains.
As a poor college student 45+ years ago, I bought many cases of beer with my plasma money. Friday afternoons, all the donor chairs would be full in the 40-chair facility. Good times!
I signed up for a NHS medical research thing – as the mobile unit was in the supermarket car park (only a few minutes walk from me) it seemed only right to do so – they gave me endless questions, many of which I could not answer (I have no idea how much I walk a day – and so on) and took blood and so on. They wanted to give me ten Pounds – but I donated it back to them. I felt I had not really done any work.
On the other hand treatment is very difficult to get – for example I have a swelling on my backside, which gives out puss when squeezed, it has been going on for a couple of months. But it does not appear to be possible to make an appointment to see a doctor. It does NOT cause me any pain (unlike my other medical problems) so it will either kill me or it will not kill me.
Such is life.