Paying for Kidneys: A Good Idea?
Paying for Kidneys: A Good Idea?
Hello. This is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology.
In a recent article in the Wall Street Journal, Gary Becker, a Nobel Prize-winning economist from the University of Chicago, and Julio Elias recommend "establishing a market for organs." Specifically they are referring to kidney transplants. In this article, they suggest that paying between $5000 and $25,000 per kidney would substantially relieve the kidney transplant organ shortage and get many patients off dialysis. These authors describe the increase in the number of patients on waiting lists and time people spend on waiting lists, and, of course, they comment on the number of patients who are on dialysis and die while awaiting transplant.
We are all familiar with the economics, indicating that patients who receive a transplant cost society less and have lower mortality rates. No one quibbles with the benefits of kidney transplants for appropriate patients who are on dialysis, or preemptive transplants for those who have not been on dialysis.
Becker and Elias argue that some form of cash payment to donors would be a way of resolving this backlog of patients with end-stage renal disease who are awaiting transplantation. They do not provide any substantive examples to show that this has been incredibly successful, other than commenting that in Iran, payment for kidneys has apparently had some impact on waiting lists. I am not sure that using Iran as an example is the best we could find in support of this concept.
They do talk about some of the ethical issues that have been raised by others. Is it really moral and ethical to create a market where organs are bought and sold? Does this have a differential impact on the poor vs the wealthy? What are the long-term vs the short-term consequences of doing this? We do not really know.
It is interesting to think about this in an era when we cannot get reimbursement for lifetime immunosuppression for people who have already had kidney transplants. I am not sure that the immunosuppression issue argues for any likelihood of success in setting up a market for kidney transplants.
In an interesting review of the concept and of some of the ethical issues in this regard, published in the December 2013 issue of the Clinical Journal of the American Society of Nephrology, Matthew Allen and Peter Reese discuss some of the challenges and dilemmas involved in offering financial incentives for living kidney donors.
Drs. Becker and Elias conclude their article by mentioning that some might consider a market for kidney organs "repugnant," which I suspect is likely the case, and Allen and Reese comment that there has been very little public support for a market in kidneys for transplantation, and very little support among transplant nephrologists and surgeons.
I am sure you will be hearing about this article. Your patients may be raising the issue with you for discussion. I know that most of our professional organizations are opposed to a market for kidneys for transplantation. The authors of the CJASN article and the Wall Street Journal article propose conducting clinical studies to look at this, so we may be seeing that in the future, although I believe that with some of the ethical, administrative, and legislative hurdles, we will not see this happening anytime soon. In my own opinion, this is probably a good thing, but we will see. Regardless, it is worth reading both articles.
Thanks for listening. This is Jeffrey Berns from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
Hello. This is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology.
In a recent article in the Wall Street Journal, Gary Becker, a Nobel Prize-winning economist from the University of Chicago, and Julio Elias recommend "establishing a market for organs." Specifically they are referring to kidney transplants. In this article, they suggest that paying between $5000 and $25,000 per kidney would substantially relieve the kidney transplant organ shortage and get many patients off dialysis. These authors describe the increase in the number of patients on waiting lists and time people spend on waiting lists, and, of course, they comment on the number of patients who are on dialysis and die while awaiting transplant.
We are all familiar with the economics, indicating that patients who receive a transplant cost society less and have lower mortality rates. No one quibbles with the benefits of kidney transplants for appropriate patients who are on dialysis, or preemptive transplants for those who have not been on dialysis.
Becker and Elias argue that some form of cash payment to donors would be a way of resolving this backlog of patients with end-stage renal disease who are awaiting transplantation. They do not provide any substantive examples to show that this has been incredibly successful, other than commenting that in Iran, payment for kidneys has apparently had some impact on waiting lists. I am not sure that using Iran as an example is the best we could find in support of this concept.
They do talk about some of the ethical issues that have been raised by others. Is it really moral and ethical to create a market where organs are bought and sold? Does this have a differential impact on the poor vs the wealthy? What are the long-term vs the short-term consequences of doing this? We do not really know.
It is interesting to think about this in an era when we cannot get reimbursement for lifetime immunosuppression for people who have already had kidney transplants. I am not sure that the immunosuppression issue argues for any likelihood of success in setting up a market for kidney transplants.
In an interesting review of the concept and of some of the ethical issues in this regard, published in the December 2013 issue of the Clinical Journal of the American Society of Nephrology, Matthew Allen and Peter Reese discuss some of the challenges and dilemmas involved in offering financial incentives for living kidney donors.
Drs. Becker and Elias conclude their article by mentioning that some might consider a market for kidney organs "repugnant," which I suspect is likely the case, and Allen and Reese comment that there has been very little public support for a market in kidneys for transplantation, and very little support among transplant nephrologists and surgeons.
I am sure you will be hearing about this article. Your patients may be raising the issue with you for discussion. I know that most of our professional organizations are opposed to a market for kidneys for transplantation. The authors of the CJASN article and the Wall Street Journal article propose conducting clinical studies to look at this, so we may be seeing that in the future, although I believe that with some of the ethical, administrative, and legislative hurdles, we will not see this happening anytime soon. In my own opinion, this is probably a good thing, but we will see. Regardless, it is worth reading both articles.
Thanks for listening. This is Jeffrey Berns from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.
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