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Should we buy and sell organs?
It’s illegal to buy and sell organs in the United States, but a new study suggests paying people to donate kidneys could address the chronic shortage of available organs and be more cost effective than the current system.
The idea immediately raises the question; is there a way to buy and sell organs ethically?
In upstate New York alone there are more than 1,300 patients on the waitlist for a donated kidney. Some have been on that list for more than four years.
According to Rob Kochik, executive director of the Finger Lakes Donor Recovery Network, there are about 120,000 patients on the waiting list for an organ transplant nationwide. And, he says the majority of those patients need a kidney.
“Well over 80,000 patients today are waiting for a kidney transplant," Kochik says. "And that speaks to our aging population as well as the incidents of hypertension and diabetes that are the primary causes of kidney failure."
The study published in the Clinical Journal of the American Society of Nephrology suggests offering $10,000 to living donors would boost the number of available kidneys and save the health care system money.
Kochik says from a purely economic standpoint, higher transplant rates are preferable because they mean fewer patients are being treated with dialysis, which is an expensive therapy often paid for by the government.
“A kidney transplant pays for itself within about one to two years because any patient who receives a kidney transplant will no longer need either hemodialysis or peritoneal dialysis,” Kochik says.
Dr. Richard Demme, medical ethicist at the University of Rochester Medical Center, agrees that financial incentives could be cost effective. He says higher donation rates would also dramatically lift the quality of life for many patients with kidney failure.
But, Demme says legalizing the sale of organs would raise huge ethical issues.
“What we would find, I think fairly rapidly if organ sales were to become legal, that by and large the sellers would be generally those who are more economically desperate and the recipients would be those who could afford to pay the most,” Demme says.
Demme says he supports living kidney donations, but offering money changes the motives for donation and creates risks for donors and physicians alike.
“Yes, there may be some benefits for somebody else, but we’re taking somebody who’s otherwise healthy and putting them at risk, and part of our charge is to first do no harm," Demme says. "So we have to be really cautious.”
Rob Kochik from the Finger Lakes Donor Recovery Network says financial incentives might be problematic, but changes to the current process need to be made.
“I think it speaks to us needing to be creative as to how we can increase and encourage everyone to consider being a donor and, perhaps even more importantly, removing some of the disincentives,” Kochik says.
According to data from the United Network for Organ Sharing, New York state has one of the highest kidney donation rates in the country. But, there are still 8,491 patients on wait lists across the state.
Kochik says more education is needed to encourage people to consider organ donation. He says it’s important for people to ensure they document any desire to have their organs donated when they die, and anyone who is interested in being a living donor should seek more information from their local donor center.