Surgeons remove a kidney from a living donor for transplant into another person. New research finds that paying donors $10,000 could cut costs compared with keeping patients on dialysis.
Paying living kidney donors $10,000 to give up their organs would save money over the current system based solely on altruism — even if it only boosts donations by a conservative 5 percent.
That’s according to a new analysis by Canadian researchers that rekindles the ongoing debate about whether it’s practical — and ethical — to offer financial incentives for human body parts.
“We have a problem. We don’t have enough organ donors coming forward,” said Dr. Braden Manns, an associate professor and clinical professor in nephrology at the University of Calgary. He led the new study published Thursday in the Clinical Journal of the American Society of Nephrology.
“We need to figure out a way to solve that problem. We shouldn’t throw out, out of hand, solutions that could increase donations.”
But other kidney experts say that even if it’s cost-effective to pay people for organs, the moral issues the practice generates might backfire.
“Sometimes these things have unintended consequences,” said Dr. Stephen Pastan, a board member for the National Kidney Foundation and a transplant surgeon at Emory University in Atlanta. “If we paid $10,000, a lot of altruistic donors would say that it’s just a cash transaction. Donations could go down.”
Right now the question is theoretical. In the U.S., Canada and other countries — except Iran — paying people to donate organs is illegal.
Still, Manns and his team wanted to find out if offering financial incentives would save money over the current system of keeping people on kidney dialysis for years. They compared cost data from a cohort of kidney patients identified in 2004 and followed them for three years.
They determined that paying living kidney donors $10,000 apiece would save about $340 per patient, compared with the ongoing costs of dialysis, and would also provide a modest boost of .11 in quality-adjusted life years, or QALY scores, a measure of the quality and length of life. (The money would come from an independent third-party entity, like the Canadian Blood Services or perhaps through OPTN in the U.S., Manns said.)
Those figures are based on what Manns called a “very conservative” assumption that financial incentives would boost kidney donations by 5 percent. If donations actually rose by 10 percent or 20 percent, the cost savings would jump to $1,640 and $4,030 per patient, respectively.
“It’s a substantial gain for the people who get the individual transplant,” said Manns, and a system-wide gain when multiplied by the thousands of people on kidney transplant waiting lists.
In the U.S., for instance, more than 98,000 people are waiting for kidneys, according to the Organ Procurement and Transplantation Network, or OPTN. Last year, more than 4,500 people in the U.S. died waiting for kidneys. Meanwhile, the number of kidney donors has fallen steadily for the past several years, to 13,040 in 2012, despite the growing need, figures show.
In Canada, the issue is the same: Wait lists of two to three years, and about 30 percent of patients die while waiting, Manns said.
“The obvious question, the elephant in the room is, ‘Why don’t more people donate?’” Manns said.
Related: Opinion: Why selling kidneys won't work
The new research follows a recent survey of 3,000 Canadians by Manns and his colleagues. It found that about 70 percent of members of the general public thought that some form of compensation for organ donation would be OK, but that only 25 percent of transplant doctors agreed.
The same survey found that about half of people who said they wouldn’t be likely to donate an organ changed their minds if the deal included a $10,000 payment.
While Manns’ study focused on paying all donors directly, others have previously suggested offering incentives that might include compensation for health costs, a break on life and health insurance or even tax relief for kidney donors.
The idea of compensating people for their organs doesn’t sit well with Lora Wilson, 53, of Pittsburgh, Pa., who donated a kidney in 2006 to a 71-year-old grandmother in New Jersey.
“For me, I just don’t like the idea that body parts are for sale,” said Wilson, who is director of an orthopedic group. “You may start with a $10,000 incentive, but what’s to say someone of means wouldn’t say, ‘I’ll pay $100,000?’ I don’t feel very comfortable with it.”
There are also questions of whether financial incentives would coerce poor and vulnerable people into donating for money, despite medical risks, Pastan noted. But a 2010 study by Scott Halpern, a bioethics expert at the University of Pennsylvania, found that many of the fears that financial incentives could cloud a person's decision about donation weren't actually true.
All of these issues are part of a decades-long debate about paying for organs, a conversation that stalls because no one really knows what effect incentives would have, experts say. In the U.S., the National Organ Transplant Act of 1984 expressly prohibits selling organs and a Senate report that accompanied it warned that "human body parts should not be viewed as commodities."
In an editorial accompanying Manns’ study, two University of Pennsylvania researchers, Dr. Peter Reese and medical student Matthew Allen, argue that “the time is ripe” to at least consider studying the real-world impact of incentives.
They’re proposing a research agenda and a limited-scope trial that would finally answer lingering questions about paying for body parts.
“We really don’t know how big the opportunities are here and we really don’t know the risks,” Reese said.
JoNel Aleccia is a senior health reporter with NBC News. Reach her on Twitter at @JoNel_Aleccia or send her an email.
First published October 24 2013, 2:01 PM