April 2010 – Helen Jaques

Meeting the demand for kidney transplants is a big problem worldwide. In the UK, for example, only 18% of patients waiting on the kidney transplant list and 28% on kidney/pancreas transplant list received a transplant during 2008-09.

Donations from living people only made up 37% of the total UK kidney transplant programme in the same period, and as such this approach represents a key method by which to increase the number of organs available.

But how do you convince someone to just give away a kidney? One very controversial way is to pay donors. Given that kidneys from living donors work so much better than those from deceased donors, even giving donors pretty large payments (for example, $90,000/£58,600) is thought to be a cost-effective way to increase the supply of kidneys available for transplantation.

Unsurprisingly, this approach hasn’t really got off the ground because people are worried about donors blithely selling a kidney without adequately weighing up the risks just to get their hands on some “easy money” or payment disproportionally luring poorer donors. Also, there’s a chance that payments may dissuade altruistic donation or cause potential altruistic donors to request financial compensation.

A study of a hypothetical regulated US market for kidneys has addressed all three of these questions and concluded that “theoretical concerns about paying persons for living kidney donation are not corroborated by empirical evidence.”

The authors surveyed 342 commuters on regional rail and urban trolley lines in Philadelphia County using 12 fictional scenarios in which the risk of subsequent kidney failure in the donor (0.1%, 1%, or 10%), the payment ($0, $10 000, or $100 000), and the recipient of the kidney (either a close family member or the next eligible patient on the waiting list) were varied. Participants responded to each scenario by stating their willingness to donate a kidney on a five-point scale ranging from “definitely would not donate” to “definitely would donate.”

As would be expected, people were more willing to donate to a family member than to a stranger. Lower risk and higher payment also encouraged donation, in particular when the scenario covered donating to a stranger.

More interestingly, incremental household income affected willingness to donate independent of payment – people with a household income of $20,000 a year or less were much more likely to donate than those who earned $100,000 or more. As such, “poorer persons may contribute disproportionately to the supply of organs with or without payment.”

The promise of hard cash didn’t affect people’s perception of the risk involved in living kidney donation: “the magnitude of reductions in willingness to donate associated with increased risk for renal failure was virtually identical across payment levels.” And the effect of a bigger paycheck on willingness to donate was the same across all income strata.

Finally, the introduction of payment for organs did not reduce the level of altruistic donation. “We found no evidence that any of the three main concerns with a regulated system of payments for living kidney donation would manifest if such a market were established,” the authors conclude.

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Halpern SD et al. (2010) Regulated payments for living kidney donation: an empirical assessment of the ethical concerns. Annals of Internal Medicine 152 (6): 358-65. PMID: 20231566

Prime minister Gordon Brown has finally announced the UK general election, which will take place on 6 May 2010. The main political parties have all since gone into overdrive promoting their policies on the campaign trail, trying to guarantee votes for what looks set to be a very uncertain election.

As well as pushing plans on the economy, immigration, the environment and such like, the parties are also making promises regarding health and the NHS. But do you know one party’s policy from the other?

Independent health think-tank the King’s Fund has launched a fun interactive “election check-up” game to test your knowledge of where the three main parties stand on health policy.

Rebecca Gray, director of communications at The King’s Fund, said: “We wanted to inject some fun into our election activities while at the same time promote the more heavy-weight work we do in shaping health and social care policy.

“When we came up with the concept we knew the game would need to be fun and witty, but not too frivolous and definitely hold some informative value. The aim is to hook people into the issues and prompt them to visit The King’s Fund’s site to access our more in-depth resources.”

With dancing, yabbering “bobble head” figures of the leaders of the three main parties, the quiz is certainly entertaining. The quiz also includes plenty of facts I didn’t know. For example, according to a MORI political poll, health is the second most important issue to voters, coming after managing the economy but topping education, unemployment, and immigration.

Shockingly I did quite badly – only four out of seven. Even more outrageously, I didn’t recognize Andy Burnham‘s sultry gaze, but did spot Andrew Lansley‘s steely glare.

How did you get on with the quiz? Are you already fully informed on the Labour, Tory, and Lib Dem health policies? Or, like me, do you need to do some serious swotting before 6 May?

Cash for kidneys might not necessarily be unethical

Election 2010: Do you know your health policies?