Cash for kidneys might not necessarily be unethical

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

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1 Comment

  1. It was also concluded that the study done was seriously flawed. The 342 people interviewed were all waiting at railway stations. Not many poor people could even afford a train ticket or tram ticket so a huge portion of very low paid people was missing from the study. Also there was a high percentage of people who said they would donate for no money. That begs the question – why haven’t they? It was concluded that many people said what they thought either put them in a good light or what they thought the interviewer wanted to hear.

    I am undergoing evaluation to donate to a stranger – with no money exchanging hands. If I was to be offered money for my kidney I would refuse it. The thought that I got paid to save someone’s life just does not sit at all well with me, and I just could not do it. Get paid out of pocket expenses, yes. Travelling costs etc etc. But to make a profit to save a fellow human being … no way.

    Having said that, I can fully understand and accept that someone who has next to no money at all, living in a hovel, no job, family to support and does not know where the next meal will come from or how they can afford to buy their kid some shoes so they are not walking around in bare feet … would find it easy money to exchange a kidney for money which will help get their family from digging deeper into the poverty trap.

    I believe there are other options to encourage people. In the USA say, where there is no NHS, people could be given lifetime health insurance as well as out of pocket expenses which could also mean loss of wages compensated for.

    I think we in the UK could also look to Spain who has the highest rate by far of cadaver kidney donors. When I say highest, I mean highest in Europe; higher than in the USA even – the donor rate in Spain reached 34.2 per million inhabitants. Twice the European Union average (16.8), well above the USA (26.6), Germany (15.1) or in England (13.2). Note we are down the bottom of the list. Other countries could learn a lot from Spain. In Israel those who have signed the organ donor register are given priority when it comes to receiving an organ, thus encouraging people to sign up.

    Iran recently started to pay donors around $1,200 to donate plus giving them a years health coverage. the amount of money given I am sure just about compensates them for out of pocket expenses and recovery time etc etc.

    But to pay huge sums of money such as around £60,000 is asking for trouble

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