Talking to Nate always stimulated new ideas and new challenges. Last time I met him, we played soccer in the park with the kids (that was also a challenge but fun and easy to win…). We also talked about an interesting hot ethical topic (It was hard and no winners…). Compensation for living organ donors! A taboo no more but nonetheless remains an ethical dilemma that needs public debate, engaging mainly specialists who care for end-stage kidney disease patients. I thought using Nate’s blog for such a debate will please him, so here we are… My approach will be, what are the facts?
- We have an increasing demand for kidney transplantation that our deceased donor waiting list can’t match. And living donation is not increasing especially when being an organ donor can negatively affect the likelihood of obtaining life, disability and health insurance. This concern is frequently raised by many potential donors.
- Recipients of living donor kidney transplants do better than recipients of deceased donor transplants.
- More people are dying on dialysis waiting for a transplant.
- Kidney donation is safe (Ibrahim et al. NEJM 2009)… Trust me, I finally watched a hockey game last week after I saw a Canadian flag in our Lab.
- And for the government (no offense) and the health insurance payers, Matas et al found that a LURD transplant saved $94,579 (US dollars, 2002), and 3.5 quality-adjusted life years (QALYs) were gained.
So no doubt increasing living donation through creating incentives for donors will save lives and money. Also keep in mind that we pay blood donors, plasma and sperm donors, egg donors and surrogate mothers…
What are the ethical hurdles? If we allow direct compensation between donors and recipients, we are turning the poor of our society into providers of body parts to wealthy people.
But what if the compensation is indirect through government agencies, providing donors, for example, with lifetime health insurance or tax deduction and maybe by treating them as the nation heroes which they deserve by the way.
I’ll be happy to hear your comments.