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In June, Dick Cass, president of the Baltimore Ravens football team, gave one of his kidneys to an old law school friend. “I was happy to do it,” Cass told the Washington Post, “and he was very grateful.”
Resident Scholar Sally Satel
I have an idea of just how grateful he was because in March, my friend Virginia Postrel gave me her right kidney. I was diagnosed with end stage renal disease in August 2004. In the interim, several friends said they would look into donation (I had no eligible family), but they turned out to have disqualifying medical problems or spouses who objected, or they grew scared. I had been on the national waiting list, which distributes organs from deceased donors, only a year and was about to start dialysis.
In desperation, I briefly considered going overseas to become a “transplant tourist.” I heard of people needing kidneys who turned to advertising: kidney-wanted ads, billboards and Internet sites. Finally, I tried the website Matchingdonors.com. I found a man who said he was willing to be a donor, but he fell through.
Mercifully, Virginia appeared in the late fall of 2005. She lives in Texas, and I live in Washington, D.C. A mutual friend mentioned my situation to her when they met at a conference. Within the week, I received an e-mail from Virginia; the subject line of her message read “serious offer.” Indeed.
I first met Virginia in 1997. I had long admired her writing, but I think we had seen each other in person only six times before the transplant. You could have called us fond acquaintances, not best friends. Everyone I knew was surprised at her decision, but it did not surprise me. I had always thought that my donor, if I found one, would be someone driven by a deep sense of humanity, not by lifelong sentimental friendship.
Unfortunately, many of the more than 68,000 people waiting on the national list will not be as lucky as I was. According to the non-profit United Network for Organ Sharing (UNOS), which maintains the list under contract with the federal government, only 16,477 people received kidney transplants last year. This left tens of thousands to languish on dialysis. In big cities, where the ratio of available organs to needy patients is worst, the wait is up to eight years.
Public education about donation after death has gone only so far. In polls, 30%-40% of Americans say they have designated themselves as donors on their driver’s licenses or on state-run donor registries. As for the remainder, the decision to donate will fall to their families, who are as likely as not to deny the hospital’s request when they do not know their loved one’s wishes. Most important, though, only a small number of the recently deceased–perhaps 13,000 a year–possess organs healthy enough for transplanting.
Without question, the chasm between the numbers of people needing a kidney and those willing and able to donate one will only worsen. This is largely due to a misplaced faith in the power of altruism. The current system expects people–living donors and the loved ones of the deceased–to give a body part and receive nothing in return. In fact, it is against the law to receive money or anything of value in exchange for an organ, a principle set down in 1984 by the National Organ Transplantation Act.
It is time to change the law and permit imaginative pilot projects to increase the number of organs from donors–living and deceased. One of the most promising ideas focuses on the large potential pool of living donors. They could receive cash, tax breaks, guaranteed health insurance, college scholarships for their children, deposits in their retirement accounts, a contribution to their favorite charity and so on.
Who would pay? Medicare is a prime candidate. Each time an individual receives a transplant and is taken off the dialysis machine, about $70,000 is saved annually by Medicare. Charities and private insurers could also serve as payers.
At first glance, the notion of compensating people for kidneys might seem distasteful. For example, some ethicists worry that the rich would benefit at the expense of the poor. But a distribution mechanism that gives each newly obtained kidney to the next well-matched person at the top the UNOS list (as is done today with allocation of cadaver organs) gives no advantage to anyone. Critics also worry about potential exploitation of the donors. One solution here is to require that incentive programs include guidelines for medical and psychological screening, informed consent (perhaps an extended education period culminating in the candidate becoming a “certified organ donor”) and ongoing medical care.
True, compensation will be attractive mostly to low-income people. But how is it unfair to poor people if compensation enhances their quality of life?
I would not dream that a plan for compensating prospective donors should replace altruism. Ideally, they’d exist side by side. There will always be wonderful people such as Virginia. Altruism is a beautiful virtue, but altruism alone cannot solve the organ shortage.
Dr. Sally Satel is a resident scholar at AEI.
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