Ways to Reduce the Kidney Shortage
The United States and many other nations are confronting a heart-rending problem: The number of kidneys available for transplants falls far short of the need.
While some argue that the way to reduce the growing shortage is to pay living donors for kidneys, either in cash or government benefits, there are many ways to increase the supply without paying for human organs, which is prohibited by the 1984 National Organ Transplant Act and generally opposed by the World Health Organization.
In the United States, the number of kidney transplants fell to 14,000 last year, while the waiting list for kidneys currently exceeds 100,000 patients. The average wait time for a transplant has risen to almost five years; more than 4,000 people die each year while waiting and a great many more, possibly thousands, become too sick to undergo transplantation and are dropped from the wait lists.
The first step in easing the shortage is to end the current shameful waste of organs.
Hundreds of kidneys taken from deceased donors that are suitable for transplant are discarded every year, probably more than 1,000 some experts say. Surgeons typically hope to transplant a kidney within 24 hours to 36 hours of the time it is recovered and placed on ice for evaluation. Sometimes the clock runs out before a suitable recipient can be found. The United Network for Organ Sharing, which runs the allocation system, will revise its formulas in December in ways that it believes will increase the utilization of donated kidneys and thus reduce wastage.
Meanwhile, many patients, possibly in the hundreds, who do receive transplants become ill again because they can’t afford to pay for antirejection drugs that can cost more than $1,000 a month; Medicare stops paying for the drugs after three years unless the patient is old or disabled. Congress ought to extend coverage for as long as necessary.
Equally important is increasing the number of people who agree in advance to donate their organs for transplantation or research. Many people already do that through driver’s license check-offs, but a stronger national campaign to get more people to allow donation could help increase the kidney supply.
To encourage more living donors, some disincentives could be corrected. Some experts propose that government agencies or health insurers pay all costs a living donor faces, like travel and lodging for trips to the transplant center for evaluation and then for surgery, dependent care while recovering from the surgery and wages lost while recuperating.
Others want to make sure that donors can jump to the top of the transplant list if they develop disease in their remaining kidney, and also allow their loved ones to jump to the top of the list if they unexpectedly need a transplant. Some say donors should be given government-paid life insurance to cover a death during surgery or later complications from the surgery.
The American Society of Transplant Surgeons and American Society of Transplantation have proposed pilot projects to test the effect of many of these ideas. Most of these proposals seem consistent with the Declaration of Istanbul, a consensus statement adopted in 2008 by an international meeting of experts that aimed to increase the kidney supply while protecting poor people from illegal organ traffickers. But some may skirt close to infringing the federal law.
A few advocates would go further by having state or federal agencies offer benefits to donors, perhaps a tax credit, college tuition, early access to Medicare or a contribution to a retirement fund. But such benefits, though not cash, clearly have monetary value, and raises the troubling issue of inducing people — most likely the poor — to sell their kidneys, which violates federal law.
There are lots of reforms that could be made without resorting to paying for kidneys. Congress ought to hold hearings on the best ways to reduce the shortage and save more lives on the waiting list."