Thursday, November 6, 2014

Further discussion of incentives and kidney donation, including "capitalism as a threat to humanity"

A paper  in the October American Journal of Kidney Diseases by a group of Australian researchers reports on surveys of a sample of transplant docs with predominantly negative opinions about compensating donors, but positive opinions about reimbursing expenses. (I couldn't help noting that one of the negative themes reported views "capitalism as a threat to humanity")

American Journal of Kidney Diseases
Perspectives of Transplant Physicians and Surgeons on Reimbursement, Compensation, and Incentives for Living Kidney Donors
Allison Tong, PhD, Jeremy R. Chapman, FRCP, Germaine Wong, PhD, Jonathan C. Craig, PhDDisclosures
Am J Kidney Dis. 2014;64(4):622-632.

Background: The shortage of donors for organ transplantation has stimulated debate on financial incentives for living kidney donors. This study aims to describe the range of attitudes and opinions of transplant physicians on financial reimbursement, compensation, and incentives in living kidney donation.
Study Design: Qualitative study.
Setting & Participants: 110 transplant nephrologists and surgeons from 12 countries across 43 transplantation units in Europe, Australasia, and North America.
Methodology: Face-to-face semistructured interviews were conducted.
Analytical Approach: Transcripts were thematically analyzed.
Results: We identified 7 major themes. Prioritizing the removal of disincentives for living kidney donors was largely deemed acceptable. By contrast, provision of financial incentives raised concerns about undermining benevolence, compromising human dignity and value, and traversing market forces. Some contended that financial incentives potentially were legitimate if regulated, arguing that this would maximize utility in transplantation, but most also acknowledged the difficulty and that operational feasibility of a regulated system of financial incentivization may be limited.
Limitations: Participants were English speaking and from Western high-income countries; therefore, the transferability of our findings may be limited.
Conclusions: Transplantation specialists believed that minimizing disincentives would support equity and justice in living kidney donation. Direct financial incentivization for living kidney donors, even in the context of a regulated market, was regarded by most as unjustified because of the potential moral consequences and uncertain feasibility. Removing financial disincentives and safeguarding the intrinsic volunteerism, value, and meaning of donation were viewed to uphold integrity in living kidney donation."

Capitalism as a threat to humanity“It's the worst thing ever and that's a complete commercialism and the victory of capitalism over humanity. So I'm very negative about it.” (Male nephrologist, 50s, Europe)

“If you start with compensation and if you start money with different things, the end of the road will be commercialization—will be money and will be I give you kidney and you give me a house, a car—I don't know—sex, money—what you want? So forget it. You don't need to compensate the donors. If you compensate—if you go on these game[s], and you start compensation with different things, at the end of the road, it's money. It's money—it’s commercialization.” (Male nephrologist, 50s, Europe)

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