Incentives can save lives (Washington Post op-ed with Congressman Cartwright)

The Washington Post published this week an opinion piece I coauthored with Congressman Matt Cartwright of Pennsylvania, in support of the new legislation he has proposed, H.R.6448 - Organ Donation Clarification Act of 2018.

Our piece ran under the headline
Student loan forgiveness and other incentives could save lives. Here’s how.
By Matt Cartwright and Al Roth
October 25
Matt Cartwright, a Democrat, represents Pennsylvania’s 17th District in the House. Al Roth, a professor at Stanford University, won the 2012 Nobel Prize in economics.

Here's the text as in ran in the paper:

"Every day 20 Americans will die waiting for an organ transplant, 13 of them waiting for a kidney. Hundreds of thousands will undergo painful and debilitating dialysis treatments to extend their lives in the hope that a kidney will eventually become available.

We are quickly marching in the wrong direction. As of mid-October,95,000 people remain on the kidney waiting list. Each year, approximately 17,000 patients are lucky enough to receive a transplant; however, 35,000 new patients are added annually to the national waitlist.

The average wait time for a new kidney is approaching five years , unless you have a family member or friend who can serve as your donor. During this time, your activity will be limited due to your fragile condition, and your schedule will be dictated by four-hour dialysis sessions several times a week. Because of this, 77 percent of dialysis patients are unemployed and reliant on social services.

The pain, suffering and death are overwhelming. And so is the cost: roughly 7 percent of the Medicare budget. Dialysis, on its own, costs Medicare more than $87,000 per patient per year. A kidney transplant, on the other hand, pays for itself in less than two years and saves an average of more than $745,000 in medical costs over a 10-year period, with 75 percent of those savings going to the taxpayers. If the supply of transplant kidneys could be increased to meet the demand, taxpayers would save more than $12 billion per year in medical costs.

Solving the organ and kidney waiting list issue is a true win-win: changing the lives of those suffering from kidney failure while relieving a significant burden on the American taxpayer.

Innovations in science and health-care management have undoubtedly increased donations. Last decade, groundbreaking registries and matching programs were created to allow incompatible patient-donor pairs to join a pool of other patients and donors so that each patient received a compatible kidney. The kidney-exchange model has saved thousands of lives and helped earn one of the co-authors of this article a Nobel Prize in economics.

The kidney wait list is now one and a half times the size it was in 2004, when the New England Program for Kidney Exchange began. This is partly because medical progress extending the lives of those on dialysis has failed to address the fundamental issue of organ failure. Meanwhile, innovation in our approach to transplantation has not kept pace with dramatic increases in the demand for kidneys. We are clearly in need of a new approach. Effective legislation can help solve the problem.

The Organ Donation Clarification Act, introduced by the other co-author of this article, proposes a new and innovative path toward increasing both deceased and living organ donation. The bill clarifies the definition of a “valuable consideration” — cash payments for donation, which are currently prohibited for organ donors — to eliminate misunderstandings and delays in reimbursement for valid donation-related expenses, which have hampered living organ donation. This bill also allows government-run, ethics-board-approved pilot programs to test the effectiveness of providing noncash incentives to promote organ donation.

What might such pilot programs look like? Perhaps a living donor might receive health insurance, forgiveness of student loans, a donation to a charity of choice, a contribution to retirement savings. The family of a deceased donor might get funeral benefits.

We do not know exactly what the effects of incentives would be on organ donation, which is exactly why these pilot programs are necessary. Would they help? What incentives would be most effective? What are the unforeseen circumstances? Let’s allow the scientific community to experiment, test creative solutions and see what might solve this crisis.

Public opinion firmly supports compensating organ donors. The pilot programs under the bill would ensure the noncash incentives would not come from the organ recipient and that organs would be distributed fairly, in the same manner they are now. With those parameters, more than 80 percent of people in a recent national academic study of nearly 3,000 voiced their support for a successful program of compensating organ donors.

There are many factors to consider when tackling the issue of organ donation. We must preserve dignity, avoid exploitation and be careful about incentives. We must ensure that the poor and desperate are not treated unfairly.

We can do this right, and these pilot programs will help us get answers to fix the organ shortage that costs us 20 American lives every day. We can save lives, end suffering and save billions in the process. The time to act is now."
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The bill is is designed to make healthcare more accessable. And it is pro-science as a way for finding out how to do this.  It is likely that it will meet with some opposition ... but it's good to know that we have representatives like Mr. Cartwright who keep trying.