To the Editor The End Kidney Deaths Act
(HR 2687) is a data-informed, ethically grounded proposal developed by
nondirected kidney donors (individuals who donate kidneys to strangers)
to address the persistent shortage of transplantable kidneys. Backed by
38 organizations,1
the End Kidney Deaths Act will provide a $10 000 annual tax credit for 5
years (totaling $50 000) to individuals who donate a kidney to a
stranger. The End Kidney Deaths Act has the potential to increase living
kidney donation, save lives, and reduce taxpayer costs.
In their Viewpoint,2
Dr Mueller and colleagues argue that the End Kidney Deaths Act risks
irreversible harm to organ donation. However, we believe their
objections are speculative and lack empirical support, while the urgency
of the organ shortage demands action. Nearly 100 000 patients remain on
the transplant waiting list, and living donation has stagnated for more
than 2 decades. The End Kidney Deaths Act offers a novel,
government-regulated model to responsibly compensate donors, ensure
donor safety, and help close the widening gap between organ supply and
demand.
Mueller and colleagues state that “[p]roviding tax
credits to nondirected donors is unlikely to significantly reduce the
organ shortage.” However, compensation has increased participation in
gamete donation, plasma donation, and surrogacy. Their statement
regarding “exploitation of vulnerable donors” overlooks the End Kidney
Deaths Act’s regulatory framework, which we believe preserves ethical
standards while reducing reliance on illicit markets.
The assertion that countries with compensation see fewer
voluntary donations is not applicable. No country has implemented a
model like the End Kidney Deaths Act, and, in our opinion, comparisons
with unregulated programs abroad are misleading. Mueller and colleagues
also warn that paid donors often regret their decision. The majority of
respondents in 2009 and 20153
American Society of Transplantation and American Society of Transplant
Surgeons member surveys, and in 4 public surveys, most recently in 2019,4 supported pilot programs for donor compensation. A recent National Kidney Donation Organization survey reported that 97.9%5
of respondents would still donate under the End Kidney Deaths Act.
Historically, 95% of US living kidney donors say they would donate
again.
Mueller and colleagues suggest that legal compensation
will worsen global exploitation. However, the current prohibition and
organ shortage have not prevented unethical practices, they have merely
driven them into illicit, underground markets. A transparent US model
would set a global ethical precedent, demonstrating how regulated
compensation can be ethically implemented. Although other solutions have
been proposed by the authors, none have meaningfully addressed the
shortage. Maintaining the status quo leaves tens of thousands vulnerable
to suffering and dying.
We urge rigorous, empirical engagement with the
legislation’s potential rather than reliance on speculative concerns.
The End Kidney Deaths Act is a practical, evidence-based policy that
could help reduce preventable deaths.