Dr Arthur Matas, the distinguished surgeon who directs the renal transplant program at the University of Minnesota, is tired of seeing his patients die for lack of an organ transplant. Here's his latest plea to the profession.
A Regulated System of Incentives for Kidney Donation—Time for a Trial!, by Arthur J. Matas, MD, JAMA Surg. Published online June 2, 2021. doi:10.1001/jamasurg.2021.1435
"In the past 2 decades, numerous attempts have been made to increase the number of both living donors (eg, nondirected donors, paired exchange) and deceased donors (eg, donation after circulatory death), yet there has been little change in the number of donated kidneys. With increasing need but limited supply, the waiting list for a transplant has grown and waiting times have increased, with substantial negative consequences for patients in the US. In the last 20 years, more than 89 000 candidates in the US died while waiting for a kidney. An additional 54 838 were removed from the waiting list because of becoming too sick to undergo a transplant.1
"A regulated system of incentives for donation could provide a sizable increase in the number of kidneys available for transplant. Yet incentives for kidney donation are illegal in the US. Proposals for a regulated system have existed since the 1980s. But, in addition to other objections to changing the law (discussed later in this article), the constant refrain has been “let’s see if this next innovation works first.” Although the previously described innovations have been important advances, none have significantly reduced the waiting list. Given the ongoing failure to provide the best treatment option for a large segment of the patient population, it is time to move forward with trials of incentives.
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"Trials of incentives for kidney donation may not be successful. Yet while trials have been prohibited, donation rates have been stagnant and wait-listed patients are dying or becoming too sick to undergo a transplant. The American Society of Transplantation and the American Society of Transplant Surgeons have endorsed moving toward pilot projects of incentives.3 The US government, recognizing the benefits of transplant, recently initiated incentivization of providers for directing kidney failure patients to transplantation9 and provided lifetime coverage for immunosuppressive drugs.10
"It is time to move past the feelings that incentives are wrong to the reality that as a result of a potentially preventable shortage of organs, patients on the waiting list are dying or becoming too sick to transplant. We need to act to determine if we can improve outcomes for these patients while providing benefit to, and not harming, incentivized donors. It is time for professional societies and patient groups to advocate for changing the law to allow trials of incentives for donation."
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