Compensation for kidney donors, reconsidered in Value in Health

Here's a paper and a commentary in the journal Value in Health, focusing on the possibility of reducing deaths from kidney failure by offering some form of  regulated compensation to kidney donors. They point out that the potential effects of such a policy are very much greater than than we have so far achieved through uncompensated donation and kidney exchange

McCormick, F., Held, P.J., Chertow, G.M., Peters, T.G. and Roberts, J.P., 2022. Projecting the Economic Impact of Compensating Living Kidney Donors in the United States: Cost-Benefit Analysis Demonstrates Substantial Patient and Societal Gains. Value in Health. Volume 25, Issue 12, December 2022, Pages 2028-2033

Their paper begins as follows:

"Losing the War Against Kidney Failure

"Economics Nobel Laureate Alvin Roth has played a crucial role in developing paired kidney donation, which is currently saving >1100 US patients with kidney failure per year from suffering on dialysis and dying prematurely. Nevertheless, Professor Roth often points out that this is a victory in a war that we are losing.1 The number of patients diagnosed with kidney failure each year in the United States is not only much greater than the number who receive kidney transplants; it is rising at a faster rate.2,3 Thus, the number of patients diagnosed with kidney failure who are fated to suffer on dialysis for an average of 4 to 5 years while their health steadily deteriorates until they die prematurely has trended upward and is now >100 000 per year.

"How to Win the War

"Many researchers have argued that the government can substantially increase kidney donations and transplants by compensating living kidney donors.4, 5, 6, 7 Indeed, there is virtually unanimous agreement in the transplant community that the government should remove all financial disincentives to kidney donation.8 This study extends that line of reasoning to its logical conclusion by asking (1) how many patients diagnosed with kidney failure each year could avoid suffering on dialysis and premature death by receiving one or more kidney transplants and (2) what level of government compensation of donors would be needed to induce this number of donations."

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The paper was preceded in the issue by this commentary:

Garrison, Louis P. "Paying for Kidneys: Reflections on Welfare Economics, Political Economy, and Market Design." Value in Health 25, no. 12 (2022): 1925-1928.

The commentary begins this way*:

"British philosopher Janet Radcliffe Richards at the University of Oxford has written: “If you die through mistakes in moral reasoning, you are just as dead as if you die through mistakes in medicine.”1 The aim of the authors of this thought-provoking cost-benefit analysis is to estimate and inform us about the cost to American society of the limits—perhaps owing to mistakes in both moral and economic reasoning—on the ability of healthy individuals to donate or supply their second or “extra” kidney to those who have kidney failure.2 The 1984 National Organ Transplant Act makes it unlawful to share anything of value between organ donor and recipient, prohibiting exchange for “valuable consideration” (meaning, specifically, payments beyond “reasonable” expenses for removal, implantation, etc)."

*It also includes this great parenthetical aside:

"(As an aside, our health economics and outcomes research field should pay more attention to “market design:” a good place to start is a visit to the blog of Roth30.)"

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The commentary also refers to the symposium I blogged about below at the University of Chicago, which you can follow on video:

Friday, July 15, 2022

The Future of Living Donor Kidney Transplantation (videos)

On May 7, 2022 the University of Chicago hosted a Symposium on "The Future of Living Donor Kidney Transplantation: Evolving National Perspectives in Kidney Transplant "

HT: Philip Held