Why living kidney donors in England should be financially compensated

 Here's an article suggesting why England should pilot a program to compensate kidney donors.  Perhaps the argument is generalizable to other countries as well...

Rodger, Daniel, and BonnieVenter,  A fair exchange: why living kidney donors in England should be financially compensated. Medicine, Health Care and Philosophy (2023). https://doi.org/10.1007/s11019-023-10171-x

Abstract: Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one ‘buyer’—in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the ‘crowding out’ of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England."

They set the stage in their Introduction:

"In 2019, the Human Tissue Act 2004 (HT Act) was amended to allow England to adopt an opt-out system of organ donation, which was subsequently passed as The Organ Donation (Deemed Consent) Act 2019 and implemented in May 2020. This amendment aims to change the way donor consent is given for transplantable organs and tissues. Its intention is to increase the number of organs available for transplantation to save lives and improve the quality of life of those on the wait list. It was estimated by the United Kingdom (UK) Government that this amendment would save 700 lives per year (Dyer 2019). Despite these intentions, this amendment is unlikely to make a significant difference to the number of available organs.

"Currently, there is no definitive evidence to suggest that merely adopting an opt-out system will increase the pool of available organs (Etheredge 2021). Nevertheless, even if the pool of organs were to increase, it is not necessarily a panacea. Spain, though not strictly an opt-out system because it does not have an opt-out register (Etheredge 2021), is considered the gold-standard system for organ transplantation. But despite their success, Spain still has an insufficient number of organs, a growing kidney transplant wait list, and patients still die waiting for a transplant (Crespo et al. 2021). Kidney transplant wait lists continue to increase despite improving infrastructure, education, and the adoption of opt-out systems. Because only around 1% of people who die each year in the UK are eligible to donate their organs (NHS Blood and Transplant, 2022), it is becoming increasingly necessary to consider alternative approaches to increase the number of available organs for transplant."