Showing posts with label compensation for donors. Show all posts
Showing posts with label compensation for donors. Show all posts

Friday, July 31, 2026

Delayed feedback on a controversial talk--and some positive signals of potential for change

 One feature of giving talks to unfamiliar audiences is that you only get noisy feedback on how your talk was received.  This past June, I gave the Starzl Lecture at the American Transplant Congress in Boston. (The ATC is jointly organized by the two big American transplant societies, the AST and the ASTS,*)  I spoke to an audience of about 1500 people (just a guess, but I could see some empty seats in an auditorium set up for 2,000).  My talk included topics, including global kidney exchange, that have raised controversies.  

Afterwards, what seemed like a lot of people came to speak to me, and were enthusiastic about my talk.  But "a lot of people" was fewer than 100. So what about everyone else? (It probably wouldn't be statistically kosher to assume that those who came to congratulate me were a representative sample:)   

Since global kidney exchange has led to some people calling me an organ trafficker, I didn't have any measure of the general sentiment of the meeting.

I got some reassuring news recently when the ATC sent out an email soliciting ideas for talks for next year's meeting, in Seattle.  The email came with a picture from this oat meeting:

 

 So I'm guessing this means that my talk was well received by people responsible for organizing the next meeting.

And, indeed, I'm getting multiple signals that there's an appetite for productive change in the transplant community.  I hope to have more to say about that in the coming year.

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*Acronyms:

ATC American Transplant Congress 

 AST American Society of Transplantation

ASTS American Society of Transplant Surgeons 

Thursday, July 30, 2026

American Red Cross Declares Second-Ever National Blood Supply Crisis

 Voluntary donation of whole blood in the US has provided adequate supply for many years, but since Covid it has sometimes come close to a shortage, and now we have a second declared shortage.  This contrasts with blood plasma, which  includes supply from paid donors.

American Red Cross Declares Second-Ever National Blood Supply Crisis, Urges Immediate Blood Donations 

I think the graphic is meant to show that the US is running near empty on blood (not that the shortage is only in Southern states...) 

 

 "The American Red Cross has declared only the second national blood supply crisis in its history after blood donations fell to a four-year summer low, deepening an emergency shortage that threatens the availability of lifesaving blood for patients across the country.

Despite thousands of people answering the call to give, blood donations are not keeping pace with hospital demand — which is up during the summer trauma season. Extreme heat, poor air quality and widespread foodborne illnesses are contributing to lower donor turnout this summer, further straining the nation’s blood supply.

As the nation's largest single provider of blood products, the Red Cross now has less than a one-day national supply of type O positive blood — the most commonly transfused blood type. To help ensure blood is available for patients facing the most critical, life-threatening emergencies across the country, the Red Cross has begun limiting distributions of type O blood to individual hospitals."

Wednesday, July 22, 2026

Surrogacy: a political scandal in Germany, and fertility tourism around the world

 Here's a story in the NYT, covering an uproar that's been in the German newspapers for a week or so now.  A leader in the German governing coalition announced on social media that he and his husband had welcomed a new baby into their family, born via surrogacy in the U.S.  But surrogacy in Germany is not legal, so this was a "for me but not for thee" hypocrisy moment there. (In general it's hard to ban effectively something that is legal in other jurisdictions: someone could write a book about that.)

Uproar Over Surrogate Baby Prompts German Official’s Sudden Resignation
Jens Spahn, a top leader of Chancellor Friedrich Merz’s party, resigned his post after announcing that he had a baby by surrogate, which is illegal in Germany. 
  By Jim Tankersley

"Mr. Spahn, 46, the leader of the party in Parliament, is a former federal health minister who has forged deep ties to the Republican Party under President Trump, including attending the 2024 Republican National Convention.

...

"Mr. Spahn stirred national outcry this week when he announced, on social media and in the tabloid paper Bild, that he and his husband, Daniel Funke, had become fathers to a son via a surrogate in the United States.

"Surrogacy is prohibited under German law. Mr. Spahn had defended that ban throughout his career, including as health minister.

"The birth announcement brought immediate cries of hypocrisy from across the political spectrum, including in Mr. Spahn’s own party. Some regional leaders of the Christian Democrats demanded his ouster. News outlets teemed with outrage. 

...

"Mr. Spahn defended himself, essentially, on a technicality: German law does not punish parents who use surrogates abroad. He told a podcast interviewer he had struggled with the decision but chose to prioritize his family." 

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Here's a related story: German couples in need of surrogacy are not the only ones, and the US is not the only destination.

The Guardian reports:

Rise in overseas surrogates ‘increases risk of stateless babies’
Calls grow for global regulation as rising numbers of westerners use surrogates in countries with different laws
  by Jessica Murray and Rachel Hall

"The rise in the use of surrogates abroad is leaving more babies at risk of becoming stateless, experts have said, amid growing calls for urgent global regulation of the practice.

"The warning follows the suspension of a 15-year effort by The Hague Conference on Private International Law (HCCH) to establish a global surrogacy convention, which was paused due to divisions among member states. 

...

"UK surrogacy agencies argue that an outdated legal framework at home is pushing couples to seek surrogates abroad, where regulations to protect surrogates from exploitation can be less robust or do not exist at all. Anti-surrogacy campaigners say the practice is fundamentally abusive in all cases and are pushing for a global ban.

"Prof Michael Hellner, who chaired the HCCH working group, said hugely differing opinions on the ethics of surrogacy between the member states involved meant the project to create a global framework on legal parentage in surrogacy cases had proved impossible.

...

"Experts said statelessness could happen in cases where a country does not automatically grant nationality to a child born there, and where surrogacy is not legally recognised in either the country of birth or the child’s final destination.

"Hellner said the project had proved difficult when some countries were “violently opposed to anything that could be seen as legitimising surrogacy, which they think is a violation of human rights and dignity”. 

...

"Most of these children were born abroad, mostly in the US, Ukraine, Nigeria, Georgia, Colombia and Mexico. British people using surrogates abroad to have babies are forced to apply to the UK family courts for a parental order to become the legal parents of their child and, in some cases, also need to apply for British citizenship for the child." 

Friday, July 3, 2026

“Voluntary, Unpaid, and Handsomely Rewarded: Donor Benefits in the World's Whole-Blood Systems,” by Krawiec and Roth

 Around the world, "non-compensation" of blood donors allows for a variety of incentives.

Kimberly D. Krawiec and Alvin E. Roth, “Voluntary, Unpaid, and Handsomely Rewarded: Donor Benefits in the World's Whole-Blood Systems,” SSRN, Virginia Law and Economics Research Paper No. 2026-12,  1 July 2026, https://papers.ssrn.com/sol3/papers.cfm?abstract_id=7030818  

 Abstract
The ideal of the unpaid blood donor is nearly universal; the practice is more complicated. Whole-blood systems around the world preserve a formal commitment to voluntary, nonremunerated donation-and then provide donors with gift cards, sweepstakes entries, cash "expense allowances," paid leave, tax relief, priority service, medals, and, in some places, extra points on a child's school exam. This Essay maps the gap between label and practice. Drawing on examples from thirteen countries spanning five continents, it organizes donor benefits by institutional mechanism: gift cards and sweepstakes; direct monetary transfers; paid work leave; other material and recognition-based benefits; and replacement donation and the informal cash markets it can generate. We demonstrate that "voluntary, nonremunerated donation" frequently coexists with substantial material benefits. Whole-blood donors nearly always receive something of value in exchange for their generosity; what varies is how those benefits are structured, funded, routed, and legally classified. 

 

Jurisdiction

Representative donor benefits

Legal classification / routing

United States

Nontransferable gift cards; sweepstakes (e.g., Super Bowl LX trip; $5,000–$7,000 raffles); promotional items (shirts, mugs, bags, movie tickets).

“Volunteer donor” label retained where benefits are not readily convertible to cash; sweepstakes framed as “no donation necessary.”

South Korea

Promotional K-pop photo cards; vendor and restaurant vouchers (5,000–8,000 won); merchandise; transferable blood-donation card.

Prohibited “consideration” distinguished from “commemorative gifts” and donor encouragement.

Kazakhstan

~$18.75 (2 MCI) for reimbursable donation; ~$2.34 meal equivalent for gratuitous donation.

Categorized as payment; reimbursable donation invited for shortages and rare types.

Bulgaria

Payment in narrow statutory cases (shortage, vaccine/serum/immunoglobulin production, research/diagnostics).

Voluntary/unremunerated rule with “against payment” exceptions.

Germany

Direct monetary transfers at some collection centers; refreshments and health checks only at DRK.

Aufwandsentschädigung” (expense allowance), set per collection service.

China

Family exam-point awards (Pujiang: 1–3 points); platelet shopping cards $31–$386; paid leave, tax benefits; prepaid phone/transport cards, movie tickets.

“Gratuitous” system plus “appropriate subsidies”; tolerated monetary-equivalent and family-directed rewards.

South Africa

Data/streaming vouchers, raffles, merchandise; private wellness rewards (Discovery Vitality, Momentum, Bonitas).

Donor benefits supplied through blood-service promotions and private wellness programs.

Brazil

One paid day off per 12 months (private employees); donation-day leave (public servants); 120-day priority service at banks, hospitals, etc.

Donation converted into paid-leave entitlement and legally recognized priority status.

Spain

Donor medals, honors, and milestone recognition.

Recognition-based; no direct monetary transfer.

India

Replacement donation; illicit “professional donor” cash market.

Patient-side payment associated with replacement donation.

Nigeria

Tokens, certificates, badges, transport refunds; in practice 68% family replacement and 12.2% commercial donors.

Patient-side payment associated with replacement donation; commercial donors openly reported in donor categories.

Sierra Leone

Predominantly family replacement donors (~90%); paid donors recorded as replacement donors.

Patient-side payment associated with replacement donation; paid donors recorded as family replacement donors.

Argentina

Post-donation meal; medical certificate; 24-hour work-absence justification; 2026 shift away from replacement model.

Statutory donor benefits plus replacement-donation phase-out.

 

"If there is a lesson in this tour of the world’s whole-blood systems, it is that “voluntary, nonremunerated donation” is a phrase asked to carry a great deal of freight. It accommodates a $7,000 gift card, so long as the gift card is offered through a sweepstakes that does not require a blood donation to enter. It accommodates €60 in cash, so long as the cash is legally categorized as an expense allowance. It accommodates extra points on a child’s high-school entrance exam, paid leave, free public transit, priority service at the bank, and a tote bag—often all while the governing statute insists that blood may not be given for reward. "

Monday, June 15, 2026

Horsemeat, Prostitution and Kidney Sales, interview by Peter Coy

 Peter Coy interviewed me about Moral Economics for his substack Economics for Everyone.

You can find the video and the transcript at this link: 

Horsemeat, Prostitution and Kidney Sales  by Peter Coy 
"Nobel laureate Al Roth tackles them all in a fine new book. I interviewed him."

"I asked Roth if he’s a libertarian, since libertarians say people should be free to do what they want as long as it doesn’t hurt others. No, Roth told me.

“People who call themselves libertarians often don’t like market regulation of any sort, but I’m a market designer,” Roth said. “I think that good regulations help markets work well.”

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 Peter C. interviewd me once before:

Tuesday, February 6, 2024

Kidney exchange (and other bits of market design) in the New York Times

Peter Coy, the veteran New York Times economics columnist, writes about kidney exchange, after an interview/conversation sparked by a recent working paper of mine, Market Design and Maintenance. (He's a rare economic journalist who reads economists' papers.)

Here's his column, published yesterday afternoon:

The Economist Who Helped Patients Get New Kidneys, Feb. 5, 2024, 3:00 p.m. ET, By Peter Coy

He's also a rare interviewer: his column includes the names of more of my coauthors than I can recall in any other interview. In order of appearance: Tayfun Sonmez and Utku Unver, Frank Delmonico, Susan Saidman, Mike Rees (implicitly) when he names Mike's nonprofit Alliance for Paired Kidney Donation, and Elliott Peranson.  Market design is, after all, a team sport."

 

Monday, June 1, 2026

The American Society of Transplantation prepares to consider a pilot study of financial incentives for living organ donation

 As I prepare to speak later this month at the American Transplant Congress in Boston, I note that  the American Society of Transplantation (AST) has, among its Key Position Statements  one from late last year called A Roadmap for Removing Disincentives for Living Organ Donors 

As the title suggests, the statement focuses on removing financial disincentives for organ donation. 

But I'm struck by the last item on the list:

"Additional Steps
"In advocating for the elimination of disincentives to living donation, AST will examine, in parallel, the legal,ethical, and practical considerations involved in a pilot study of financial incentives for living organ donation."

  

Wednesday, May 27, 2026

Survey of economists, concerning Living-Donor Kidney Transplants

Romesh Vaitilingam writes to draw my attention to the recent survey of economists, concerning Living-Donor Kidney Transplants, conducted by the Clark Center for Global Markets at Chicago Booth.

He says 

" I’m writing now as I thought you might be interested in the results of this survey, which was inspired by reading your recent Wash Post column."*

Below are the three questions they asked, and the results to each one. At the survey link above you can find the responses of the individual economists surveyed.

 

 

 Only one economist appeared to be skeptical about kidney exchange, and I was surprised at who it was (respondents may answer these questions very quickly...).

 

The next question concerns the End Kidney Deaths Act, which was introduced to the respondents at these links:

"There is draft legislation in Congress to increase the supply of human kidneys by encouraging donations to strangers: https://www.congress.gov/bill/119th-congress/house-bill/2687

"It is summarized here: https://www.hawaiibusiness.com/bipartisan-bill-aims-to-prevent-kidney-deaths-by-compensating-donors/ "

 

 

 The End Kidney Deaths Act gets a good deal of support (above) while an unspecified decentralized market gets considerably less support, below.

 

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*Earlier posts

Friday, May 8, 2026 It’s time to carefully but urgently rethink payments to kidney donors. My op-ed in the Washington Post