As President Obama focuses on rising costs in his efforts to overhaul the U.S. health care system, Virginia Postrel points to a particularly costly area of health care--dialysis treatment for patients awaiting kidney transpants--and suggests some solutions.
One of those solutions, donor chains, has already arisen with the National Kidney Registry, a small nonprofit that matches willing donors with recipients in need. When someone needs a kidney and his/her friends and relatives don't match (a common occurrance due to blood types and the development of antibodies in "sensitized" recipients), strangers with willing donors can get matched. The registry creates a matrix of people to achieve just that.
But another, more controversial suggestion, is offering financial incentives--paying people to donate kidneys. If Medicare paid for it, Postrel suggests, it could save taxpayers billions.
Providing long-term dialysis--which is covered by law under Medicare to Americans of any age who've made minimum Social Security payments--is costly, to the tune of $100,000 on average per patient, Postrel says. Eliminating the 80,000-patient waiting list for transplants would save taxpayers $8 billion.
If donors got something in return for their altruism--$25,000 or $50,000, for instance--the list would go down faster, saving and vastly improving lives, and saving the government money. Many are vehemently opposed to the idea,: it would corrupt the system, they say, and possibly induce poor people to make bad medical choices in return for the cash.
But if Medicare paid $50,000 to nondirected donors (those who aren't giving to save a particular person, rather to a stranger at the hospital's discretion)--instead of the $100,000 on average for dialysis--it would save taxpayers $4 billion.
It's tough to get organ-donation policy passed in Congress, Postrel notes: often, a lawmaker has to die for a bill to get through, named in the lawmaker's honor. And it's also a controversial argument--but, according to Postrel, it makes both moral and financial sense.
Hi Chris--Virginia's last name is Postrel, not Prostrel.
Chris -- one flaw in our current system is that donors must provide consent, and not everyone thinks (or wants to think) about doing so. Donor organizations believe that instituting an implied consent system would help. Basically, this would change our current opt-in system to an opt-out system -- upon death, everyone would automatically be considered a donor unless they chose NOT to donate. It would definitely increase donations. Often, the decision is made by relatives of the deceased, who must weigh their own feelings against those held by their loved one -- feelings about which they may not even have a clue. As a parent of a child who received a heart transplant, I have to say we feel incredibly fortunate that our donor's parent made a difficult decision during a moment of absolute grief. We were lucky; we wish others could be so, too.
Thanks Mike--sorry for the error. It's fixed.
Chris
As the death toll from the organ shortage mounts, public opinion will eventually support paying for organs. Changes in public policy will then follow.
In the mean time, there is an already-legal way to put a big dent in the organ shortage -- allocate donated organs first to people who have agreed to donate their own organs when they die. UNOS, which manages the national organ allocation system, has the power to make this simple policy change. No legislative action is required.
Americans who want to donate their organs to other registered organ donors don't have to wait for UNOS to act. They can join LifeSharers, a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.
Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. Non-donors should go to the back of the waiting list as long as there is a shortage of organs.
I admire Dave Undis's indefatigable concern with the issue, but LifeSharers has yet to get anyone a transplant--in part because it is 100% focused on deceased donors. The most important paragraph in my article, which also explains why the popular "opt-out" solution AlisonHMS advocates will not solve the kidney shortate, is this one:
To end the list, we first have to give up the idea that “organ donor” means someone dead. Deceased donors are, of course, essential for hearts. But not for kidneys. And not enough people die in exactly the right way to meet the need for kidneys. The best estimate is that there are between 10,500 and 13,800 brain-dead potential organ donors each year. More than half already become donors, and not all their kidneys can be used. If every single person who died the right way became an organ donor, an optimistic estimate would be that 7,000 more kidneys a year would be available for transplant. Since the list is now increasing by 6,000 a year, that would be enough to end it—in 80 years.
Kidney Transplantation is a miracle. I know because my husband received a kidney/pancreas for a deceased donor in 1999 which motivated me to be a non-directed donor in 2006. And if I'm honest and Virginia Postrel is honest, we must admit that until someone we knew and cared about needed one, we gave little thought to those waiting for transplants.
There's no shortage of donor kidneys in the United States-- healthy people have one to spare. There is a shortage of compassion and accurate information about what it takes to donate a kidney. Most of the 80,000 people waiting have someone in their extended circle of family and friends who would willingly and freely donate if they knew what was involved and could get help with expenses related to donation, guarantees of return to work, legal protections to ensure that insurance was not denied, etc. These are ways that the government could help without strapping the already struggling Medicare program.
It's tempting to believe that have Medicare pay for organs would solve the problems of the waiting list, but what this article and many other on the pay for organs bandwagon fail to consider is the fact that 17% of kidney transplants do not last three years, putting patients back on dialysis and assuredly negating the "cost savings" of paying for organs.
Leading to some of this graft failure is the fact that Medicare only pays for immunosuppresant medications for the first three years post-transplant, leaving patients to find their own means or go back on dialysis.
Mr. Hil realistically is planning ahead for his daughters next transplant, and doing what he can to promote kidney donor chains-- a means available right now without changing the whole system. We need to take a multi-faceted and comprehensive approach to solving the complex problems of organ allocation, rather than focusing so much press on the unrealistic proposal that Medicare should pay for organs.
The National Kidney Foundation's End The Wait initiative is a multi-faceted and comprehensive approach to eliminate the waiting list for transplants within 10 years. Learn more at www.kidney.org.
In response to Lora Wilson's point about transplants not lasting long, the study I cite on cost savings takes that into consideration. Also, transplants are more likely to last a long time if they are from living donors, if the donors are well-matched, and if the recipient's health has not deteriorated over years on dialysis. The National Kidney Foundation's "End the Wait Initiative" has a great name but few results so far. The initiatives to cover donor expenses could, however, make a big difference if they caught hold. (I will note that the NKF is actively opposed to any kind of payment, to the extent that it actively tries to suppress discussion of the ideas: http://www.dynamist.com/weblog/archives/002165.html)
Ms. Postrel -
It's clear that we both want the same thing: End the Wait, End the List, the result is the same.
It's difficult for me to understand those who advance paying for donors as the most promising option. In her piece in the Times, your recipient made it quite clear that she did not want to humble herself enough to ask those she knew to help her. She preferred going offshore to seek an arms-length transaction from a stranger. And in fact, she didn't overtly ask anyone for help.
This appears to be a matter of finding someone as desperate for money as those who are waiting are desperate for a kidney. Humbling someone else so I can have what I want, when I want it without any real regard for that person's long term best interest.
Of course, the model outlined in Dr. Satel's book is designed not to appeal to those who are actually poor, offering trust funds and insurance instead of cash. I've forced myself to read it, and the analysis is suspect because, among other oversights, it fails to fully consider the impact of currently legal options and promising programs. For example, the National Organ Donor Collaborative and its successes are barely mentioned.
While living donors are certainly preferred, many recipients (my husband included) do very well for quite long with donations from the deceased. We must continue to do everything we can to encourage this and not lose valuable opportunities.
Until Medicare or other legitimate programs can adequately pay for immunosuppresson, donor complications and donor's transplant related- expenses, the notion of paying for the actual organs is not a viable solution and is in fact a distraction from the types of policies that will reduce the wait today.
In talking with other donors, you've surely found that we've all felt rewarded although we can't measure it by our bank accounts. Things like health and well-being, and a sense of having done the right thing do have real value.
Hi,
i am 30 years old, completely healthy, not Alcoholic ,but i smoke. i am ready to sell my kidney
Contact me at
00971503152488
or
badermourched@yahoo.com
Syrian Man, But right now ,, i live in Dubai ,, UAE
i am not asking for big PRICE like the others
but i badly needed some amount of money ,, that`s why i came up with such decision.
Thank you So much ,,
Bader