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Kidney failure: Preview of a 4-part series

Part 4: The ethics of kidney donation: Two views

By ARTHUR MATAS

Last update: October 05, 2009

By Dr. Arthur Matas

Current law prohibits incentives for kidney donation. Yet there are powerful reasons to think that this should change. The average wait time for a deceased donor kidney is more than five years, and in many parts of the country it is approaching 10 years. We are reaching the point where someone in need of a kidney has a 50-50 chance of dying before receiving one. Starkly put, each day about 13 people on the wait list die before receiving a transplant.

As a transplant surgeon, I see first hand the need for a better system. In spite of this tremendous need, and in spite of decades of public appeals, the number of organ donors has been practically stagnant for years, and actually has decreased recently.

Patients dying for want of organs is only one side of a double tragedy. The other side is a thriving international black market in organs. Black markets do not protect the donor or the recipient. U.S. citizens are participating in this market; in late July, a Brooklyn-based international organ broker was arrested.

Even when people want to give one of their kidneys to a friend or relative, our system makes it too hard. For example, the donor loses wages for time out of work and incurs the cost of travel and accommodation for both the evaluation and the surgery. Although the recipient's insurance pays for the donor's operation, donors may not have health insurance for follow-up care -- or may be concerned that, if they change jobs, they will lose their health insurance.

What to do? A government-regulated system of incentives for living donation could significantly increase the number of transplants. Donor disincentives would be eliminated and donors would be rewarded for doing a good thing -- not only a benefit to the individual recipient but a benefit to society.