Life on the Kidney Queue in the Land of the Market

Michael Giberson

Virginia Postrel has an op-ed in the Los Angeles Times on kidney donations and methods to encourage donations. Postrel favors legalizing financial incentives for live donors, though the idea of paying people to give up a kidney makes some folks squeamish. In fact, the National Kidney Foundation doesn’t even think people should talk about financial incentives for donors. The NKF wants patients to shut up, stay in line, and wait their turn. Never mind that hastening donations would be the difference between life and death for some folks on the kidney queue.

Almost exactly twenty years ago this month my mother received a heart transplant after years of steadily decreasing health. Despite a bout with hepatitis after the transplant, picked up from the new heart, my mother rapidly recovered her health. She lived nearly 10 more years – about twice longer than we were told to expect. We – her family – were grateful for every moment.

I can understand when the NKF or others raise concerns about potential issues raised by financial incentives. Maybe someone in desperate financial condition will give up a kidney and later regret it. Of course, I can also understand how people in deteriorating health may prefer recovery to life in a growing line of increasingly desperate kidney patients.

Postrel opens her op-ed discussing a controversial Kaiser-Permanente program a few years ago in which Kaiser forced their kidney patient customers in the San Francisco Bay area to switch from hospitals at UC-Davis and UC-San Francisco to Kaiser’s own program. Just this month Kaiser began transferring its patients back to the UCD and UCSF hospitals. The description of the transfers carried in a bay area newspaper doesn’t offer a lot of hope:

Cindy Ehnes, director of the Department of Managed Health Care, said transferring the patients back to UCSF and UC Davis is progressing well, though the process is “extremely complex.” …

For patients waiting for a donor kidney, UCSF will switch those patients over to its wait list, working with the United Network for Organ Sharing, which coordinates organ transplant activities nationwide, Ehnes said.

“Our goal is to place those patients on the UNOS donor list so they can begin accruing time,” Ehnes said.

A felicitous phrase, isn’t it, “begin accruing time.? Shuffle here, shuffle there, hurry up and wait.

As Postrel notes on her blog, the American Enterprise Institute is hosting a discussion on the incentives issue on Monday, June 12. Despite a direct conflict with the first half of the United States-Czech Republic World Cup match, I’ll be there. (If anyone knows the best nearby bar to watch the second half, let me know.)

3 thoughts on “Life on the Kidney Queue in the Land of the Market

  1. One of my good friends was on a waiting list for a liver transplant. She followed doctors’ instructions. I think she wanted to live. When her condition stabilized, she was moved down the list. She died there waiting for help that was not going to come.

  2. I understand that organs, including kidneys, are assigned to patients based on a points system (eg closeness of match, patient’s health otherwise, etc). Why not say that if you agree to be an organ donor you will get x number of points if in the future you need an organ of your own?

    I doubt that sort of incentive would match supply and demand, but it would help. And, unlike financial incentives, there’s no need to worry about someone feeling financially forced into providing a kidney or any murders taking place to pay for a kidney. Also it’s even between poor and rich people. This may get around the political objections to incentives for kidney donation.

  3. @Tracy W

    What you’re describing already exists (at least in the US), and is called LifeSharers:

    While the organ donation laws of the US forbid outright sale, they do allow “directed donation”. LifeSharers exploits this by having their members direct their donation first to another LifeSharers member, and if there is not a viable recipient, to any other person.

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