Paying kidney donors could be 'less costly, more effective'

Paying living kidney donors $10,000 could boost donations and cost effectively improve quality of life for people who would otherwise be on dialysis, say Canadian doctors who modelled the idea.  
 
Kidney transplants offer better outcomes than dialysis for people with kidney failure, but donation rates from living and deceased donors haven't changed much over the last decade, doctors say.

 
Currently, there is no compensation or incentives for donors in Canada although donors' expenses can be reimbursed. 
 
"Our model demonstrated that a strategy where living donors are paid $10,000, with a corresponding assumption this strategy would increase the number of transplants performed among wait-listed dialysis patients by five per cent, would be less costly and more effective than the current organ donation system," Lianne Barnieh of the University of Calgary and her co-authors concluded in an upcoming issue of the Clinical Journal of the American Society of Nephrology.
 
Money would be saved from reduction in dialysis costs, Barnieh said. The length and quality of life for patients with end-stage renal disease would also increase.
 
The researchers used $10,000 because in an earlier survey, they found 54 per cent of respondents who previously would not consider giving a kidney might consider doing so for a relative for a payment of $10,000.
 
The cost of administering the system isn't known and wasn't included. The researchers used 2010 Canadian dollars.  

 
In an editorial published with the study, Dr. Peter Reese of the University of Pennsylvania noted there are four main critiques of paying for living kidney donation:

• "Undue inducement" – coercing individuals into accepting risks they would otherwise find unacceptable or in short, "everyone has his price." 
• "Undue inducement" – people of lower socioeconomic status may be particularly vulnerable because they have no choice but to sell a kidney.
• "Crowding out" – if payments are introduced, in short, "dollars will destroy altruism."
• Commodification – allowing someone to sell the body or part of it degrades that person's dignity or in short, the body is sacred and money is dirty.

 The first three critiques could be verified through a trial of financial incentives for kidney donation but the commodification isn't empirically testable, Reese said. Studies don't provide support for the main critiques, he added.
 
Trends in use of financial incentives in medicine, such as to quit smoking or lose weight, suggest "the time is ripe for new consideration of payments for living kidney donation," Reese concluded.

In 2011, about 3,000 people were on the wait list for a kidney transplant, according to the Canadian Institute for Health Information.

Nearly 3,400 Canadians are waiting for a kidney transplant, according to the Kidney Foundation of Canada.