Each week, In Theory takes on a big idea in the news and explores it from a range of perspectives. This week we’re talking about government compensation for organ donors. Need a primer? Catch up here.
Josh Morrison is a kidney donor and the executive director of WaitList Zero, a nonprofit devoted to representing living donors and supporting living donation.
Each year in America, 35,000 people are added to the kidney transplant waiting list — 20,000 more than the number of people who actually receive one. There are more Americans who fail to receive a lifesaving transplant than there are homicides committed in the United States annually, yet there is more news coverage of gun violence in one day than there is of transplants in an entire year.
The media attention that kidney transplant does attract often revolves around a tired debate about incentives framed by two unacceptable responses: Should we treat people like human vending machines and purchase their organs with cash? Or should we do nothing, repeat the words “pure altruism,” and let thousands of people continue to die each year?
[Other perspectives: Will lab-grown kidneys fix our transplant waiting lists?]
There’s a better way: a path of transplant support that treats organ donation like a public service and honors donors like public servants. That means giving donors lifetime health insurance to offset the risks of donation; providing them with annual research stipends to enable long-term follow-up; and paying for lost wages, travel and childcare expenses when they take time off to donate. It means making sure all patients and their families receive specialized education about transplants.
The goal of transplant support is to make kidney transplants easy to ask for and easy to give. Right now, asking for a transplant is hard. As many as 80,000 patients who are eligible for a transplant are not even listed. Seventy-five percent of kidney recipients feel inadequately educated about live donation. Imagine asking a friend to borrow money; now imagine asking for an organ. It’s not an easy conversation, which is why education and ensuring donor health is so important.
The risks of donation are manageable but real, and while scientific understanding continues to improve, it is still imperfect. Kidney donors accept these risks individually. But because their sacrifices aid us all, they deserve the best health care possible. They deserve lifetime health insurance and lifetime follow-up. Yet they currently receive no health-care guarantee — just two years of required follow-up by transplant centers, and no coverage for lost wages, travel and childcare expenses.
Some say that kidney donation needs to be a “pure gift,” meaning donors should not receive different treatment for having donated. But by and large, these people have never given or received an organ. Treating donation as an isolated act of individual generosity imposes an enormous burden on recipients, who may unjustly feel guilty that they can never repay their donors’ generosity.
Donors are proud to have been able to save the lives, and studies show that more than 19 out of 20 are satisfied with their decision. Donation is an act of public service that society should support and honor with tangible commitments, and donors merit the same level of respect given to police officers, firefighters, soldiers and teachers. But so far our society has displayed a thankless response in the face of those who give of themselves to save another’s life. Donors deserve better treatment than they have so far received.
So why has such a crucial issue been given such short shrift? It’s not because the problem has been solved: 2014 saw the lowest number of living kidney donors — 5,537 — since 2000, when 50,000 patients were on the waiting list. Today, more than 100,000 are waiting, and the list grows each year.
Transplant rates have stagnated, leaving more and more patients to perish on dialysis. It’s not because the cost is prohibitive: a transplant saves Medicare hundreds of thousands of dollars per patient and saves private insurers even more. Ending the kidney shortage would save health-care providers approximately $6 billion per year. And it’s not because the organ transplant shortage is a problem without a solution. There are solutions; we’re just not implementing them.
If 1 in 10,000 Americans donated a kidney each year, there would be no transplant shortage. Supporting donation — making it better for the donor and easier for the recipient — will dramatically expand access to lifesaving organs. Right now, America is not providing that support.
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