A new Canadian study finds that offering cash for kidneys from living donors could be cost-effective — meaning it would be cheaper to pay for the organs than paying for the care of very sick patients waiting for transplants.
The study only looked at the cost-effectiveness, not the many ethical issues surrounding offering money for organs.
One of the lead researchers, Lianne Barnieh of the University of Calgary, said it makes sense to explore the financial ins and outs of this option before delving into the very complicated ethical issues.
About 80,000 people are waiting for a kidney in the U.S. right now — and many of them will die before they will receive a new organ. Offering cash incentives to increase the amount of donor organs is an idea that has come up repeatedly but remains highly controversial.
The new study assumed that offering $10,000 to potential donors would result in a 5 percent increase in kidney transplants, finding that would reduce cost of care and improve outcomes for patients.
As controversial as it is, that avenue should be investigated, said Peter Reese, a University of Pennsylvania professor of medicine.
“I think we have an ethical obligation to explore any option that we can to expand access to organ donation, so I don’t think that we should take anything off the table completely,” he said, adding that it is treacherous terrain.
“We’re so lucky that the public respects and trusts what we do. If we erode that trust through any of these initiatives, then we’re in trouble,” he said. “So we have to be very careful in moving forward here, and have to make sure all the key people are on board.”
Another possibility could be offering incentives that are not cash, such as paying for donors’ health care coverage and medical care for 20 years, Reese said.
“Cash for kidneys” will never happen, said Art Caplan, medical ethicist at New York University.
“We need to come up with ideas, the shortage is real, and people are dying,” he said. “But I think you’re hitting a real wall, in terms of cultural and moral views about sale of body parts, and this is not going to be the road that people take.”
Caplan says another, easier approach could be changing the way people become organ donors — from an “opt in” mechanism where you click a box to choose to become a donor, to an “opt out” mechanism, where you click a box indicating you do not want to be an organ donor.