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The number of people who are in need of new kidneys in the United States is growing, but so is the waiting list for new organs. About 7 percent of the entire Medicare budget is spent on dialysis treatments for people with end-of-life kidney disease. The issue has become such a burden that some are calling for the government to take a new approach: paying for people to donate their kidneys. ... There’s one problem: Paying for human organs is illegal almost everywhere in the world. The U.S. strictly banned payments for organs in 1984 under the the National Organ Transplant Act. The medical industry has long referred to compensation for organs as taboo, as evidenced by the uproar following claims that Planned Parenthood has been selling body parts of aborted fetuses. (Robert Gebelhoff, 12/28)

A recent study in the American Journal of Transplantation just reached what to many people may be a shocking conclusion: Taxpayers would be able to save thousands of lives and about $12 billion per year if the government started compensating people for kidney donations. According to the study, “these numbers dwarf the proposed $45,000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list.” For economists who have long advocated for the creation of a market of organ transplants, this news is not surprising. (Scott Sumner, 12/30)

Clearly, our current organ transplant policy is a qualified failure. And it is because our current system, by law, mandates altruism as the sole legitimate motive for organ donation. ... So, to save lives, let’s test incentives. A model reimbursement plan would look like this: Donors would not receive a lump sum of cash; instead, a governmental entity or a designated charity would offer them in-kind rewards, such as a contribution to the donor’s retirement fund; an income tax credit or a tuition voucher; lifetime health insurance; a contribution to a charity of the donor’s choice; or loan forgiveness. Meanwhile, the law can impose a waiting period of at least six months before people donate, ensuring that they don’t act impulsively and that they offer fully informed consent. (Sally Satel, 12/28)

[B]uying organs would be wrong. And aside from being wrong, it would also harm existing, voluntary donation programs and be ineffective in increasing the supply of organs. There are better ways to increase the number of organs donated than paying for donations. In recent decades, thousands of organs have been bought from the destitute around the world, for transplantation into the social elite in their own countries or “transplant tourists” from other nations. This has tarnished the reputation of organ transplantation and led to poor medical outcomes. In all countries, it is the poor who sell organs as a way out of their financial straits — usually only temporarily. (Francis Delmonico and Alexander Capron, 12/29)

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? 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. (Josh Morrison, 1/1)

I was formerly skeptical about the prospects for growing a kidney, but the developments over the past two years have convinced me that this could be a viable option. Realistically, we are still probably 15 to 25 years away from success, so it remains important to pursue other avenues to increase the pool of transplantable kidneys. But certainly our patients have reason for cautious optimism. (Benjamin Humphreys, 12/31)