Dynamist Blog

Cash--and a Little Respect--for Kidneys

I have an op-ed in today's LAT on--surprise!--kidney donations. It's called "Cash for Kidneys," and it does argue that payments would be a good idea. But before we get a market, we have to change the widespread attitude toward live donation: that kidney donors are quite likely crazy or criminal and, hence, should be deterred. Here's an excerpt:

Unfortunately, our laws and culture discourage healthy people from donating organs, as I learned this spring when I gave a kidney to a friend.

My parents were appalled. My doctor told me, "You know you can change your mind." Many people couldn't understand why I didn't at least wait until my friend had been on dialysis for a while.

This pervasive attitude not only pressures donors to back out, it shapes policies that deter them. Some transplant centers require intrusive, demeaning psychological probes that scare people off. Some bioethicists suspect that donors suffer from a mental disorder, as opposed to being motivated by benevolence or religious conviction.

The scrutiny is particularly nasty when healthy people want to give their organs to strangers — not truly unknown people, mind you, but patients they have gotten to know through Internet sites or press coverage.

Many transplant centers flatly refuse "directed donations" to specific strangers. Some argue that it's "unfair" for patients to jump the queue with personal initiative and an appealing story; others insist that such donors aren't to be trusted (they must be either criminal or crazy). Posters at livingdonorsonline.org warn givers to never even mention the Internet, lest their good intentions be thwarted.

Sandra Grijalva, a San Francisco woman with polycystic kidney disease, asked Kaiser officials if she could find a donor online — after having one of her friends disqualified because of high blood pressure. "They said absolutely not," she says. The donor, Kaiser maintained, might someday try to extort money. (So might your cousin, but at least you'd be alive.)

Instead of dire possibilities, consider a cold reality: Without tens of thousands of new living donors, most of the people on that very long waiting list are going to suffer and die on dialysis. The transplant community's top priority should be increasing the supply of willing donors.

I also take aim at the National Kidney Foundation's shocking attitude toward discussing incentives.

But even talking about incentives is taboo to some self-styled patient advocates. On Monday, the American Enterprise Institute will hold a conference in Washington on incentive-based transplant reforms. (It's organized by my kidney recipient, a physician and health-policy scholar at the institute.) When the National Kidney Foundation heard about the conference, its chief executive, John Davis, complained to the institute's president, "We don't see how an AEI forum would contribute substantively to debate on this issue."

Davis' group adamantly opposes donor compensation, lobbying against even experimental programs and small tax credits. It's as though the National Parkinson Foundation opposed stem cell research, or thought researchers should work for free.

The AEI conference, which is open to the public, will be aired live on C-Span2, beginning at 10:00 a.m. Eastern on Monday. I will moderate the first panel and speak on the second. After the conference, AEI will probably also post video.

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