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News Article: Donor Dilemma - National Kidney Registry - Facilitating Living Donor Transplants
This letter from Garet Hill, the CEO of the National Kidney Registry, was
in response to “The Organ Donor Taboo” published on Forbes.com
(October 15, 2007):
Donor Dilemma
I learned firsthand how our government policy is exacerbating the organ
shortage ("The Organ Donor Taboo,"
Oct. 15 – Full text below.) When my 11-year-old daughter lost kidney function in February. My wife and I were
medically incompatible as donors. We did an extensive search, and my 24-year-old
nephew was able to donate his kidney. Both are now doing great. But there are
thousands of people in this country willing to become living kidney donors
who need financial support to cover donation-related expenses. Medicare and
insurance companies don't help. At a bare minimum our tax law should be changed
to allow all donor expenses to be tax deductible. Ideally, the recipient's
insurance should pay for all donor expenses.
Garet Hil
CEO , National Kidney Registry
West Islip, N.Y.
The Organ Donor Taboo
Michele Goodwin 10.15.07, 12:00 AM ET
Don't be a sick person in need of an organ donation in America. As of
mid-September 97,191 patients were waiting on the list maintained by the United
Network for Organ Sharing. More than 7,000 of these patients will die while on
the list; thousands of others will be booted off, too weak or old to qualify
for a transplant.
The mismatch between demand and supply is getting worse. Though 6,729 live
donors volunteered last year and the list of needy patients increased by only
4,100, many donor organs are not viable and the backlog remains. A total of
28,930 transplants took place last year, 6,700 from live donors and the rest
from cadavers. Meantime, some 90,000 patients got sicker and 7,041 died.
What's the solution? Let's consider something that has long been a taboo
in this country: payment to donors. I don't favor a wholesale repeal of the
law against buying and selling organs. I support, instead, a shift of power
to the states on this touchy matter. The federal government should let states
write their own laws on organ donor compensation.
Federal law criminalizes payment for organs. It's a felony for you to sell
one of your kidneys, and it's a felony for your family to get payment for a
cadaver transplant after you die. The ban includes helping out with household
expenses or other costs borne by the donor or donor's family.
States (or regions, if states collaborate) should be allowed to test pilot
programs and provide a reprieve for patients. Such experiments would not disturb
altruistic donations, nor need they alter the rules on who gets priority in
receiving an organ. We do not have to contemplate whether rich people could
outbid poor people for a kidney. I have in mind only that states could take
novel approaches to increasing the supply of donors.
The federal government could retain some power, as it does in the Medicaid
system. States get some flexibility in setting rules, and they can ask for
waivers from the U.S. Department of Health & Human Services. Several
states got waivers from section 115 of the Social Security Act, enabling them
to help Hurricane Katrina survivors by making treatment available to those
who normally would not qualify.
Currently Medicaid pays for dialysis, which costs from $60,000 to $90,000
per year. Why not use those funds for kidney transplants? A transplant might
cost $70,000, plus another $5,000 a year for maintenance medicine.
Financial incentives for organ donation are very restricted. Wisconsin lets
live donors deduct, on their state income tax returns, expenses related to
donating an organ, such as transportation and medical expenses. The Pennsylvania
legislature proposed nearly a decade ago to provide a burial benefit of up to
$300, paid by the state to relatives who donated their deceased relatives'
organs. Given more freedom, a state might reimburse live kidney donors for
lost wages.
At a recent conference sponsored by the Illinois branch of the National
Kidney Foundation, I suggested state experimentation with donor incentives and
was roundly criticized by one audience member for advocating a system that would
exploit minorities. This rhetoric hurts people of color. Ask yourself how the
current system impacts racial minorities. African-Americans make up a third
of the kidney transplant waiting list. They wait longer than any other ethnic
population for organs, and they suffer the highest death rate while waiting.
Some commentators fear that African-Americans and others will not be able to
"afford" organs--that is, they won't have the insurance to cover the $70,000
transplant cost. But those fears are overstated because Medicaid currently
pays for transplants. Moreover, there is no reason African-Americans or other
groups could not organize among themselves in their churches and fraternal
societies. Under present federal law the legality of directed donations is
murky. Let states clarify the matter.
In the array of products from the human body--ova, sperm, milk, tissues,
blood, bones and hair--only organs are excluded from markets. It's time to
end this rule, and save lives.
Michele Goodwin, Visiting Professor of Law, University of Chicago Law School,
and Professor , University of Minnesota Law School.
