Kidney foundation plan targets financial barriers to donation
■ The group opposes payment for organs but recommends that donation-related costs be covered. Some say the idea will not end the kidney shortage.
By Kevin B. O’Reilly — Posted Feb. 23, 2009
There are more than 78,000 Americans waiting for a kidney transplant, according to the United Network for Organ Sharing. Worse, the gap between the number of patients waiting and the number of kidney transplants performed has grown by 110% in the last decade.
Cutting the lengthy wait for a kidney will take more than innovative changes in medical practice, according to the National Kidney Foundation. As part of a new initiative unveiled in late January, the patient service and advocacy organization said compensation should be part of the solution.
That represents a shift from the group's 2003 position that "offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society." Now, NKF recommends that deceased donors' families and living donors be reimbursed for donation-related costs or medical care. For living donors, that would include lifelong coverage for any medical problems related to the donation.
It does not make sense that donors must sacrifice wages when their gifts help save money as well as lives, said NKF's CEO, John Davis. He said it costs $71,000 annually to care for a patient on dialysis but $17,000 a year to care for a kidney transplant recipient.
The new proposal "is simply reimbursing for costs incurred directly by the donation," Davis said. "We believe that in deceased donation and living donation, no one should profit from the decision to donate, but no one should be penalized, either."
There is no estimated cost for the initiative. NKF President Bryan N. Becker, MD, said the proposal does not amount to paying donors for their kidneys.
"We're focusing on [paying for] things related to your event that make you transform from a healthy individual into a patient and making sure that you have appropriate health insurance and a safety net financially, given the commitment you're making," said Dr. Becker, a transplant nephrologist and professor of medicine at the University of Wisconsin School of Medicine and Public Health.
NKF said eliminating financial barriers to donation, along with a series of improvements in education and medical practice, could, within a decade, cut the wait for a kidney from the current five years to less than a year.
The American Medical Association has policy supporting studies on the effect of presumed consent as well as financial incentives for cadaveric organ donation. In November 2008, the AMA House of Delegates called for federal legislation to allow such studies.
Initiative prompts cheers, doubts
Goran B. Klintmalm, MD, PhD, immediate past president of the American Society of Transplant Surgeons, said the NKF's proposal is significant because the group serves as a voice for patients.
"This has a huge importance," said Dr. Klintmalm, who is chair and chief of the Baylor Regional Transplant Institute in Texas, but speaking on his own behalf. "The fact that they are stepping into this and changing their position and taking this on is very encouraging."
Others were less enthusiastic. The notion that covering a limited set of donation-related expenses would cut dramatically the wait list is "an absurdity," said Sally Satel, MD, a kidney transplant recipient and editor of When Altruism Isn't Enough: The Case for Compensating Kidney Donors.
"What [NKF] tried to do as specifically as they could is to make it so narrowly tailored to donation per se that they can't possibly be fingered as promoting incentives," said Dr. Satel, a psychiatrist. She described the proposal as "stingy" to kidney donors and their families.
At best, the NKF proposal would double the number of kidneys donated each year, but that still would leave about 40,000 patients on the waiting list, according to Bahar Bastani, MD, medical director of the renal transplantation program at the Saint Louis University School of Medicine.
Dr. Bastani is from Iran and has studied the government-run kidney donor compensation system there that claims to have virtually eliminated the kidney waiting list. He said he welcomed the NKF proposal and the broader turn in the American debate on compensating organ donors.
"Ten years ago," he said, "nobody would dare to even talk about it."