The Case for Paying for Kidneys

By: Dave Roos
Edwina Jones (right) embraces her kidney donor LeQuenes Smith as they both recover from the kidney transplant surgery at Methodist Hospital. Smith donated a kidney to Jones.  Nikki Boertman/ZUMA Press/Corbis
Edwina Jones (right) embraces her kidney donor LeQuenes Smith as they both recover from the kidney transplant surgery at Methodist Hospital. Smith donated a kidney to Jones. Nikki Boertman/ZUMA Press/Corbis

In the U.S. alone, more than 100,000 people are waiting for a new kidney. Every day, they are subjected to debilitating and costly dialysis treatments to keep them alive until that new organ finally arrives. Sadly, it may never come. 

Only 17,000 kidney transplants are performed each year in the U.S. from both living and deceased donors. Because of this dire shortage of viable organs, 5,000 to 10,000 people die on the waiting list every year, or become so sick that they're removed from the list and left to perish. 


So how do we cut down that waiting list? It is illegal to buy or sell organs, in the U.S. and every other country in the world except Iran. The ban against buying organs is for ethical reasons. If we legalize the buying and selling of body parts, the argument goes, we open the door to a dystopian sci-fi future in which the rich and powerful harvest the poor and vulnerable for their kidneys, lungs and livers. 

Or maybe not. 

Dollars and Sense 

Economists Philip Held and Frank McCormick co-authored an eye-opening new report in the American Journal of Transplantation that presents a detailed cost-benefit analysis of paying donors for their kidneys. 

The report concluded that if the U.S. government paid $45,000 per kidney — yup, $45,000 to each living donor — it would save American taxpayers $12 billion a year. 

Wait a minute. How does paying money to kidney donors save taxpayer dollars? 

"This isn't common knowledge, but practically every person in America with kidney failure, regardless of age, is insured under the Medicare program," explains Held, who is a consulting professor in the Department of Nephrology at Stanford University. "Since 1973, if you develop kidney failure, you essentially qualify for national health insurance." 

That means taxpayers are currently paying for years of dialysis treatments — which add up to $1.4 million per patient over a lifetime — as patients waste away on the waiting list. Actual kidney transplants are comparatively cheap, around $145,000 per operation, according to the report. 

Held and McCormick predict that if you began offering people $45,000 for a healthy kidney, the resulting influx of available organs would erase the waiting list in five years. After that, no one with kidney failure would have to suffer through years of expensive dialysis before getting a transplant. 

kidney operation
Dr. Dorry Segev marks which kidney to remove on a kidney donor before a kidney transplant operation at Johns Hopkins Hospital in 2012. Would paying donors for kidneys lead to unethical practices?
Brendan Smialowski/AFP/GettyImages

Not only would their quality of life post-transplant be greatly improved, but taxpayers would save $403,000 per kidney recipient. (Those savings even take into account the purchase of a second kidney 10 to 12 years later.) 

Paying for kidneys seems to make tremendous sense economically. But how would such a government-run system work? 

Uncle Sam, Organ Buyer 

Under the current U.S. transplantation system, patients waiting for a transplant are matched with donors based on a computer calculation that considers blood and tissue type, organ size, waiting time and geographic location. It's not a strictly first-come, first-served waiting list, as many imagine. 

Under the system proposed by Held and McCormick, prospective donors would first have to pass a series of medical and genetic screenings. If they are eligible to donate, the same computerized system would match live donors with patients. The system would be overseen by the federally funded Organ Procurement and Transplantation Network

The $45,000 payment doesn't have to be a lump sum cash award, which economists know encourages poor financial decisions. It could be distributed as cash payments over time, as tax refunds, as insurance packages or any other arrangement that makes the most financial sense for the individual. Families donating the organs of a deceased individual would receive a $10,000 compensation package to the deceased's estate. 

Ending the Exploitation Argument 

Back to the ethical dilemma. Held and McCormick ultimately believe their idea of a government-run system for paying donors is a convincing reproach to the critique that paying for organs exploits the poor. 

"If there is a ‘shot across the bow' in our paper, it's that we argue the total reversal of the notion that this program would be exploitative of the poor," Held says. "We specifically say that the government would be in the business of compensating these individuals. We are very much against this notion of the rich man walking up to the poor man, asking for an organ and handing over a check. We propose that the allocation of those organs be done in the same fashion that's currently being done and has been done for years." 

The truth, Held says, is that the current transplantation system is the one that truly punishes the poor. 

"Most of these patients [on the kidney transplant list, and in dialysis] are poor and often African-American," Held says. "The family members of these individuals" -- who might otherwise consider donating a kidney -- "are often poor. It takes time to recover from donating a living kidney. For higher-income people, taking off six to eight weeks from work may be manageable. But for an hourly worker, taking off six to eight weeks is a substantial burden."