Those with kidney failure need dialysis. Dialysis is expensive. Dialysis care in the United States accounts for 7% of Medicare’s budget and nearly 1% of the entire federal budget (yes, really).
Dialysis is should be a stop gap measure. Ideally, dialysis is just an interim solution until a kidney donor is found. Folks with kidney failure really need a new kidney, but most will never receive one. So regular dialysis is a life-long state for many.
More than 100,000 patients in the United States are on the kidney transplant list, but fewer than 20,000 kidneys are transplanted from deceased donors each year and fewer than 10,000 kidneys are transplanted from living donors. About 40,000 people die in the US each year from kidney failure.
The beauty of non-directed kidney donations
Most kidney donations are directed.
With directed kidney donations, a prospective donor states either:
- “I’m signing up to give a kidney to this friend/family member”
- Or “I’m signing up to eventually give a kidney to anyone as long as this friend/family member finds a matching donor in exchange for my donation”
A small minority of kidney donations are non-directed kidney donations. Non-directed donors have discovered that they have 2 kidneys but only need one and that donating a kidney is relatively safe and it saves lives (lives, plural, due to kidney chains). A sizable minority of prospective non-directed kidney donors don’t make the cut, often due to medical concerns.
When a non-directed kidney donor does successfully donate a kidney, that pretty much always unlocks a kidney donation chain, which usually saves 3 or more lives!
Many people have altruistically donated one of their kidneys. Ned Brooks, Allyssa Bates, Dan Drew, and Rochel Smoller all gave TED talks about their experience donating a kidney. But most kidney donations are directed, meaning the donor has agreed to donate a kidney only if a loved one receives a kidney donation as a result. That’s the reason non-directed donations are able to unlock donation chains.
Kidney donations are priceless (literally)
Non-directed kidney donations save lives. Thanks to the math behind kidney donation chains, non-directed donations often save many lives!
But kidney donations also mean less dialysis and dialysis costs money from all of us. Remember, nearly 1% of the federal budget is spent on dialysis.
Interestingly, non-directed kidney donors don’t receive any money for their donation. The doctors, nurse, and all medical staff involved in a kidney transplant receive compensation for their work, but the donor, who is literally donating an organ, receives no compensation at all.
The End Kidney Deaths Act
What if we could save tens of thousands of lives every year, reduce the cost of dialysis to US taxpayers, and incentivize more non-directed kidney donations?
The End Kidney Deaths Act, which is currently going through Congress, is meant to do just that.
If the End Kidney Deaths Act passes, non-directed kidney donations would provide $50,000 of tax credits to the donor, broken up into $10,000 per year over 5 years.
I might donate a kidney for $50,000
I first heard someone argue that donating a kidney was a sensible act in 2020.
The argument goes like this:
- Donating a kidney saves multiple lives
- The short-term downside of donating a kidney is largely lost work time
- The long-term health risks involved with donating a kidney are minimal
- Therefore you should donate a kidney
I’m somewhat convinced by this argument. And yet I have not donated a kidney.
Why have I not donated a kidney?
Well, I run my own business and I don’t think I would want to lose 2 weeks of work. Also I don’t really want to go through the process. Plus, I can always donate a kidney next year, right?
I’m choosing not to save someone’s life because it’s a large inconvenience for me. That may sound selfish, but you’re in the same situation that I am.
For $50,000 of tax credits, I would much more seriously consider donating a kidney.
Let’s think through the “ick” factor
We’re generally uncomfortable with the idea of paying another human for their body parts. There are good reasons and bad reasons for this, but I don’t believe the good reasons apply in this case… at least not enough to outweigh the lives that this bill would save.
Around 70% of the world’s donated plasma comes from the US, largely due to the fact that plasma donors in the US are compensated for their donation. There are ethical considerations around plasma donation and this industry should be better regulated. Kathleen McLaughlin wrote a book about this: interview and book review. And yet, regulation aside, I think it’s worth compensating plasma donors to reduce the world plasma shortage (Planet Money episode).
Another thing to note when comparing kidney donations to plasma donations: the End Kidney Deaths Act would compensate kidney donors via tax credits, not through private markets. Each approach has pros and cons, but the “this is exploitative” argument is often applied to markets but rarely applied to tax credits.
You may be experiencing a “this might not be a good idea” reaction when thinking about paying non-directed kidney donors, even through tax credits. It’s worth thinking through why that is. What is your brain telling you? Which of the underlying arguments against this are worth considering? And how do those arguments look when put within the bigger picture?
Let’s compensate altruistic kidney donors
Non-directed kidney donations are extremely valuable. I think we should incentivize these donations. I hope Congress passes the End Kidney Deaths Act.
What do you think?
Is this something you would write your representative about?
Please join this effort
The podcast episode with Elaine Perlman is what inspired me to spend a couple hours researching and writing this post.
Since originally publishing this post, I clicked the “join the team” button at EndKidneyDeathsAct.org. The form took only a minute to fill out, I’ve received a few emails since then, including an email thread with a few others in my congressional district, and I’m now considering writing an op-ed in a newspaper about this.
If, like me, you feel that this is a very sensible idea, so much so that you would spend a few minutes or a few hours of time to try to make this happen, please get involved a bit more deeply. You can click the “contact your leaders” button at EndKidneyDeathsAct.org or, like me, you could click “join the team”.
I’m glad to now be a small part of this very important effort. I think you will be glad to be part of this too.
