Could PAYGO End the Prohibition on Paying Organ Donors?

By Brannon, Ike; Batkins, Sam | Regulation, Spring 2016 | Go to article overview

Could PAYGO End the Prohibition on Paying Organ Donors?


Brannon, Ike, Batkins, Sam, Regulation


What is the cost of self-righteous indignation? In the case of indignant opposition to compensating transplant organ donors, we can actually ascribe a number to it: a cool $125 billion over the next decade for the federal government alone, according to a new study recently published in the American Journal of Transplantation (AJT). That staggering figure is just a fraction of the $40 billion the federal and state governments spend each year providing free kidney dialysis for people suffering from renal failure, a sum that equates to nearly $100,000 per dialysis patient per year.

But what if we paid organ donors, thereby boosting the supply of transplant organs? The authors of the AJT study estimate that if we were to pay kidney donors enough to eliminate the current organ shortage, it would generate $46 billion per year in net societal benefits via longevity gains and a higher quality of life for transplant recipients. It would also save government roughly $12 billion a year. Beyond saving money, compensating donors would also save lives: roughly 7,000 people die each year waiting for a kidney, liver, or heart to become available for transplant, and an equal number perish without being considered for a trans plant list because of the improbability that an organ could be found in time to save them.

While a few thousand preventable deaths may not be enough impetus for the government to relax the prohibition on paying organ donors, Congress's Pay-As-You-Go spending constraint offers a more tangible incentive to abolish this lethal ban. Under the current budget rules, any savings generated from a change in the law could be used to cut taxes or boost spending elsewhere. Given the dearth of usable "pay-fors" these days and the propensity of Congress to do favors for its constituencies, it has every reason in the world to enact such a bill.

Supply and demand / The genesis of today's flawed transplant organ policy emanates from two pieces of legislation, the National Organ Transplant Act of 1984 (NOTA) and the Organ Donation and Recovery Act of 2004.

NOTA established the Organ Procurement Transplantation Network, a national system for matching organs and individuals in need. Paradoxically, NOTA did nothing to drive down transplant waiting lists--in fact, the length and wait time has grown enormously since its passage. In 1988 about 16,000 individuals were awaiting an organ for transplant, a figure that jumped to 44,000 by 1995, and today exceeds 122,000, which amounts to a 700 percent increase in 24 years. There are currently a little over 100,000 patients seeking kidneys alone, a number roughly equal to the population of Peoria, Ill. That number excludes people who need a kidney but who aren't put on the list because they aren't expected to survive long enough for one to become available to them under current rules. The National Kidney Foundation estimates that 500,000 Americans are on dialysis.

The explosion in the number of people awaiting a kidney transplant owes largely to two factors: First, higher obesity rates have contributed to a large increase in the incidence of type 2 diabetes, which greatly increases the incidence of renal failure. Second, advances in medicine have improved the health of people suffering from chronic illnesses. The ravages of diabetes that would have taken a life 30 years ago have been turned into chronic conditions that people can manage successfully for an extended period of time.

But while the demand for kidneys has exploded, the supply has not. And there is no reason to think that it ever will, given that there are no incentives in place to encourage people with two healthy organs to go through the pain, hassle, and slight increase in risk to their own health from a non-minor operation and life with one kidney. (For perspective, the death rate for a person donating a kidney is about 0.2 percent, or one out of every 5,000 donors.) The long waiting lists lead to a predictable outcome: a significant proportion of these people do not survive the wait. …

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