Financial Compensation for Organ Donors is Working

by on April 14, 2008 at 7:40 am in Economics | Permalink

Only one country in the world has eliminated the shortage of transplant kidneys.  Only one country in the world has legalized financial payments to kidney donors.  That country is Iran.

In an important report, transplant surgeon nephrologist Benjamin Hippen argues that the Iranian system has saved thousands of lives and it should be used if not as model then to inform America’s efforts to eliminate its deadly shortage.

In the Iranian system organs are not bought and sold at the bazaar.  Instead a non-profit, volunteer-run Dialysis and Transplant Patients Association (DATPA) mediates between recipients and donors.  Recipients who cannot be assigned a kidney from a deceased donor and who cannot find a related living donor may apply to the DATPA.  The DATPA identifies a possible donor from a pool of people who have applied to the DATPA to be donors.  Donors are medically evaluated by transplant physicians, who have no connection to the DATPA, in just the same way as are non-financially compensated donors.

The government pays donors $1,200 plus limited health insurance coverage.  In addition, charitable organizations also provide renumeration to impoverished donors.  Thus demonstrating that Iran has something to teach the world about charity as well as about markets.  Will wonders never cease?  Recipients may also contribute to donor remuneration.

Hippen reports that the system works well, although better follow-up of donors would be an improvement.  He concludes with a call to legalize financial compensation in the United States.

shawn April 14, 2008 at 8:24 am

…i wish there was a way to take a snapshot of people’s moral unease with ‘paying for donors,’ so that when this becomes the norm, we can show people “hey, you remember how much you hated this? maybe there are other things you’re wrong about.” Unfortunately, the change will be rather gradual, and most people will just gradually come to be okay with the idea, and hold on to their other ideas just as stubbornly.

Mike Huben April 14, 2008 at 8:49 am

You’ll notice that this is a liberal-like institution of checks and balances between many parties:

donors
recipients
evaluating physicians
DAPTA
government
charities

Mere legalization of payments will not create such an institution: it opens the door to libertarian-style abuses of all sorts.

I’d welcome laws creating such an institution adapted for our society.

Sally Satel April 14, 2008 at 9:26 am

Dr Hippen’s paper on the Iranian system is excellent.

The kind of system that would work best in the U.S. is one in which governments — state or federal — offer an incentive to prospective donors.

These individuals would be evaluted medically and psychologically just as altruistic donors. Their kidney would go to the next person in the queue. To avoid battles over “exploiting the poor,” incentives would take the form of a health insurance, a contribution to the donor’s 401k, loan forgiveness, tuition voucher for their children, etc.

If the government (a third party) procured the organ, and not the individual then worries that only the wealthy would benefit are soothed. (Nor would grey market develop as some fear.) And if no immediate cash is given then worries about the poor being “coerced” into relinquishing a kidney are also addressed. It is not low-income people that we are trying to protect from their own impulsivity but rather people who are *desperate.* And the way you handle that is by not offering what desperate people want: cash now.

More details will be forthcoming in an AEI book called When Altruism Isn’t Enough – The Case for Compensating Kidney Donors (due out in Fall 08).

Also, polling data on attitudes toward donor compensation– which I have summarized and am happy to send to anyone interested — are encouraging.

Of course, NOTA has to be revised so that rewarding donors is no longer a felony.

Bartman April 14, 2008 at 9:48 am

Wait a minute, isn’t Iran an EVIL!!! place?

That’s what David Frum said, and surely he can’t be wrong.

shawn April 14, 2008 at 10:08 am

marc…for spelling, you’ve got to work with firefox: automatically spell checks and red-underlines misspelled words in any form.

It can’t stop me from writing stupid things…but at least they’re spelled correctly.

hojak April 14, 2008 at 10:35 am

Bartman´s sarcastic remarks are exactly the sort of snark that endangers this sort of program. The fact that Frum might or might not be right on Iranían “evilness” says nothing about how good this program is. Though he may not have meant it this way, his suggestion that the soundness of this program in any way undermines the moral geopolitical critique of Iran works wonders in discouraging potential allies in favor of a more liberal market in transplant organs.

Bartman April 14, 2008 at 11:17 am

Chairman:

I’m glad you got it. When I worked in the Gulf I got to know many real, live, actual Iranians. Despite the mad mullahs, Iran is a place where thought and introspection are still viewed as positive attributes, and not limp-wristed leftish afflictions, like in certain segments of certain other countries.

I’m not at all surprised that the Iranians were able to come up with a sensible, nuanced and balanced policy and procedural framework, that effectively meets the net underlying goal of extending and improving human life.

foo April 14, 2008 at 12:25 pm

That would be “remuneration”. I’m sure people prefer to be paid, and not just counted.

sidereal April 14, 2008 at 1:40 pm

That would be “remuneration”. I’m sure people prefer to be paid, and not just counted.

Ah, but it’s worth a little more if you’re being counted again. Still not as good as being paid, though.

Sudha Shenoy April 15, 2008 at 7:17 am

Daniel says: ” Again, I love the idea and think it’s awesome that there’s an example somewhere. Just unfortunate that it comes from a place that comes with so much baggage.”

What baggage? Where? Says who? Does the whole of humanity — all 3,000 million of us — consist solely of Washington DC policy nutcases?

Ryan April 15, 2008 at 1:34 pm

Ive read some disturbing news about the Iranian system that basically confirms the worst fears of opponents of organs sales in the United States.

My hunch is that Hippen’s paper describes the system as it should be, rather than as it is–according to the column that ran in the Wall Street Journal earlier this year, Iran has problems getting the recipients who most need a transplant to the top of the list. Equally disturbing are reports that impoverished families pressure their children to sell their kidneys, and that middlemen often take most or all of the money.

Advocates of legalized organs sales in the United States claim that our government could regulate this sort of thing. Im not so sure.

lix May 17, 2008 at 8:37 pm

No, actually “temporary marriages” in Iran are not unpopular with women, sorry to burst your bubble!

As Shahla Haeri revealed in her 1989 book, Law of Desire (published in the UK by I B Tauris), many [temporary marriage] contracts in Iran are transformed into permanent, loving relationships. Contrary to popular myth, it is usually not men but women, particularly divorcees and widows, who seek muta marriage. Haeri’s extensive survey showed that many older women approached “young men, particularly handsome ones, directly and frequently†.

jarot July 2, 2008 at 4:29 pm

My name of Jarot from indonesia.I hope could be helped by the metter of financial me.One last year I has been remained died parenst me.And now I live did not have money to pay study I and my debt many.Please helped me money to live me.Thank you,God bless you.
Your help was very valuable for me. This my complete data.

FULL NAME : Djarot sugiarto
BANK NAME : Bank Mandiri (Indonesia)
MY ACCOUNT No : 137-000497451-1
BANK ACCOUNT No : 137-000473770-2
BANK PHONE No : 0274-586425
BANK SWIFT CODE : BEIIIDJA-068
OCCUPATION : Student
PERSONAL MOBILE : 62-0817462862
PERSONAL FAX : –
AGE : Sleman October 13th 1985
COUNTRY : Indonesia

jarot July 7, 2008 at 4:03 pm

My name of Jarot from indonesia.I hope could be helped by the metter of financial me.One last year I has been remained died parenst me.And now I live did not have money to pay study I and my debt many.Please helped me money to live me.Thank you,God bless you.
Your help was very valuable for me. This my complete data.

FULL NAME : Djarot sugiarto
BANK NAME : Bank Mandiri (Indonesia)
MY ACCOUNT No : 137-000497451-1
BANK ACCOUNT No : 137-000473770-2
BANK PHONE No : 0274-586425
BANK SWIFT CODE : BEIIIDJA-068
OCCUPATION : Student
PERSONAL MOBILE : 62-0817462862
PERSONAL FAX : –
AGE : Sleman October 13th 1985
COUNTRY : Indonesia

contact person: jarot_woyo@yahoo.co.id

jarot July 7, 2008 at 4:05 pm

My name of Jarot from indonesia.I hope could be helped by the metter of financial me.One last year I has been remained died parenst me.And now I live did not have money to pay study I and my debt many.Please helped me money to live me.Thank you,God bless you.
Your help was very valuable for me. This my complete data.

FULL NAME : Djarot sugiarto
BANK NAME : Bank Mandiri (Indonesia)
MY ACCOUNT No : 137-000497451-1
BANK ACCOUNT No : 137-000473770-2
BANK PHONE No : 0274-586425
BANK SWIFT CODE : BEIIIDJA-068
OCCUPATION : Student
PERSONAL MOBILE : 62-0817462862
PERSONAL FAX : –
AGE : Sleman October 13th 1985
COUNTRY : Indonesia

contact person: jarot_woyo@yahoo.co.id

jarot July 7, 2008 at 4:07 pm

My name of Jarot from indonesia.I hope could be helped by the metter of financial me.One last year I has been remained died parenst me.And now I live did not have money to pay study I and my debt many.Please helped me money to live me.Thank you,God bless you.
Your help was very valuable for me. This my complete data.

FULL NAME : Djarot sugiarto
BANK NAME : Bank Mandiri (Indonesia)
MY ACCOUNT No : 137-000497451-1
BANK ACCOUNT No : 137-000473770-2
BANK PHONE No : 0274-586425
BANK SWIFT CODE : BEIIIDJA-068
OCCUPATION : Student
PERSONAL MOBILE : 62-0817462862
PERSONAL FAX : –
AGE : Sleman October 13th 1985
COUNTRY : Indonesia

contact person: jarot_woyo@yahoo.co.id

Amanda December 2, 2008 at 10:09 am

My family just went through a living donor transplant in the U.S and I think it would be wonderful if the donor could get some financial help after such a nobel gesture. Many people in my family were willing to donate however were unable to pass the medical screening to become a donor, It is very hard to be accepted as a donor and they do many tests to rule out potential donors and the doctors make the final decision if they will use you as a donor or not. We were fortunate and had a non-blood related family member was able to pass the medical tests and get approval to donate, but it has been hard on her family finacially to take a month off of work.

Gabriel January 20, 2009 at 10:51 am

I see no reason why a person who changes another person’s life can’t get a recompensation for it.
If I could get something in return I would become a donor.
If you give an organ,you can’t work for a certan period.I think that should be recompensated to.
This would help a lot of people with their problems.

kate May 13, 2009 at 4:14 am

who is so bigness?

bluce May 13, 2009 at 4:17 am

Is it realistic?

r4 software March 12, 2010 at 12:09 am

As a Nocturnal home dialysis patient I am costing the taxpayer an enormous amount of money (and water) to stay well. If organ donation was encoraged more and better funded, the savings would be enormous to the health system and people like myself would be enormous and the health outcomes of people with kidney disease would be greatly enhanced.

eee June 13, 2010 at 11:34 pm
Kerry Kocik January 20, 2011 at 10:19 am

Thanks for the insightful post regarding this issue – a lot of the things you have mentioned I was never aware of before.

Comments on this entry are closed.

Previous post:

Next post: