Kidney Gift Vouchers

by on July 13, 2016 at 9:20 am in Economics, Medicine | Permalink

I am not expecting a market in kidneys anytime soon but ever more sophisticated barter is slowly improving kidney allocation. Most recently, UCLA has started a program where a kidney donation may be swapped for a kidney gift certificate good for a kidney transplant at a time of the recipient’s choosing.

The program allows for living donors to donate a kidney in advance of when a friend or family member might require a kidney transplant.

…“It’s the brainchild of a grandfather who wanted to donate a kidney to his grandson nearing dialysis dependency, but the grandfather felt he would be too old to donate in a few years when his grandson would likely need a transplant.”

Nine other transplant centers across the U.S. have agreed to offer the gift certificate program, under the umbrella of the National Kidney Registry’s advanced donation program. Veale anticipates that more living donors will come forward to donate kidneys, which could trigger chains of transplants. Then, when a patient redeems his or her gift certificate, the last donor in the chain could donate a kidney to that recipient.

Improving allocation is important but the real constraint today is supply. This program may help with that on the margin, however, because altruistic donors could donate and keep a gift certificate as insurance in case any of their family members one day needed an transplant. More fundamentally, however, increasing supply will require some form of compensation or incentive such as no-give, no-take.

1 Aretino July 13, 2016 at 10:01 am

Why not just switch to an opt-out system from the current opt-in system? This is known to increase organ donations.

http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0131-4

2 dan1111 July 13, 2016 at 10:06 am

We’re talking kidney donations here (usually living donors)!

What is the opt out system? Don’t go to sleep unless you are wearing a shirt that says “I do not consent to my organs being surgically removed right now”?

3 JWatts July 13, 2016 at 10:34 am

Chinese Penal system organ donation, of course. Oh wait, that’s not an Option. Never mind.

4 KenB July 13, 2016 at 11:18 am

Mr Bloke: Look, I can’t give it to you now. It says ‘In The Event of Death’…

First Man: No-one who has ever had their liver taken out by us has survived…

5 Virginia Postrel July 13, 2016 at 2:35 pm

Smart people always think opt-out is a panacea. But it doesn’t work as well as advertised, and where it does work it’s likely a proxy for institutional improvements (which have also increased procurement in non-opt-out places): https://kieranhealy.org/publications/presumed-consent-law/ And that leaves out the huge cultural issues of mistrust, particularly among African Americans (who are disproportionately in need of kidneys), thanks to centuries of grave robbing. See Michele Godwin’s “Black Markets,” which convinced me that opt-out would be a disaster in the U.S.: http://amzn.to/2a9VJ7T

Also it’s not enough to die. You have to die in exactly the right way and not enough people do to meet the demand for kidneys. Living donors are essential.

6 JWatts July 13, 2016 at 4:13 pm

“particularly among African Americans (who are disproportionately in need of kidneys), thanks to centuries of grave robbing”

I’m doubtful of that explanation. My wife, who worked in the field, never once heard a black family give that as a reason.

Here’s a short paper on the article that seems more likely: http://www.clevelandmottep.org/myth.pdf

Intergenerational and Community Myths:
 Myth: If I agree to donate my organs, the hospital staff won’t work as
hard to save my life.
 Myth: Maybe I won’t really be dead when they sign my death certificate.
 Myth: Organ donation is against my religion.
 Myth: I’m under age 18. I’m too young to make this decision.
 Myth: An open-casket funeral isn’t an option for people who have
donated organs or tissues.
 Myth: Because I poor Rich and famous people go to the top of the list
when they need a donor organ..
 Myth: My organs may be sold on the black market.
 I need to be whole when I get to heaven

7 JWatts July 13, 2016 at 4:15 pm

“Why not just switch to an opt-out system from the current opt-in system? This is known to increase organ donations.”

This isn’t common knowledge, but “you” don’t decide to donate your organs after death. Your surviving family does.

Legally you might have a right to, but in practice, the donor organization gets consent from the family soon after death.

8 Justin Kelly July 13, 2016 at 10:12 am

But we have a kidney market… its just a black market.

9 Art Deco July 13, 2016 at 10:44 am

I wouldn’t want any organs from a black person if I needed them. It’s unbiblical.

10 Zombie John Gotti July 15, 2016 at 9:19 am

You are an idiot. If you ned an organ, you should take any one that is available and matches. When facing death, come back and tell everyone that crap again.

11 When are you going to discuss this article? July 13, 2016 at 10:44 am
12 Ray Lopez July 13, 2016 at 10:52 am

It was discussed yesterday or the day before, see the previous posts.

13 Anon. July 13, 2016 at 10:56 am

“surprising”

14 Art Deco July 13, 2016 at 10:58 am

You are forgetting that Alex unfortunately buys into the narrative of the Lawfare Democratic Party that would like to ignore the sky high crime and degeneracy rates in the black community. When one considers that in 2012 alone 86% of arrests of black males in New York State were repeat offenders it’s hard to square that with the assertions of the Times reporter, too young to remember the 2nd Clinton administration, that there is no correlation between crime rates in the fatherless black community and police policies

15 Floccina July 13, 2016 at 11:15 am

I wonder if in kind payment would make it seem less icky to people. For example we pay your health insurance premiums for the rest of you life if you give a kidney.

16 JWatts July 13, 2016 at 11:57 am

That’s illegal. You can only legally cover the costs associated with the surgery.

17 Byomtov July 13, 2016 at 2:04 pm

Seems like a good idea to me.

Maybe it could be legalized.

18 Virginia Postrel July 13, 2016 at 2:37 pm

A bill has been introduced to allow some pilot projects along those lines. Unfortunately the sponsor is a House Democrat, so it’s not likely it will go anywhere soon: https://cartwright.house.gov/sites/cartwright.house.gov/files/Final%20Text%204.7.16.pdf

19 Hazel Meade July 14, 2016 at 9:11 am

If only Republicans believed in things like free markets.

20 Jimbino July 13, 2016 at 12:27 pm

Wouldn’t it make more sense to allow everyone over 18 to make a kidney donation from his fresh cadaver in return for a certificate of some sort? The value of the certificate could be increased to the point where supply equalled demand. That would eliminate much of the “ick” factor, increasing donations. Of course, a cadaver kidney isn’t worth what a kidney from a living donor is worth, but it’s better than nothing and can be removed at no risk. I imagine the religious nuts would have less objection to a market in cadaver kidneys.

21 JWatts July 13, 2016 at 12:44 pm

“I imagine the religious nuts would have less objection to a market in cadaver kidneys.”

It’s odd that you think objections to kidney donations are primarily from “religious nuts”. My wife worked in the tissue transplant field for years. And that objection was pretty rare. Most religions either encourage donations or declare that it’s an individual choice. More often not donating is a cultural issue. Minorities donate at lower rates in the US, for example.

http://www.donorrecovery.org/learn/religion-and-organ-donation/

http://www.ahrq.gov/news/newsletters/research-activities/13sep/0913RA25.html

22 Byomtov July 13, 2016 at 2:05 pm

How much worse is the cadaver kidney, and in what way?

These are serious questions.

23 Virginia Postrel July 13, 2016 at 2:38 pm

On average, transplanted cadaver kidneys last about half as long as kidneys from living donors.

24 rayward July 13, 2016 at 1:01 pm

With a national kidney bank those bank members needing kidneys could be joined with those bank members who have kidneys to contribute. An excellent idea. In order for health care decisions, including the availability of organs, to be made according to the needs of the members, those members given priority for a kidney donation would have to be determined by an independent medical advisory board, rather than, for example, according to which member needing an organ can and is willing to pay the most for the organ. But why limit the national bank to kidneys, why not a national health care bank in which all members contribute funds and share life-saving medical procedures such as organ transplants and the health care bank provides for the health care needs of its members. I suppose those with lots of money may not like that system, and would prefer that organs go to the person willing to pay the highest price. Of course, that person would run the risk of needing an organ and nobody willing to contribute it, at whatever price she is willing to pay – and there’s the added problem that selling/buying organs is both a crime and unethical. What the person with money would prefer is a market in organs, and medical care generally, that would allow her to get the needed organ or other health care by paying whatever price is necessary to obtain it. I suppose those favoring markets for allocating scarce resources, including organs, would prefer this approach, while those with little or no money would not. Of course, there are more people with little or no money, but generally speaking they don’t make policy, the people with money do. Markets in everything. Including organs.

25 Bill July 13, 2016 at 1:58 pm

Can you regift?

26 Steve Adams July 13, 2016 at 10:30 pm

Impressive how innovative the serfs can be getting around the crazy dictator’s regulations. Gotta love politicians and bureaucrats.

27 Hazel Meade July 14, 2016 at 9:09 am

What happens when a donor says “oops, sorry, changed my mind!” ?
There is no way a contract like this could be binding.

28 Erich July 14, 2016 at 10:23 am

I would like to donate both of my kidneys to Donald Trump. They’re full of stones and cysts and are generally shit.

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