Compensating Kidney Donors

The Trump administration will allow greater compensation for live kidney donors.

Supporting Living Organ Donors.  Within 90 days of the date of this order, the Secretary shall propose a regulation to remove financial barriers to living organ donation.  The regulation should expand the definition of allowable costs that can be reimbursed under the Reimbursement of Travel and Subsistence Expenses Incurred Toward Living Organ Donation program, raise the limit on the income of donors eligible for reimbursement under the program, allow reimbursement for lost-wage expenses, and provide for reimbursement of child-care and elder-care expenses.

While pure compensation is still illegal this goes a long way to recouping costs. In addition the executive order improves the rules that govern the organ procurement organizations with the goal of deceasing the number of wasted organs. Compensating kidney donors is a policy that I have long supported. Together the two changes could save thousands of lives. Even Dylan Matthew, a living organ donor who writes for Vox, is pleased.

Hat tip: Frank McCormick


You know, I bet there is a surprisingly large number of people willing to donate kidneys right now, with the proper incentives. Any guesses whether the Trump administration will be truly innovative in this area? After all, cheap non-American outsourcing is a proven method to keep costs low for American consumers.


What, he regrets not having sold to the highest bidder? Apparently not - 'So the very same day that I donated, Craig’s relative had their kidney taken out as well and flown to the West Coast. This second recipient also had a friend or relative agreeing to an exchange; so did the third recipient, who got the second recipient’s friend’s kidney. Our chain will let people enjoy 36 to 40 years of life they would’ve otherwise been denied.'

And he even highlights this as a potential explanation for the policy change - 'Melania Trump was hospitalized for kidney issues last year; Health and Human Services Secretary Alex Azar’s father received a kidney transplant last year; Adam Boehler, the director of the Center for Medicare and Medicaid Innovation, has talked about his aunt’s death from kidney disease.' Trump is the sort of president who can be counted on to pay attention to the personal.

All of those people work for him.

Trump is certainly the sort of President who can be only be counted on to pay attention when things effect him personally, that much is true. He can also be counted on to take things personally when they're not, and make things personal when they have no business being as such.

'All of those people work for him.'

What a depressing way to look at Melania's marriage.

Good points. Kidneys are very important. I can't stress enough how important they are. They remove waste products and excess fluid from the body, and produce hormones that help regulate blood pressure and control calcium metabolism and srimulate red blood cell production. It is good to know there are measures underway to assure America has a steady, reliable supply of kidneys.
We live in amazing times, don't we? Another interesting Trump Administration measure is its new policy for Brazil. We are, I am glad to be able to say that, repairing the diplomatic brigdes to Brazil. America's overtures are being welcome by the South American giant (Brazil is bigger than the Roman Empire at its height).

Brazil's leader, President Captain Bolsonaro, has officially said he intends to nominate his son, Congressman Eduardo Bolsonaro to be Brazil's ambassador in the United States.

Brazil's Minister of Foreign Affairs, Mr. Araújo, has said this nomination will help to fix the damage past Brazilian administrations, leftist ones, did to the Brazil-United States reletionship.

Mr. Bolsonaro has said he believes his son, as son of a chief of government, will get preferential treatment and be able to further the Brazili-United Statesorebem his son will ahve apecis tretamente and will be in a better situepation to seek a Brazil-United States rapprochement.
Brazil's President Captain Bolsonaro has pointed out that Brazilians and Americans share many practical interests and cultural traces. Both countries oppose drug use, abortion, feminism, climatw change scaremongering and immigration.
A Brazil-United States block would be more than twice as big as the Roman Empire at its height, have the biggest military budget in the world, have the biggest economy in the world and control entire economical sectors, such as meat, orange, soy and airplanes. Brazil strategic postion makes it the ideal place from which a nuclear assault onnAsia could be launched.
Mr. Eduardo Bolsonaro is a member of Mr. Bannon's anti-establishment movent and has studied in the United States.

Do you have a file of pre-written comments? Or, do you compose this voluminous bull shit each comment.

I don't know what you are talking about. I have found this blog a few days ago, and that was my first comment.

Good morning Thiago!

Thanks for the laughs! 😂🤣

I think you are mistaking me for someone else. I am Mr. Morrison from upstate New York. I like to read blogs.

And I am the ghost of Adam Smith, aka God.

I am pretty sure iy is a case of mistaken identity, when one person is thought to be someone else.

Hey James, the use of "President Captain Bolsonaro" is a dead giveaway, as I'm sure you're aware. Just in case there are new readers to the blog.

Sorry, I don't know what you mean. Brazil's leader is a President and is an Army Captain (I have read he is a Black-Ops-trained guy)

Brazil is bigger than the Roman Empire at its apex but Brazil consists primarily of poisonous spiders and weeds.

As far as I know, Iran is the only country with a kidney market. And as far as I have studied this market, and as incompetent as you might call the regulatory system there, it works. My guess is that it would work much better in the US. It will always have problems, but it will save lives, tens of thousands of them each year. So this is a move in the right direction but it is not good enough. New regulations are needed and a new mechanism must be designed.

That seems to be right.
There are obvious cultural differences, but it might be fruitful to send a group consisting of an ethicist, an economist, and a physician to study the Iranian system.

There's no point in sending the ethicist. Their answer is always "this is an affront to 'human dignity' and there should be a global moratorium on the practice".

Null hypothesis: The number of people Bioethicists have killed by impeding progress is less than the number saved because of their interventions

Economists' views on the organ liberalization by political party, Q14 here:

And in other kidney news...

Human trials of the device are about to begin. (November, 2017)

Last year, Roy said they could me on the market in 2020.

Roy said the bioartificial kidney could eventually be used by the vast majority of the people now on dialysis and the kidney transplant list.

"The Trump administration will allow..."

... why is organ donation/sale a function of the Federal Government under the Constitution?

a rhetorical question, obviously -- our central government does whatever it wants, regardless of which temporary personalities occupy the WhiteHouse/Congress/SCOTUS.

Kidney concerns rank with deck-chairs-on-the-Titanic in the big legal/economic piture.

'why is organ donation/sale a function of the Federal Government under the Constitution'

Interstate commerce? Just throwing it out there, rhetorically, of course.

It should be quite obvious why the government should absolutely be involved in regulating, or at the least, tracking and verifying, the sale of human body parts.

This IS a site that deals with economics. Can you MAYBE spot any dangerous incentives to allowing people to donate organs that aren't tracked and verified by a legal body with investigative authority and legal recourse?

"... dangerous incentives ..."

You are correct, but they don't care, all that matters to them is the free flow of capital - money, goods, people, body parts - across borders which shouldn't exist.

If its obvious, then you should be able to describe that rationale that doesn't apply to, literally, everything.

"Can you MAYBE spot any dangerous incentives to allowing people to donate organs that aren't tracked and verified by a legal body with investigative authority and legal recourse?"

Cars, soda, paper, etc, Everything can be written off to be subject to mandatory registration. As for 'legal body with investigative authority and a legal recourse' - that's just government. There doesn't need to be a special agency for one specific product.

Especially since you're worried about the 'dangerous incentives' to providing an untracked product where, literally, everyone involved in the provision of that product gets paid for it - except the person donating the kidney.

I think you dialed the wrong number.

Organ donation is in a sense social insurance...we never know if we or a relative will need one in the future...but, we probably will know someone in our lifetime.

So, contrary to Libertarian position--you can buy this meat on the open market, available to those with the gitas to buy it--you can look at how comes that bad word...governments can support organ donation since this is a risk borne by everyone.

The obvious is policy--auto opt in.

The less so obvious is government heard that credits for organ donation, paid hospital bills for the donor, public recognition and thanks, maybe even something like early medicare coverage for donors for the rest of their life, just like a VA system where if you serve you have lifetime coverage.

But, you will never hear this from a Libertarian.

How much is that kidney in the window? That one with the one with those purple blue veins?

How much is that kidney in the window?

In the market for organs, the poor will sell and the rich will buy. The poor can't buy and the rich won't sell.

Talk about income inequality. It's life and death inequality.

But poor people could make a killing at the market.

"...poor will sell and the rich will buy..."

Correct! That's the point! The organs should go to the people who - supposedly - make the highest contribution to GDP! The goal is to maximize GDP/(body part)!

Can't pay your kids college tuition? Sell a kidney!

Can't pay the rent? Sell an eyeball! (Of course the rent money just goes back to the owner class. That's the beauty of being in the owner class - everytime you buy something you pay yourself.)

Can't pay your auto loan? Sell a testicle!

It will be great! The poor will be able to get through the month - and the late middle class - and our elite overlords will have everlasting life! What a deal!

"...poor will sell and the rich will buy..."

No. The poor would sell and insurance (private and government) would buy. The recipient would get to live. The poor donor would get a life-changing amount of money. But no! you say. Unethical! The current system -- under which thousands of people on the waiting lists die needlessly every year -- is much better! (And yet you still sleep at night apparently).

I'm not a libertarian. So, I don't know. I assume that a "libertarian" is opposed to unlimited governmental authority and responsibility, not against people's access to other people's kidneys.

And, The VA!? You need to find a better alternative to the current, imperfect Medicare, Medicaid, and private insurance systems. ACA didn't work. Maybe you can shoe horn the DMV model on the US health system.


Burn your Medicare card!

Burn it right now!!!

Ignorant people, AOC comes to mind, have the answer to everything.

"Ignorant people, AOC comes to mind, have the answer to everything."

Pot, meet kettle.

It's not surprising Cowen supports a market in body parts, being a libertarian and all. But what's to become of the sellers, having sold kidneys, eyes, parts of livers, where does it stop: how about feet, or legs, or hands, or arms, or parts of the brain. Rather than a market in body parts, how about changing the hospital protocol for the body parts of the departed: a presumption for donation unless the departed has expressed her wish to keep her body parts in case she needs them later. When I expressed this simple but logical and likely effective policy, Cowen's friend Scott Sumner wrote that I was "wrong on all accounts". Are Cowen and Sumner more concerned with creating a market (praise markets) or increasing the supply of body parts?

I am not on the organ donor list. One, I'm too old. Two, a liberal would reject a body part from a "deplorable."

Are you departed? And resurrected? Or did you sell your eyes in Cowen's body parts market?

I'm a-ok with parts from deplorables. Just not their tiny brains and tinier penises. I'll feed that to my pet dog.

To be fair, St. Paul taught the resurrection of the body at the end of time (contrary to the typical Christian's view that grandma is in heaven with the family dog), which might suggest that one will need her body parts later. On the other hand, at a funeral several years ago the priest taught that the body to be resurrected would be the 35-year-old body, not the emaciated body of the recently departed. It was reassuring since I have bad hips.

An excellent example of why no one really talks about heaven much, certainly not its specifics, even Christians. It always breaks down.

No grandmas in heaven? I would want to see my grandmother: which inevitably means - her soft powdered skin, so loose in the arms that she never wore short sleeves out of vanity, her humped back, her hair that had turned snow-white before her thirtieth year.

I'm sure your grandmother in heaven would be her younger self, such that you probably wouldn't even recognize her.

The first organ transplant and exchange program was described in the Bible.

An eye for an eye and a tooth for a tooth.

Markets are more important than anything! Except maybe growth!

Growth is good!
Growth is great!
It's the people that they hate!

Now I'm really slumming ...

The twisted views of economists and their heroes - the entrepreneurs and the merchant class - and their Asperger's like indifference to human attachment to family, tradition, and culture - are a threat to the security of everyone. They are more than happy to loose the blood dimmed tide, out of an infantile lack of awareness.

And what body part do we sell to pay the butcher's bill?

Nothing wrong with family, tradition, or culture, but those are usually the first things to go when there isn't enough bread to go around. Man is always 9 missed meals away from revolution.

OBAMACARE provides all Americans with economical quality health care, especially the poor.
Bill's enlightened socialism is absolutely the way to go for the future.
Sweeping government paternalism has no downside.

You use buzz words because you are unable to think through a rational proposal.

The Enlightenment and rational policy is an option to calling something Socialist, although I am puzzled by you reference to Obamacare, as most people support it.

I am waiting for your better than, cheaper than, Obamacare proposal. Or, was that just another fraud perpetrated by Don the Con.

This fits neatly into my vision of the future: I would certainly not have appended that "even" to the stylite Vox dude's enthusiasm. When there are 7.5 billion people on the planet, each individual human life is worth less, but they'll throw you something for your kidney.

A guy I knew slightly in college died of kidney failure. The rumor was that his hard-hearted mother refused to donate. I found that hard to believe. He was so affable. He was also broke; he seems like he'd have been the type to donate a kidney for cash if his kidneys hadn't sucked. There was a steady supply of young people in our set, who participated in the clinical trials at the research facility not far from campus. (People joked about the footpath worn between the facility and the adjacent mall.) My roommate got her wisdom teeth out that way. College expenses were so much cheaper; people spent years going to school, or hanging around in some vague capacity like the guy I mentioned, who was a fixture at the school paper. But there was little subsidizing - lots of people had to scrape. But they had the gift of time.

"...the Secretary shall propose a regulation..."

What happened to deregulation?
What about deconstructing the administrative state?

I guess they're against regulations, except when they like them.

No, it is far simpler than that. He is smarter than you are. Only an ass would complain like you did.

interesting conundrum. theres obvious incentive problems and equal access problems with a free market system for organs. i recall the urban legend stories about accepting a drink from a pretty girl and waking up in a bathtub full of ice...

however, in the current system, someone is making a lot of money, yet it starts with uncompensated donations, which seems also perverse.

the notion of giving an organ ultruistically gets hung up as it is laundered through a profit system, although admittedly most follks arent really aware of that aspect

Everyone gets a slice of the kidney pie - except the donor.

Headline: Draft Regulations Leaked From HHS On Kidney Program

***For the poor,

HHS will establish

A state of the art

Go Fund Me Page.***

I also wonder how many high priced and wealthy kidney transplant surgeons

Have contributed

One of their own kidneys?

"the goal of deceasing the number of wasted organs"

Ironic typo...

If health care were treated like car repair, those who can't afford treatment would be subject to creative destruction, "deceasing" to supply organs without wasting them sustaining the life of poor people who can't afford treatment.

People need kidneys. Not just White People. Solution: Conscription, using a lottery system (which is equal and equitable, everyone has an exactly equal chance of being selected both for receiving and for donating).
Everyone will be randomly assigned a number, which will then be randomly drawn from a sealed box. The number can be assigned at birth, or later. The drawing can take place at some appropriate time (for example allowing the donor 18, 20, or whatever number of years of obligation-free life). Compensation can be given at market-rates or via some other method (similar to eminent domain rules, for example). These who are selected will be required to donate a kidney (the program can be expanded to include other surplus body parts). Depending on your political-religious preferences, the recipients can be randomly selected people, or particular groups. If they don't actually currently need a kidney, they can postpone possession til later, or sell their right to the one they won.
Or the recipient list can be constructed in other ways, such as according to merit, or contribution to GNP, social worthiness, social connections, race, ethnicity, or voluntary identity choice, self-assessed need, and so on.
Or, the randomly selected donor can assigned a probability of having to donate, rather than a certainty (certainty being a probability of 1).
This is not grossly unlike being conscripted into a military during time of national emergency. You win a probability of having your legs blown off.
One could argue that Americans today are too self-interested to go along with such a plan, but not that it isn't equal and equitable. No blastocytes need be murdered.
I read this in a book somewhere. I disavow any responsibility.

Do living donation makes economical sense?

Let's say I feel motivated to donate a kidney today to family member as a healthy man. Due to my generosity, my family member lives 20 years more. Eventually, I get older and three scenarios can happen.

In a first scenario I stay "healthy" until my death caused by anything but kidney disease. In this scenario the transplant is an economical success because 20 QALY/DALY years were gained at no loss of QALY/DALY years to the donor, the only cost was the transplant.

In a second scenario, my single kidney fails and I need a transplant. I get a transplant but the accumulated costs comprise 2 transplant procedures. I survive 20 more years but the risk is transferred to the living donor. This is an interesting case because people with family antecedents of high blood pressure and diabetes are advised to not donate a kidney because they will themselves get kidney disease in the future. Alex suggests subsidizing living donation is good when usually risky behavior is taxed: drinking, smoking, etc.

In a sad scenario #3, I don't get a transplant and die. My beloved family member lived longer but my life was shorter. "Society" gained zero QALY/DALY years in spite of a costly transplant 20 years before.

From 3 scenarios, only 1 makes clear economical sense. Of course, I'd totally do it for a family member. Albeit, things that are good for individuals may not be good for society.

In most jurisdictions, kidney donors immediatly go to the front of the queue if they should need one in the future.

Because the remaining kidney grows to restore much of the pre-donation total function, and because most kidney disease strikes both kidneys simultaneously, this usually puts a donor with unanticipated (after heavy testing) future kidney issues ahead of where they would be at the back of the normal line. There are issues if the donor moved jurisdictions.

There is no heavy testing, it's just Diabetes. In the US there's 23 million of diagnosed cases, an estimate of 7 million of undiagnosed cases and an second estimated of 80+ million in prediabetes condition: ~1/3 of the population cannot be a kidney donor.

To qualify as a living kidney donor (donated to an acquaintance two years ago) I had to go through a lot of testing (process took almost 2 years), including a review family history, to rule out most of likelihood I will myself need a kidney in the future. For me Diabetes would be 99% a result of self-inflicted lifestyle choices now. (I am in Canada so the public system is particularly incented to optimized for total costs).

We need to get Trump out of office before he fixes everything.

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