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Cash for kidneys program may be a good idea

Robin Wulffson MD's picture
The feasibility of paying kidney donors was evaluated

A kidney donation is a gift of life, but would you sell one of yours for the right price? According to a new study by researchers at the University of Calgary in Canada found that that paying kidney donors would not only increase donation rates but also would be cost-effective. They published their findings online on October 24 in in the Clinical Journal of the American Society of Nephrology.

Currently, a tremendous shortage of donor kidneys are available in both Canada and the United States. According to the U.S. Department of Health and Human Services, almost 100,000 Americans are currently in need of a kidney donation; sadly, many will die waiting for one. At present, people in need of a donor kidney can attain one by one of two methods: (1) From a deceased donor who previously gave consent; or (2) A living volunteer (not uncommonly a relative). Of the two methods, the receipt of a fresh kidney from a living donor is preferable to one from a deceased donor because of damage to the kidney that can occur between the time that elapses from when the donor expires and the kidney is transplanted. The donor kidney is packed in ice for preservation and does not receive oxygenated blood until it is placed in the recipient.

The study authors note that, for patients with kidney failure, transplantation is considered the optimal treatment compared with dialysis. In addition, the number of patients in need of a transplant is increasing; thus, new strategies for increasing the donor pool are in need of a kidney transplant. For the study, the investigators used a decision analysis model, which compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. The made a base case estimate, which assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. (The current exchange rate is 1 U.S. dollar = 0.96 Canadian dollar.)

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The investigators found that, compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Furthermore, increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1,640 and $4,030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively.

The authors concluded that the impact of their proposed strategy is uncertain; however, their model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. They noted that further research should be conducted to determine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors.

According to the National Kidney Foundation:

  • 26 million American adults have chronic kidney disease (CKD) and millions of others are at increased risk.
  • Early detection can help prevent the progression of kidney disease to kidney failure.
  • Heart disease is the major cause of death for all people with CKD.
  • Glomerular filtration rate (GFR) is the best estimate of kidney function.
  • Hypertension causes CKD, and CKD causes hypertension.
  • Persistent proteinuria (protein in the urine) means CKD is present.
  • High risk groups include those with diabetes, hypertension and family history of kidney failure.
  • African Americans, Hispanics, Pacific Islanders, American Indians and seniors are at increased risk.
  • Three simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.

The two main causes of CKD are diabetes and high blood pressure, which are responsible for up to two-thirds of the cases. Diabetes occurs when your blood sugar is too high, causing damage to many organs in your body, including the kidneys and heart, as well as blood vessels, nerves and eyes. High blood pressure, or hypertension, occurs when the pressure of your blood against the walls of your blood vessels increases. If uncontrolled, or poorly controlled, high blood pressure can be a leading cause of heart attacks, strokes and chronic kidney disease. In addition, CKD can cause high blood pressure.