National Kidney Month Cont'd
Drew Carey's latest Reason.tv video makes the case for allowing markets in kidneys. It also reveals what yours truly looks like in a wig.
The video is excellent, even though all of us look pretty awful. The only thing I'd fault it for is not making the point that--I cannot say this often enough--EVEN IF EVERY SINGLE ELIGIBLE CADAVER KIDNEY WERE DONATED, THERE WOULD NOT BE ENOUGH. This shortage cannot be fixed by changing the law to override families' wishes and turning everyone who hasn't explicitly said no into a deceased donor. All that would do is sow further mistrust of the organ transplant system, particularly among (calling Barack Obama) already-suspicious African Americans. (Even if you don't care about individual rights, Michele Goodwin's book Black Markets is extremely convincing on this point.)
If the 1984 law criminalizing organ sales were simply repealed, here's what I think would happen. In the short term, neither public (Medicare, Medicaid) nor private insurers would cover the cost of paying vendors. Many hospitals would not accept them either, just as many until recently would not accept donors who learned about their recipients from media accounts or sites like MatchingDonors.com. But some transplant centers would accept vendors, assuming they passed other medical and psychological tests. Recipients would have to pay out of their own pockets or perhaps with the help of charitable institutions or community fund-raising drives. This short-term situation would indeed benefit affluent kidney patients the most. But by taking these patients off the waiting list for cadaver kidneys, it would also help poorer people, just not as much.
Over the long run, however, we could expect payments for kidneys (and possibly liver lobes) to become as much a part of the normal transplant process as payments for surgery, anesthesia, or immunosuppressant drugs. Instead of making a deal with an individual patient, someone who wanted to sell a kidney would contract with a transplant center, which would screen vendors and match them with recipients. (Since screening is expensive, one proposal is to have a national or regional standard for "qualified vendors," so that someone who didn't pass muster couldn't just go from hospital to hospital.) Insurers, whether private or governmental, would establish the prices they were willing to pay, with, I would hope, a strong desire to find the market-clearing price that would eliminate the waiting list. In the video, I make the point that since the federal government already pays for everyone's dialysis, even a price of $90,000 a kidney would save the taxpayers money.
In the meantime, the best hope for kidney patients is a much stronger emphasis on living donors, including better matching systems to take advantage of "paired donation." One such effort is the National Kidney Registry, which was founded by the father of a young kidney recipient after he and other family members proved incompatible as donors to his daughter. The National Kidney Registry seeks to facilitate living donation by creating "donor chains" and covering some of living donors' expenses. The registry's goal: "Every living donor in the world will pass through a common registry to be matched with the most compatible recipient, providing over 90 percent of the world's kidney recipients with well-matched kidneys, extending the functioning life of these transplanted kidneys by an average of ten or more years over the current average while simultaneously reducing the deceased donor waiting lists."
Here's an inspiring story from a kidney donor.