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The Ethics of Offering Payment to Living People Who Donate a Kidney FREE

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The summary below is from the full report titled “Regulated Payments for Living Kidney Donation: An Empirical Assessment of the Ethical Concerns.” It is in the 16 March 2010 issue of Annals of Internal Medicine (volume 152, pages 358-365). The authors are S.D. Halpern, A. Raz, R. Kohn, M. Rey, D.A. Asch, and P. Reese.

Ann Intern Med. 2010;152(6):I-46. doi:10.7326/0003-4819-152-6-201003160-00002
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What is the problem and what is known about it so far?

The kidneys filter blood to remove unwanted substances and fluid from the body. When kidney disease is so bad that the kidneys cannot do this filtering, people need dialysis or a kidney transplant. Dialysis involves hooking a person to a machine that filters the blood for several hours several times per week. Kidney transplant involves taking a kidney from a person and surgically placing it in the person with kidney disease. Many donated kidneys come from people who have recently died. However, living people can donate one of their kidneys and still stay healthy.

In the United States, the number of people who need a kidney transplant outweighs the number of kidneys available. One way to motivate more living people to donate kidneys might be to have a carefully regulated, national system that provides fixed payments to kidney donors. However, some worry that offering payment for kidneys could create problems. First, people might donate kidneys without fully considering their own health. Second, payment might push poor people into donating kidneys. Third, people might be less likely to donate a kidney just to help another person. However, because we do not have such a payment system, we do not know whether some of these unwanted results would really happen.

Why did the researchers do this particular study?

To explore whether offering payment for kidneys would make people donate without considering their own health, would push poor people into donating, or would make people less likely to donate just to help another person.

Who was studied?

342 people riding trains or trolleys in the Philadelphia area who were healthy enough to donate a kidney were surveyed.

How was the study done?

The researchers asked about each person's characteristics, such as age and income, and whether he or she would be willing to donate a kidney in several different situations with different personal health risks to the donor and different amounts of payment.

What did the researchers find?

People were most willing to donate a kidney when the personal health risks were low, when payment was higher, and if the kidney was going to a family member rather than to an unknown person on the waiting list. The relationships between health risk and personal income and willingness to donate did not suggest that payment would make people donate without considering the health risks or that payment created unfair incentives for poor people to donate. Payment did not alter a person's willingness to donate just to help another person.

What were the limitations of the study?

The way people answered the survey might differ from what they would do if they really had to make a decision about kidney donation.

What are the implications of the study?

This study suggests that the main worries about unintended consequences of a national payment system for living kidney donation would not actually happen, and it would be reasonable to do a real-world test of such a system.





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