As of January, there were 99,200 people waiting for kidney transplants in this country, with a new patient added to the list every 20 minutes.
About 14,000 kidney transplants were performed in the United States last year, but 3,381 people died while waiting on the transplant list – 14 people every day.
Just in time for Donate Life Month, Julio Jorge Elias, a former University at Buffalo economist who now teaches at a university in Argentina, has a radical solution for this shortage of kidney donations:
Pay for them.
Elias, who spent the spring semester at UB as a visiting professor of economics, has studied kidney donations for a dozen years, since he was a research assistant for Gary S. Becker, the Nobel Prize-winning economist at the University of Chicago.
They have written several papers on the topic and earlier this year published an essay in the Wall Street Journal titled “Cash for Kidneys.”
Critics say the idea of paying for a kidney is repugnant, or immoral, but Elias and Becker believe the only way to address the kidney shortfall – and the terrible personal and societal costs that come with it – is to create a market for kidneys and give prospective donors a financial incentive.
The economists would pay live donors, and reimburse the families of people who agree in advance to donate a kidney after they die, and they’ve even set a price for how much a kidney from a live donor is worth: $15,000.
Stephen T. Watson: Why do you study the market for kidneys?
Julio Jorge Elias: First of all it is a very big, important problem. I think that it is a great thing that an economist like Gary Becker is interested in this problem, and trying to find a solution. One reason I think that he has been interested in this problem is because he really thinks that economics has to be judged on how useful it is in helping improve people’s lives. I share (that view) 100 percent.
SW: Why aren’t there enough kidneys to meet the need?
JE: When an economist sees a shortage, the first thing that you do is try to look for an obstacle that is not allowing supply to meet demand. The reason, the obstacle, in the actual system for kidney transplantation is obvious. The main obstacle is you, or the system, does not allow for monetary payment for kidney donors. This is the main reason of the shortage.
SW: Why do you want to overturn a system of altruistic donation that is supported by patients, donors, transplant surgeons and the organizations that procure and assign organs?
JE: Altruism is really important. This is clear. Under the current system, you have an annual number of transplants, now it is close to 16,500. (That figure from 2012 has since dropped to 14,029, according to the National Kidney Foundation.) But clearly this is not enough. It is not enough because the annual demand for transplants is close to 25,000, 24,000, and you have a waiting list that today is close to 100,000 patients. Again, altruism is important but it is not enough to close the gap.
SW: New York and a handful of other states allow living organ donors to deduct certain related expenses. Why not expand that set of tax deductions instead of paying for kidneys?
JE: So what is the effect of this policy? It’s better than nothing. But, again, I think that this incentive is small. And it’s also among a reduced pool, because it’s among altruistic donors. And I think that one thing we know from economics is that small incentives have small effects.
SW: How did you come up with your estimated value of $15,000 for a kidney?
JE: We answered the following question: What is the minimum that you have to give to a person to induce him or induce her to donate a kidney as a live donor? So then we said you have to compensate mainly for three things. First of all you have to compensate the donor for the risk of dying in the surgery. The second part is you have to compensate the donor for foregone earnings (while recovering from the procedure). And the third component is the most difficult one, the risk of reducing the quality of your life.
SW: Wouldn’t paying for kidneys create an imbalanced system of people of limited means selling their kidneys to the well-to-do?
JE: So what is going to be the typical organ donor under this system? OK, clearly rich people are not going to be selling a kidney. But what you can say is that a good example there is the voluntary army. There was a big question if it was going to be an army of the poor. And I think this is not the case in the U.S. Now, in the case of organ donors, you may think that it’s going to be lower – healthy, because you have to be healthy – middle-income people. OK, well, suppose that you say you don’t like the idea of poor people selling an organ. ‘Why don’t we put a minimum income to sell an organ?’ This is going to be much better? Why deny a source of income to these people? A very important thing, in any market system, the donor will be able to walk away. Even one hour before the procedure.
SW: Do you worry about people taking advantage of a cash-for-kidney system?
JE: Of course we are going to have abuse. Like in most markets, there are cases. There was abuse in the mortgage crisis in the United States. Now, it doesn’t mean that all the market (was bad) – I think that this is a very small part of the story, the abuse.
SW: Iran allows for the sale of kidneys from living donors. What has their experience been?
JE: From the thing that we know from Iran – there are some papers – the system is working well. The waiting list has been eliminated. In this case, the system is a centralized system. You have a foundation that is in charge of recruiting donors. In Iran, the government pays part of this and another part is negotiated, is basically paid by the family of the recipient. So the system is working well.