New Zealand’s Ministry of Health has implemented a new program that would compensate living organ donors for lost earnings. Now anyone who donates a kidney or part of their liver to an eligible person can receive up to twelve weeks of compensation for earnings lost while they recover, and also receive travel and accommodation assistance. With the new policy, New Zealand is leading the way in creating a framework that could reduce long waiting lists for organ donation, and attenuate the hardships created by the limited supply of donations.
The United States a lacks organ donors and could usefully copy New Zealand. More than 96,000 candidates are waiting for a kidney, and another 14,000 waiting for a liver. Every ten minutes another person is added to the national transplant waiting list. More than 19,000 kidney transplants took place in 2016. Living donors accounted for only about 30 percent of these transplants.
These shortages have serious consequences for those on waiting lists. A recent study by Stanford University researcher Philip J. Held and coauthors at the American Journal of Transplantation estimated that between 5,000 and 10,000 kidney patients die prematurely in the United States each year, and another 100,000 suffer from effects of dialysis due to the shortage.
One constraint on organ donation is that donors would be worse off financially, either due to time away from work recovering or cost of travel and accommodation. Another study in the American Journal of Transplantation by Professor Scott Klarenbach of the University of Alberta and coauthors estimated that 96 percent of kidney donors in a Canadian study experienced adverse economic consequences. Almost half of the donors reported lost pay, with an average loss of $2,144, while the average for other associated costs such as travel was $1,780.
Under the system established by the National Organ Transplant Act of 1984, kidneys can be donated but must be given for free. NOTA does allow “reasonable payments” for associated expenses incurred by the donor, but these are financed by the recipient themselves, which places limitations on the extent to which donors can be compensated.
A 2014 panel of economists issued by the University of Chicago Booth School of Business found that 45 percent of respondents agreed that a market allowing payment for kidneys should be established on a trial basis to help extend the lives of patients with kidney disease, while 29 percent were uncertain and 12 percent disagreed.
But ethicists disagree. Opponents of introducing compensation suggest that such a shift could crowd out voluntary donation, or lead to a situation where the poor donate organs for financial remuneration. A more robust system of compensation for lost wages or related expenses could avoid some of the more strident opposition to a market for organ donation, while still resulting in an increase in the supply of organ donations.
In 2006 the U.S. Department of Health and Human Services announced a program to help living donors reduce financial disincentives to donation, awarding a grant to help fund the National Living Donor Assistance Center. The Center aimed to help defray these costs, but was limited in terms of its scope, receiving about fewer than 4,000 applications from 2007 to 2013. Eligibility was also restricted, which might explain part of the reason only 19 percent of the donors were unrelated to recipients. In order to boost organ donations to the extent that waiting lists decline, donations would have to come from unrelated individuals.
The NALDC is now conducting a randomized controlled trial to assess the effect of wage reimbursement on the provision of kidney donations. The trial is projected to run through 2018 so the results should be available in 2019. The experiment could give a sense of how much donations would increase with a more developed system of reimbursement for donors.
The government spends substantial amounts on dialysis through major health care programs, and some of the government's restrictions are exacerbating the shortages. Federal reimbursement from the government for associated costs, in the same vein as New Zealand’s new policy, could improve the lives of people on those waiting lists while also reducing the amount of money spent on major public health programs.
The United States is grappling with the costs of long waiting lists and the status quo is not working for those who need life-saving treatment. A more robust system of reimbursing donors for costs related to making that donation could substantially increase supply and reduce suffering. New Zealand could be one model to follow.
Charles Hughes is a policy analyst at the Manhattan Institute. Follow him on Twitter @CharlesHHughes.
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