Four decades after the enactment of the the National Organ Transplant Act, it is time for Congress to adopt the End Kidney Deaths Act. We should recognize, at long last, that altruism isn’t enough to save everyone who needs a kidney.
Those who would be motivated by a tax credit to donate their body parts are not going to be the rich, it would make organ donors of a class of poor people. More ethically sound would be to unconditionally give to potential donors a living income for 10 yeaars, and then ask them to donate organs, with the yes or no decision not affecting their income. You could do a pilot of that. Let's see how many donors you get,.
The future lies more in figuring out pig immunology so they can become donors.
I think you're right about that. It's like surrogate motherhood. You don't see Park Ave socialites volunteering for that. It's dirt poor women in Thailand (now that India has banned it.)
Allow the family of deceased donors to be with the donor as they harvest the organs... So they can accompany the family member as the machinery is turned off. Currently I wouldn't allow a family member to donate because their body is isolated and ignored after the harvesting process... As a family member I can't accompany them in their final moments (even if they're technically already dead), and neither does anyone else. I'm familiar with OT environments, I'm happy to stand in the corner, just let me stay with my loved one (donor) in their final moments. Currently they're ignored once the harvest has happened. Those of us with a spiritual connection to the deceased donor who believe the body is more than a shell can be dissuaded from agreeing to donation by the practical realities of the way the donor is handled, and it's an easy fix, if you stop treating relatives as bombs that could go off, and recognise we are trustworthy medical professionals too.
Far more effective just to prevent and treat kidney disease better. Plant-based diet, some nutraceuticals (especially for preconditioning to prevent contrast toxicity), getting toxins out of the environment (this includes in this case fluoride and glyphosate).
I also wonder about EECP and remote ischemic conditioning. These seem to help with CKD. RIC has been shown to even reverse cerebral small vessel disease. These therapies may have a high ceiling in terms of cumulative benefit that can be had. For the costs of kidney disease management, every patient could have an EECP machine in their living room. I know someone who spent 20k to get one because it made his general health so much better. He says he is aging backwards, his erectile function is great, and phlebotomists comment on this nice veins now.
The experiment has been done to a very poor outcome. Time to revisit and SAVE lives by devising a compensation methodology. Transplant surgeon/team gets paid, f/u transplant coordinator and transplant MD gets paid, hospital gets paid - everybody gets paid but the donor. And like Sally stated, the ongoing care costs for ESRD is tremendous - with significant mortality outcomes vs a cadaveric or LR kidney donation. Seems like a no brainer...
Haven't thought enough about the details to know if I fully agree with this specific proposal, but I'm fully in support of the idea in general of compensating people financially for making organ donations. I can't imagine how awful it would be to desperately need an organ and to suffer and die needlessly because people who might have been willing to donate if compensated financially are not donating.
The other change we should institute is to make becoming an organ donor when you die opt out rather than opt in and to make anyone who opts out ineligible from being an organ donor recipient (at least from anyone but a family member).
Putting a value on something changes the altruist's decision-making. Society is telling me that organ I thought was priceless is really only worth $10k a year for 5 years (and only if I pay more than that in taxes today). In my mind this has turned a 1000+x EV gesture into a negative . I'm taking my name off the list.
The law of diminishing marginal utility: As the value of an organ donation declines, the satisfaction derived from being a donor declines. Satisfaction is not just about saving or improving a life. Donors get satisfaction from leaving a legacy, from social confirmation of their good work, perhaps from enhanced standing among peers or family and from reinforcement of their own opinions of themselves as a good or caring person. The law of marginal returns would suggest that to increase donations, we should do more to increase the value potential donors place on all of the intangibles.
The tax credit approach will attract donations from those who are more transactional and place less value on the intangibles. But, as each of these “suppliers” moves into the market, I’m less motivated to stay: my donation that I valued at $Infinity now has a value approaching the transactional price and my peers would suspect I’m only staying for the money.
While I am in favor of anything reduces taxes, I am opposed to anything that involves the government further in medical care. Each person's ownership of their body is the fundamental principle of freedom. Without that right, no one is really free. There should be a free market in body parts. Allowing the government to price it would, no doubt, ensure that the seller is not getting full value. And before anyone brings it up---No, a fetus is not part of your body and you have no right to sell it or kill it.
Once you give a tax credit or money, consent is no longer truly voluntary. It also commodifies a human. The altruism of truly voluntary living donors is a wonderful generous act, it needs no recompense.
This particular author (while working for AIE which got funding from Purdue which she did not initially disclosure or even think to investigate) had opinions about opiods that were totally wrong. So why should we trust her judgment here?
And maybe her judgment is also clouded by her personal receipt of a kidney, because if she is going to need another one (not unusual for second transplant to be required down the line) she has vested interest in increasing supply. That itself is a conflict of interest which should have been disclosed and considered.
What percentage of kidney transplant doctors and transplant teams voluntarily do living kidney donations?
What percentage of doctors in general do living kidney donations?
Why should kidney donations be prioritized with a tax credit over many other behaviors for which a tax credit could be given?
Every dies. What is happening is the delay of death. Living donation must be fully voluntary with no inducements and with full informed consent.
1-3 in 10,000 living donors will die within 3 months from making the donation. Aren't those deaths also unnecessary? Since the donor faces a risk, the act must be completely voluntary.
“In addition to saving lives, the EKDA has a built-in “pay for” – as more patients received kidneys, the revenue loss from the tax credit would be more than offset by Medicare’s savings reaped from the fewer number of patients on dialysis. On average, Medicare spends almost $100,000 a year for every person on dialysis.”
This assertion does not take into account the fact the fact that longer survival will incur additional costs associated with the underlying reasons for renal failure (diabetes, hypertension, etc.), so the savings would be much smaller or possibly completely offset.
The issue of organ replacement sounds very similar to the fertility crisis. The only difference seems to be the level of comfort people have with offering financial incentives.
Ultimately my guess is that neither will suffice. I've been reading lately some interesting work and discussion around the power of Status Signals. Likely we will need to create new policies and change/eliminate old policies so as to give people who donate their organs a higher Status marker than those who do not.
All good points. I'm very close to this as my daughter is on dialysis and I desperately want to be considered as a donor for her. I must admit I am skeptical using the system that one donates their kidney to a person and then the next compatible kidney goes to her.
What about the proposition I've heard about that accepting less than perfect kidneys should get more consideration? If I needed a kidney and there was one available from a person with HTN and hypothyroidism I'd take it in a heart beat. It will get me off dialysis and on my own until this slightly damaged kidney fails and I get put on the list again.
What about people who want to donate but are labelled ineligible? I'm 70. I have HTN. As a nurse I understand the risks of donating and I dismiss them. It seems to me that the possibility of a death on the OR table might give the hospital a red checkmark, but I'm ok with that. I'm walking in with eyes wide open. I know my kidney wouldn't last the rest of my daughter's life, but it will help her lead a better life until she needs another one. And, hey, there's also a chance I'll live post surgery. I even asked if I "accidentally" dropped dead at the operating room door, would they take my kidney then?
Educate people. Give them all of the necessary information they need in wording they can understand and let them make a choice.
Desperate people, desperate times = poorly planned decisions.
And we will JUST pass up the reasons that so many people are on dialysis and have kidney issues and move right to the money. What's changed that so many people are on dialysis? How is that fixed? Creating a money plan (yes, I know it's a tax credit) for donors is just skipping the real issue just like Big Pharma does all the time. I think it's sad that we just jumped the shark here.
Let's not even go to the monetary issue of exchange for an organ.
Back decades ago when I was a new RN and worked in Inpatient Oncology, we dealt with organ transplant frequently, usually corneal donations.
I wondered then and wonder now why every associated person, every organization and every facility- except the donor and family- gets some sort financial benefit from organ donation.
The reason the other orgs get money is that people do not generally or reliably work for strangers for free. Someone had to show up that day to fill out the paperwork, put the ice in the bucket, etc. Like you were being paid to show up and be the RM. The kidney donation process doesn’t require labor from the family. And when you start paying for things like body parts it gets dangerous.
Those who would be motivated by a tax credit to donate their body parts are not going to be the rich, it would make organ donors of a class of poor people. More ethically sound would be to unconditionally give to potential donors a living income for 10 yeaars, and then ask them to donate organs, with the yes or no decision not affecting their income. You could do a pilot of that. Let's see how many donors you get,.
The future lies more in figuring out pig immunology so they can become donors.
I think you're right about that. It's like surrogate motherhood. You don't see Park Ave socialites volunteering for that. It's dirt poor women in Thailand (now that India has banned it.)
Allow the family of deceased donors to be with the donor as they harvest the organs... So they can accompany the family member as the machinery is turned off. Currently I wouldn't allow a family member to donate because their body is isolated and ignored after the harvesting process... As a family member I can't accompany them in their final moments (even if they're technically already dead), and neither does anyone else. I'm familiar with OT environments, I'm happy to stand in the corner, just let me stay with my loved one (donor) in their final moments. Currently they're ignored once the harvest has happened. Those of us with a spiritual connection to the deceased donor who believe the body is more than a shell can be dissuaded from agreeing to donation by the practical realities of the way the donor is handled, and it's an easy fix, if you stop treating relatives as bombs that could go off, and recognise we are trustworthy medical professionals too.
Far more effective just to prevent and treat kidney disease better. Plant-based diet, some nutraceuticals (especially for preconditioning to prevent contrast toxicity), getting toxins out of the environment (this includes in this case fluoride and glyphosate).
https://pubmed.ncbi.nlm.nih.gov/31725014/
https://pubmed.ncbi.nlm.nih.gov/32457981/
https://casereports.bmj.com/content/12/12/e232080
https://pubs.acs.org/doi/10.1021/acs.estlett.3c00504
I also wonder about EECP and remote ischemic conditioning. These seem to help with CKD. RIC has been shown to even reverse cerebral small vessel disease. These therapies may have a high ceiling in terms of cumulative benefit that can be had. For the costs of kidney disease management, every patient could have an EECP machine in their living room. I know someone who spent 20k to get one because it made his general health so much better. He says he is aging backwards, his erectile function is great, and phlebotomists comment on this nice veins now.
The experiment has been done to a very poor outcome. Time to revisit and SAVE lives by devising a compensation methodology. Transplant surgeon/team gets paid, f/u transplant coordinator and transplant MD gets paid, hospital gets paid - everybody gets paid but the donor. And like Sally stated, the ongoing care costs for ESRD is tremendous - with significant mortality outcomes vs a cadaveric or LR kidney donation. Seems like a no brainer...
Haven't thought enough about the details to know if I fully agree with this specific proposal, but I'm fully in support of the idea in general of compensating people financially for making organ donations. I can't imagine how awful it would be to desperately need an organ and to suffer and die needlessly because people who might have been willing to donate if compensated financially are not donating.
The other change we should institute is to make becoming an organ donor when you die opt out rather than opt in and to make anyone who opts out ineligible from being an organ donor recipient (at least from anyone but a family member).
Putting a value on something changes the altruist's decision-making. Society is telling me that organ I thought was priceless is really only worth $10k a year for 5 years (and only if I pay more than that in taxes today). In my mind this has turned a 1000+x EV gesture into a negative . I'm taking my name off the list.
Be careful what you wish for!
Can you say more about why this means that you don’t want to save someone s life as a deceased or living donor? You don’t have to take the tax credit.
The law of diminishing marginal utility: As the value of an organ donation declines, the satisfaction derived from being a donor declines. Satisfaction is not just about saving or improving a life. Donors get satisfaction from leaving a legacy, from social confirmation of their good work, perhaps from enhanced standing among peers or family and from reinforcement of their own opinions of themselves as a good or caring person. The law of marginal returns would suggest that to increase donations, we should do more to increase the value potential donors place on all of the intangibles.
The tax credit approach will attract donations from those who are more transactional and place less value on the intangibles. But, as each of these “suppliers” moves into the market, I’m less motivated to stay: my donation that I valued at $Infinity now has a value approaching the transactional price and my peers would suspect I’m only staying for the money.
While I am in favor of anything reduces taxes, I am opposed to anything that involves the government further in medical care. Each person's ownership of their body is the fundamental principle of freedom. Without that right, no one is really free. There should be a free market in body parts. Allowing the government to price it would, no doubt, ensure that the seller is not getting full value. And before anyone brings it up---No, a fetus is not part of your body and you have no right to sell it or kill it.
Once you give a tax credit or money, consent is no longer truly voluntary. It also commodifies a human. The altruism of truly voluntary living donors is a wonderful generous act, it needs no recompense.
This particular author (while working for AIE which got funding from Purdue which she did not initially disclosure or even think to investigate) had opinions about opiods that were totally wrong. So why should we trust her judgment here?
And maybe her judgment is also clouded by her personal receipt of a kidney, because if she is going to need another one (not unusual for second transplant to be required down the line) she has vested interest in increasing supply. That itself is a conflict of interest which should have been disclosed and considered.
What percentage of kidney transplant doctors and transplant teams voluntarily do living kidney donations?
What percentage of doctors in general do living kidney donations?
Why should kidney donations be prioritized with a tax credit over many other behaviors for which a tax credit could be given?
Better yet, we need a free market for organs.
No thank you to the commodification of humans.
Better: the unnecessary death of humans?
Unnecessary death? What exactly does that mean?
Every dies. What is happening is the delay of death. Living donation must be fully voluntary with no inducements and with full informed consent.
1-3 in 10,000 living donors will die within 3 months from making the donation. Aren't those deaths also unnecessary? Since the donor faces a risk, the act must be completely voluntary.
“In addition to saving lives, the EKDA has a built-in “pay for” – as more patients received kidneys, the revenue loss from the tax credit would be more than offset by Medicare’s savings reaped from the fewer number of patients on dialysis. On average, Medicare spends almost $100,000 a year for every person on dialysis.”
This assertion does not take into account the fact the fact that longer survival will incur additional costs associated with the underlying reasons for renal failure (diabetes, hypertension, etc.), so the savings would be much smaller or possibly completely offset.
There are offsets but it’s still a net plus. If you want a reference , let me know Also, some will return to work force and pay taxes.
The issue of organ replacement sounds very similar to the fertility crisis. The only difference seems to be the level of comfort people have with offering financial incentives.
Ultimately my guess is that neither will suffice. I've been reading lately some interesting work and discussion around the power of Status Signals. Likely we will need to create new policies and change/eliminate old policies so as to give people who donate their organs a higher Status marker than those who do not.
Not everyone w kidney disease requiring a transplant got ill from our food stuffs. Autoimmune disease is just one of the possible etiologies
All good points. I'm very close to this as my daughter is on dialysis and I desperately want to be considered as a donor for her. I must admit I am skeptical using the system that one donates their kidney to a person and then the next compatible kidney goes to her.
What about the proposition I've heard about that accepting less than perfect kidneys should get more consideration? If I needed a kidney and there was one available from a person with HTN and hypothyroidism I'd take it in a heart beat. It will get me off dialysis and on my own until this slightly damaged kidney fails and I get put on the list again.
What about people who want to donate but are labelled ineligible? I'm 70. I have HTN. As a nurse I understand the risks of donating and I dismiss them. It seems to me that the possibility of a death on the OR table might give the hospital a red checkmark, but I'm ok with that. I'm walking in with eyes wide open. I know my kidney wouldn't last the rest of my daughter's life, but it will help her lead a better life until she needs another one. And, hey, there's also a chance I'll live post surgery. I even asked if I "accidentally" dropped dead at the operating room door, would they take my kidney then?
Educate people. Give them all of the necessary information they need in wording they can understand and let them make a choice.
Desperate people, desperate times = poorly planned decisions.
Did the medical industry CREATE the problem by not addressing the root cause and NOW we have a crisis. That's rhetorical by the way LOL
And we will JUST pass up the reasons that so many people are on dialysis and have kidney issues and move right to the money. What's changed that so many people are on dialysis? How is that fixed? Creating a money plan (yes, I know it's a tax credit) for donors is just skipping the real issue just like Big Pharma does all the time. I think it's sad that we just jumped the shark here.
Let's not even go to the monetary issue of exchange for an organ.
Back decades ago when I was a new RN and worked in Inpatient Oncology, we dealt with organ transplant frequently, usually corneal donations.
I wondered then and wonder now why every associated person, every organization and every facility- except the donor and family- gets some sort financial benefit from organ donation.
I think that issue should be addressed.
The reason the other orgs get money is that people do not generally or reliably work for strangers for free. Someone had to show up that day to fill out the paperwork, put the ice in the bucket, etc. Like you were being paid to show up and be the RM. The kidney donation process doesn’t require labor from the family. And when you start paying for things like body parts it gets dangerous.