Hmmmm. The problem that I am seeing, which doesn't seem to be adressed in the article, is sheer cost. Let us postulate that a kidney transplant is already expensive; if you compensate 'donors' (which they aren't anymore, if they've been given cash, any more than I am donating goods that I sell at my store), you raise the cost of the operation. Regardless of who pays for the operation, the price tag is going to have to rise somewhere.

Perhaps it's anti-capitalist, but not allowing people to buy or sell organs and requiring that they be on a national waiting list gives wealthy and poor people more equal footing. Once you can essentially buy an organ, the wealty people have an enormous advantage, at the cost of the poor people. That is, you probably aren't going to see a huge flood of new people willing to give away/sell a kidney, just because you're giving them, say, $10K for their organ. That means more kidneys for people who can afford to pay, less for those that can't. (Insurance already balks at paying for expensive treatments like kidney and bone marrow transplants; I would strongly be that adding most costs onto the operations would make them even more likely to find a reason why they shouldn't pay for it. Likewise, medicare/medicaid are seriously underfunded and underpay to health care providers, and many hospitals are already losing money. Increase in costs for hospitals means less healthcare available all the way across the board.) Since full-on renal failure is pretty much a death sentence, that means that, essentially, you are condemning poor people to death while granting a reprieve for people who have cash.

On the flip side, a national waiting list allows a higher level of equality. Having money doesn't get you bumped up the list (although certain political connections and worsening condition might...).

The other real, viable option is to socialize/nationalize all healthcare in the country (except fully elective procedures), keep the national registry/waiting list, and using public funds to compensate donors. This increases the supply of organs slightly, and yet keep rich and poor people on the same footing so that transplants would still be determined by need and availability, not by who is the most able to pay.

That said, if someone offered me $100K for a kidney, I'd be awfully tempted...

This is what I was going to say. Compensation is only appropriate if everyone has the same opportunity to get the kidney. Otherwise, never mind setting a bad example for other countries; we will be the country where the rich buy organs from the poor.

Sure, there will be some private exchanges, more than likely between family members or with patients who can afford to take on the cost. But most organ donations will happen due to harvesting. The compensation will perhaps not make the loss to the family any less a tragedy but at least less of a burden, financially. Or the funds could be donated to a charity or back to the foundation that will be controlling the payouts.

As to making the process more expensive, you failed to take into account the care needed to treat a chronic disease especially those of the lung and the kidney. Insurance will happily pay 10K to get a patient off of dialysis onto a transport drug regimen.

But even then, it probably would not the insurance that would have to pay anyway. Medical foundations, such as the reluctant NKF, can tweak their operations just a bit to help fund the expense. They already have powerful fundraising arms that could take on this additional duty without having to change how it does business too much.

The only downside would be a shift away from research, monetarily speaking. Foundation monies that once focused on finding a cure or viable treatment could disappear as more and more people opt to receive compensation for organ transfers (can't quite call them donations since they will be getting paid for them). But that part seems remote since big pharma is still part of the mix as well and organ transfers, while helping, can't ever fully replace the owner's original pipeworks.

I'm even less comfortable with the idea of family members standing to profit from harvesting organs. They're the ones who would decide whether to continue treatment in many cases, so I don't think they should be given financial incentives to refuse them. Especially since, after we decide it's okay to pay for harvested organs, we'll soon decide it's okay for harvested organs to go to the highest bidder, instead of clinging to a system that is clearly socialistsic.

As long as I've had a driver's license, I've been an organ donor. If it were possible to buy and sell organs, I would probably remove myself from the program. It may sound cruel but I would much rather my family receive some compensation from my death and sell my organs, than for them to be given away for free.

I am a lung and kidney transplant receipient. I was on dialysis for a year. I support anything we can do to increase kidney donations by any amount. It's not an either/or situation. We can try this. We should try anything that comes to mind. Try it and see the results. Let's see if it works or it doesn't work and if it doesn't, try something else. Keeping working and trying until people aren't dying for lack of kidneys and people don't have to suffer with dialysis.

When you've been through what we've been through, you'll understand the urgency.

To be honest, I really don't care if it would lead to more organs or not. It would be fundamentally wrong for the rich to take body parts from the poor.

This is especially offensive when you consider that the number of available organs could be increased tenfold, in a couple of years, by putting the words "refuse to" after "hereby" on the back of every drivers license. Require drivers to "opt out" rather than "opt in."

Dr. Satel didn't say anything about changing the way organs are allocated. In fact, she elsewhere says that part of the system should remain the same, which does not discriminate based on wealth. So, the rich would NOT be buying organs from the poor, everyone in need would. And the insurance companies would likely pay for the organs, since transplants save lots of money spent in years of thrice-weekly kidney dialysis.

"And the insurance companies would likely pay for the organs, since transplants save lots of money spent in years of thrice-weekly kidney dialysis."

Oh yeah, right. The same insurance company that won't cover my Nexium perscription is going to pay thousands to BUY a kidney? Dream on.

The harvesting of organs from deceased donors for cash is one thing. Volunteering one's own organs (kidneys) while one is ALIVE is another thing entirely.

I am a recent recipient of a kidney donated by a friend. I was at Stage V of kidney failure, perhaps months shy of requiring dialysis. I feel like the luckiest man alive.

My donor and I are interested in promoting the concept of LIVE kidney donors receiving college tuition credits in return for their donations (along the lines of Obama's plans for national service --Peace Corps or military service--resulting in a 'free ride' through college). In order to qualify, the donor would have donate to whoever was the best match (not a friend or relative). In other words, it would be an anonymous donation, though donor and recipient COULD be put in touch with one another.

A comment (above) focused on the cost (that would be added to the medical procedure) of 'purchasing' a kidney. Consider that a kidney transplanted BEFORE a recipient needed dialysis would sidestep years decreased productivity on the part of the recipient. Not to mention preventing years of physical PAIN, malaise, dietary restrictions, blood tests, blood pressure meds, etc. And, of course, the time and unpleasantness of dialysis itself!

Please visit our blog & join in the conversation (kidneytwin.wordpress.com).

Look. I am what would be considered "Poor". I'm up against it right now but I haven't always been. When things were good I considered "Donating" a kidney for a long time. Now that things are tough I would definately consider Donating for compensation. Things are desperate. This whole philisophical debate about protecting the "poor" from the organ entitled "rich" is a luxery many in my position don't understand. Is it better to let some one in need die and a poor man get swept to sea by the undertow of poverty? Who shouldn't both donor and recipient have a shot at a new life?

Actually, this is a Medicare problem. Medicare currently pays $50,000 - $75,000 per year for hemodialysis per patient. The cost of immunosuppressive medications is about $15,000 per year. Even if Medicare pays the kidney donor and also for all surgical aspects of the transplant, Medicare will be paying less one year after transplant, and for the life of the patient. It has been called a win-win situation, and it is ...