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June 2, 2021

A Regulated System of Incentives for Kidney Donation—Time for a Trial!

Author Affiliations
  • 1Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis
JAMA Surg. 2021;156(9):807-808. doi:10.1001/jamasurg.2021.1435

For a patient with kidney failure, a successful transplant, compared with dialysis, provides longer life and better quality of life. Significant improvement in transplant outcomes has led to expansion of candidacy criteria and a marked increase in the number of patients eligible for transplant. In the past 2 decades, numerous attempts have been made to increase the number of both living donors (eg, nondirected donors, paired exchange) and deceased donors (eg, donation after circulatory death), yet there has been little change in the number of donated kidneys. With increasing need but limited supply, the waiting list for a transplant has grown and waiting times have increased, with substantial negative consequences for patients in the US. In the last 20 years, more than 89 000 candidates in the US died while waiting for a kidney. An additional 54 838 were removed from the waiting list because of becoming too sick to undergo a transplant.1

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1 Comment for this article
Financial incentives for organ transplantation
Martin Roy First, MD, FAST | Self- employed
I addressed this issue in my 1991 address as president of the American Society of Transplantation. Unfortunately, little has changed over the past 30 years. Kudos to Dr. Matas for pursuing this long overdue change that is needed to improve the lives of those with end-stage organ failure.
My talk was published in Transplantation 1992; 53: 1-11.
Excerpt below:
Financial Incentives to Donor Families
The exploration of various types of financial inducements to enhance organ donation has recently been suggested. Among ideas that have been proposed are the concept of a death benefit that would be paid directly to
the donor family, possible reductions in the state and/or local income taxes, payment of some or all of the costs associated with burial of the donor, payment of some portion of the hospital costs incurred by the donor family during the terminal hospitalization of the donor, and the provision of an insurance credit in the event a surviving member of the donor's family were to require a transplant in the future. The issue remains highly controversial and fears have been expressed that payment for cadaveric organs would result in a loss of altruistic values.