Buying A $100,000 Kidney: A Story of Supply and Demand

The idea of  compensating donors of vital organs, which strikes many as morally repugnant, is gaining acceptance among some parts of the medical community which has grown frustrated at watching thousands of patients die awaiting transplants.

A survey done a few years ago found that roughly 70% of respondents backed the idea though as Dr. Alan I. Reed, director of the Division of Transplant and Hepatobiliary Surgery at the University of Iowa Medical Centers,  notes doctors remain opposed to cash payments for organs.    Instead, they would prefer other types of compensation such as life insurance policies.

Though it’s long been opposed by religious groups and medical ethicisits, some economists such as Nobel Prize winner Gary Becker of the University of Chicago argued in a 1997 article in Business Week, that the situation was so dire that payments made sense.  He figured a $15,000 payment would increase the kidney supply by 44%.    The idea of compensating donors contines to trouble some doctors.

“… a rift in the transplant community resulting from a marginally supported
organ market will likely be much more detrimental to organ transplantation in the United States than any putative increase in donation from establishing financial incentives,” the American Journal of Transplantation argued in an editorial last year.

Shortages for organs are so bad that people will sign up on waiting lists in different parts of the country,  which is what Apple Inc. (NASDAQ:AAPL) CEO Steve Jobs did, which is perfectly legal.   Several hundred U.S. citizens — the number could be much higher — grow frustrated with the multiple-year waits and are believed to acquire black MARKET organs overseas. The illegal trafficking in human kidneys is roughly a $60 million to $100 million business, according to estimates by 24/7 Wall St.   The cold, stark realities of supply and demand make incentives an appealing proposition for kidney patients.

“Its something that I believe can be tried under very close regulation,”  Reed says.   “When you regulate a market, the black market goes away….  A lot of trans planned professions are frustrated that people are dying while we wait for organs.”

For now, payments for organs are prohibited under the National Organ Transplant Act (NOTA) which prohibits “any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration
for use in human transplantation.”  In a 2009 paper, Reed argued that the law was never designed to forbid any compensation to donors.

“The ASTS (American Society of Transplant Surgeons)  supports amending NOTA to allow for limited trials of measures to provide incentives for organ donation in the United States,” he writes. “It is possible that a limited trial of incentives for live donation in the form of provision of health care coverage by Medicare.”

Kidney disease can be cruel and insidious for both patients and their families, especially if they need a transplant.  Waits vary by region and blood type and can last as long as 9 years.  Patients have to bide their time waiting for either a donation from a living donor or one donated from a deceased person.  The operation costs about $250,000.   In 2008, more than 4,500 people died waiting for a kidney, according to the National Kidney FOUndation.

About 110,000 people are waiting for an organ transplant and more than 4,000 new patients are added to the waiting list each month, most of whom need a kidney. Government officials estimate that about 23 million adults have evidence of chronic kidney disease. Another 300,000 people are on dialysis and may need transplants.  Their ranks will swell in the coming years because of rising rates of obesity and diabetes, leading causes of kidney disease.

“People will live longer on a transplant,” he says.   “Now you see the motivation to buck the system and go out of the country.”

Frustrated by the wait for new kidney, at least several hundred U.S. residents travel overseas in the hopes of finding life-saving surgery.   Though exact figures are hard to come by, a study published a few years ago estimated that more than 400 U.S. patients received transplants overseas between 2004 and 2006, mostly in China.   These patients appear undisturbed by reports of China using executed prisoners as unwitting organ donors.

“Nevertheless, the extreme shortage of transplant organs in the U.S. continues to make organ transplantation in China an appealing option for some patients with end-stage disease,”  according to a 2010 article in the medical journal Liver Transplantation.  ” Their choice of traveling to China for an organ leaves U.S. transplant programs with decisions about how to respond to the needs of patients who return after transplantation.”

Hospitals in other parts of the world including India, Pakistan, Israel and the Singapore also are actively marketing to U.S.  patients.  Business, by many accounts, is booming as the numbers of live kidney transplants soars by double-digits in many countries.   Research published in the American Journal of Transplantation in 2008 found that a hospital in Pakistan reported that at least 2,000 transplants had been performed on tourists.  Doctors in  the Philipines have done more than 3,000 such operations.

The price for kidneys is about $100,000.  Most of that money lines the pockets of the overseas brokers and hospitals who do the surgery.   Very little — the World Health Organization estimates as low as $800 — goes to the donors themselves.

According to a joint 2009 report from the United Nations and the European Union, 5 to 10% of kidney transplants of the 65,000 or so kidney transplants are trafficked.   Demand for the organ far outstrips supply throughout the world.  The sale of organs is prohibited in most countries including the United States. One notable exception is Iran.

Arthur Caplan, a leading bioethicist, tells 24/7 Wall St.  that paying for organs should remain illegal for a host of legal and ethical reasons.  First of all, the U.S. would lose the moral high ground and pick a fight with the world’s major religions which all oppose the practice.

“If you create market here you are going to have a black market flourish around the world,” says Caplan, director of the Center for Bioethics at the University of Pennsylvania, in an interview. “In America, people aren’t going to sell their organs for small amounts of money…….You are really going to take advantage of the poorest of the poor.”

And that’s exactly what happens to many donors for pay.  Studies have shown that many have serious health issues such as hypertension following their operations.   Many donors also report that their economic circumstances are no better off than they were before they sold a vital organ.  Reed agrees that the exploitation of donors is appalling but argues that patients rights can be protected in the United States.

Transplant tourist also experience difficulty Some transplant tourists wind up getting sicker after their overseas hospitalizations because the standards of care are not as stringent in many countries as they are in the United States.    Surgical wounds take longer to heal and disability is more common,  according to the American Association of Kidney Patients.

In the end, the lessons of the kidney market are many but can be boiled down to one: you get what you pay for with sometimes tragic results.

–Jonathan Berr