A bill in Congress would create a pilot project, allowing for people who donate kidneys to an anonymous recipient on the national kidney waitlist to get a $50,000 tax credit, spread over five years. The National Kidney Foundation reports more than 100,000 Americans need a kidney transplant, around 17,000 get one each year. This proposal aims to increase that last number.
A paper published in 2019 tried to estimate the financial disincentives to becoming a kidney donor. When taking into account factors like loss of income while recovering, decrease in long-term quality of life, the pain and discomfort of removing the kidney itself and the worry that a close friend or family member may need a kidney down the road, the authors put the financial disincentive at nearly $38,000. They also concluded that if the government removed all disincentives, kidney donations would increase by 60 percent per year.
But, offering money to potential organ donors raises a host of questions and problems. Dr. David Beyda, chair and professor in the Department of Bioethics and Medical Humanism at the University of Arizona College of Medicine – Phoenix, joined The Show to talk more about this proposal.
Full conversation
MARK BRODIE: First off, just what do you make of this proposal?
DR. DAVID BEYDA: There are some significant ethical issues here and you know, there's, there's positives and negatives. The, the main issue is how do we go about making sure that this truly is an altruistic donation of a kidney without marginalizing those who are not able to kind of contribute to something like this.
You know, there's, there's a lot of danger in giving $50,000 to someone who's already marginalized and they are coerced because of the, the amount of money that they can receive rather than being truly altruistic. So there's some issues here.
BRODIE: It sounds like you're worried about people maybe being targeted and saying, hey, look, you've got two kidneys, you only really need one, here's 50,000 bucks if you're willing to do it and they're maybe not so on board, but they need the money. So they do it.
BEYDA: Absolutely. That's, that's the biggest issue that I think many of us in the ethics arena are really concerned about.
BRODIE: Do you see a problem with, for people who might be inclined to offer a kidney to give them an incentive to do it? If, even if it's not, you know, their decision is not entirely altruistic, maybe it's, you know, 50% altruistic. But, you know, the money certainly also doesn't hurt.
BEYDA: No, I don't, I don't think there's an issue with, with that, but we have to make certain that those who engage in receiving money for their kidneys and they're not being coerced and they're not marginalized. That they in turn need to have some rigorous protections, specifically, a very detailed informed consent and long term health monitoring because they only will now have one kidney.
So, you know, it's just not taking their kidney and then saying, thank you, here's $50,000 and watching them walk away. We have to be truly engaged in following up with them to make sure that let's say their second kidney, the remaining kidney starts to fail. Who's responsible for maintaining their health at that point?
BRODIE: Well, it sounds like from a societal standpoint, it could also mean that this is more than a $50,000 per person endeavor, right? Like if that, if that donor needs some kind of health care down the road, you're saying that it should be not just on them to pay for that?
BEYDA: I agree. I think if we're going to be engaged in, in going in this direction, we have to protect the donor and we also have to protect the recipient. And that means having ongoing health-care monitoring for both of them to make sure that everything is in place.
BRODIE: Is there a way to try to reduce the danger of coercion as you're describing, like is informed consent, for example, is that enough, can there be enough to make sure that to the extent possible, that sort of thing doesn't happen.
BEYDA: You know, this whole concept of informed consent is, is an ethical dilemma in and of itself. There's, there's many who believe that informed consent as it is portrayed today doesn't exist. And let me be frank because this is kind of where I see it. And as a physician, I've seen this happen.
Informed consent is usually garnered when the information is given in order to receive the answer that the physician wants. So, you know, it's, it's almost like a coercion. I'm being a little facetious at this point, I'm probably gonna get a lot of pushback on this. But think about it, if, if I as a physician want to do a particular procedure or start a therapy, I'm gonna give just enough information to get the answer want, which is, I agree, the patient's gonna say, I agree. Where we really have to have a detailed informed consent process where we examine everything and to be frank physicians, we, we don't know everything. And so how can you truly have a, have an informed consent?
BRODIE: So, if this proposal of offering this tax credit is, is problematic, are there other ways to try to increase the number of kidney donors? Because obviously, there's a pretty long list of patients who need them and you know, people are, are not able to get them and, and they're not able to continue living. So, is there a better way in your mind to, to get more people to donate so more people on the, the transplant list can get transplants?
BEYDA: Well, I don't think there's essentially a better way because all the different ways that are currently being offered carry with them ethical issues. But one of the ways that we do know is for example, retrieving organs from a patient who is brain dead. But there's another format that is being done and that's donation after cardiac death.
BRODIE: But if that's already being done, and we still have this long list of patients who need kidneys. Is, is that enough? Like are there more steps that may need to be taken?
BEYDA: Yeah, I think everyone's looking at that, what are the steps? And it comes down to making sure we ask the right ethical questions before we engage in the next steps. So that's being explored and, and I think that where we're at right now is making sure that we don't engage in coercive behavior trying to get more kidneys, that we don't engage in a lackadaisical approach to declaring someone dead.
And so the long and short answer to your question is, you know, people are looking at it, but there really is no good answer at this point. People are struggling to try and find a way to increase the amount of organs for those who truly need them.
BRODIE: Well, I wonder if there are other instances in the health-care world where there are incentives to do something, maybe not quite at the scale, for example, of donating a kidney. But, you know, I can imagine, you know, you get tickets to something for donating blood or, you know, there's something else that needs to be done that there's an incentive offered for people to do them. Do you see that in, in the kind of work that you're doing?
BEYDA: You know, here's an example where there is no incentive. There is, for example, a huge list of individuals who altruistically volunteered to be bone marrow donors. And that's across the world. So people with different types of leukemia or anemia, I mean cancer, who need a bone marrow transplant and their names are put into this list, that's huge of individuals around the world who altruistically say I will donate my my blood for a bone marrow transplant or for a blood transfusion, et cetera, for a patient with cancer.
They're not paid for that. It's an altruistic approach. And you know, that may be a better way to go for kidney donations because that truly exemplifies altruism.
BRODIE: Is there a danger, do you think, that if for example, this End Kidney Deaths Act were to go into effect, that people who might be otherwise inclined to donate bone marrow, donate other organs, you know, in the name of helping people, in the name of altruism might look at this and say, well, wait a minute, why are kidney donors getting a $50,000 tax credit? And I'm getting nothing.
BEYDA: Well, welcome to the world of ethics. So that's the big issue. Once you start something on one end, you better be prepared for what's going to happen down the line. So, absolutely, that could certainly happen.
