Responding to the the concerns raised by opponents of compensating donors:

Myth: Reimbursing donors for just lost wages and travel costs will increase the number of living donors.

Most donors are currently reimbursed for wages and costs, but, for the past 25 years, there has been no noticeable increase in the number of living donations. 22 states offer tax credits and deductions to reimburse donors. The federal reimbursement system reimburses 20% of donors. The National Kidney Registry reimburses 40% of donors. All donors should be cost neutral at the end of donation. The current system of reimbursement has not resulted in an increase in living donation rates.

Myth: Fixing the deceased donation system will provide far more kidneys.

From this article in JAMA Surgery, “There is currently a considerable emphasis on minimizing the number of deceased donor kidneys recovered but not transplanted; however, at best, that alone might result in approximately 2,000 more transplants per year, a mere dent in the problem.”

Myth: 13 people on the kidney transplant waitlist die waiting for a kidney every day.

Every day, ≈27 people who are on the waitlist either die directly from the waitlist or are removed because they become too sick to be transplanted, meaning they will die on dialysis. That’s 10,000 people a year who were well enough to be transplanted when they joined the waitlist and were killed by the long waiting times for a kidney. In total, 115 Americans die each day as a result of the kidney shortage. For a number of reasons, many people are not waitlisted even though they would be eligible for a kidney transplant.

Myth: Incentivizing donors is “horrific.”

Providing an incentive for a living kidney donor who goes through the work (time loss, stress and pain) of donation to save a stranger’s life is lifesaving, not horrific. What is truly horrific is that more than 100,000 Americans died who were on the kidney waitlist died from 2010-2021. Far more than that died from the kidney shortage.

In the last four decades since the passage of NOTA, opponents to compensation claimed that it’s more horrific to incentivize kidney donation than to watch someone who did not need to die have a miserable death from kidney failure. Since 1988, over a million Americans died from the kidney shortage. They would have survived and thrived instead of died if the End Kidney Deaths Act had already been passed. 

Myth: The End Kidney Deaths Act will “create a market in body parts.”

This is plainly false. Tax credits have traditionally been used to encourage prosocial behavior. And nothing is more prosocial than saving the life of a stranger through kidney donation. Tax credits are not “markets.” When people receive a tax credit for adopting a child, they are being rewarded for their prosocial choice. The government has not created a market in the adoption of children by providing a tax credit. A market is one where the rich have superior purchasing power. The End Kidney Deaths Act will provide a uniform incentive for those who save both lives and billions of tax dollars. 

Myth: Incentivizing kidney donation to strangers “could undermine efforts to end illicit organ markets in some foreign countries, where people in poverty may be coerced into selling a kidney or driven to make a decision they’ll regret.”

In fact, the opposite is true. Transplant tourism in developing countries is directly linked to the kidney shortage in developed countries like the US. Those with kidney failure are desperate to survive and thrive with a new kidney, as 60% of dialysis patients die within the first five years. If they live in a state like California with a ten-year waitlist, kidney failure patients are aware that they are unlikely to survive the wait. So some make the decision to buy a kidney on the underground market so they can survive. Once we have a far greater supply of living kidneys, those who would seek kidneys in a risky surgery abroad will instead receive a kidney in this country. The illicit organ market will have far less demand. The End Kidney Deaths Act will contribute to the decline of the catastrophic black market for kidneys that is estimated to provide 10% of all kidney transplants currently world-wide. 

Myth: Incentivizing donors is not acceptable because “kidneys are a finite resource.”

The implicit idea in this argument is that because we cannot regenerate our kidneys like we regenerate blood, we should not incentivize people to donate kidneys. But the finitude is not what’s important — it’s the risk. Blood is renewable, but we would not let people donate it if it were risky.  The reality is that people can thrive with only one kidney. One person in every 500 is born with only one working kidney. Hilary Steinour and Matt Cavanaugh who both donated kidneys to strangers ran twelve marathons in 2023 to demonstrate that one kidney can provide all that is needed for such a physically demanding feat. To be sure, kidney donation carries some risk - around 1 death in 10,000 donations - lower than appendectomies or giving birth (which is for surrogates generously incentivized.) Those who are willing to donate kidneys are screened for both mental and physical health in order to qualify. Only two out of every one hundred people who step forward to donate actually donate, often due to being medically disqualified. Kidney donors range in age from 18 to 91. Donors take a minimal risk to save a stranger’s life. Firefighters do this every day at a greater level of risk. Kidney donation is so rewarding that 95% of donors surveyed would do it again if they could. 

Myth: “It would send the wrong message to countries that already struggle with unsanctioned transplant tourism — wealthy patients who travel to acquire a kidney.”

Again, the opposite is true. By reducing the kidney waitlist in the US, the End Kidney Deaths Act reduces the demand for transplant tourism. 

Myth: Kidneys are not renewable like sperm, eggs and plasma and therefore should not be donated.

Kidney donors live longer lives than the general population because donors need to be in top health in order to qualify for donation. When people donate, their kidney grows in size and takes over the job of filtering blood. Health outcomes for living donors are excellent.

Myth: “The tax credit proposal would be burdensome for people who don’t normally file full income tax returns. Also, donors might have to wait months to receive the tax benefit.”

For low income donors (“those who don’t normally don’t file full income tax returns”), filing for a tax credit is not burdensome. The fact that donors will need to wait for the funds is a built-in safeguard that a donor will not immediately receive the financial support that could motivate someone who is desperate. Instead, the End Kidney Deaths Act will gradually provide the incentive over five years, beginning the year after the kidney donation. 

Myth: “And the cost of a kidney transplant is covered for all Americans under the government’s Medicare program. So low-income kidney patients are not at a disadvantage.”

The wealthy have the financial resources to list at multiple transplant centers in several states as well as run campaigns, hire a team to help them find a kidney, put up billboards and conduct a search on social media. Low-income Americans do not have the same resources and are therefore at a disadvantage.

Sources:

“Most Americans Favor Compensation for Kidney Donors if it Leads to More Saved Lives,” Johns Hopkins University, July, 2019

“Poll: Americans Show Support for Compensation of Organ Donors,” National Public Radio, May, 2012

“A regulated system of incentives for living kidney donation: Clearing the way for an informed assessment,” American Journal of Transplantation, Dr Arthur Matas, MD and Dr. Luke Semrau, PhD, July, 2022

“Would You Donate a Kidney for $50,000?” Vox News, Dylan Matthews, April 2024

“Views of US Voters on Compensating Living Kidney Donors,” JAMA Surgery, Dr. Thomas Peters, MD, Dr. Jonathan Fisher, MD, Dr. Robert Gish, MD and Dr. Richard Howard, MD

 “It’s illegal to pay people for organs, but some advocates want a $50,000 tax credit for kidneys,” Philadelphia Inquirer, May, 2024, Wendy Ruderman
“We shouldn’t treat kidneys as commodities” LA Times, June, 2014, Alexander M. Capron and Gabriel Danovitch