A strategy of paying living kidney donors $10,000, with a consequent increase in the number of transplants performed of five per cent or more, would be less costly and more effective than the current organ donation system, according to a new study.
The findings demonstrate that a paid living donor strategy is attractive from a cost-effectiveness perspective, even under conservative estimates of its effectiveness. The study, co-authored by the University of Calgary’s Lianne Barnieh, PhD, and Dr. Braden Manns, was published in the Oct. 24 issue of Clinical Journal of the American Society of Nephrology.
Shortage of kidney donors leads to legal, ethical, moral debates
Kidney transplantation is the best treatment for patients with kidney failure. Unfortunately, there’s a shortage of kidneys available to those in need of a transplant, and donation rates from both living and deceased donors have remained relatively unchanged over the last decade.
There is considerable debate around the use of financial incentives in living kidney donation regarding legal, ethical, and moral issues. By estimating the likely costs and consequences of paying donors, experts can determine whether a strategy of paying donors is worth pursuing with the goal of clarifying these remaining issues.
Would paying donors $10,000 be cost-effective?
Barnieh and Manns, along with their colleagues, published “The cost-effectiveness of using payment to increase living donor kidneys for transplantation.” They studied whether a government or third party administered program of paying living donors $10,000 would be cost-effective. In other words, would it save money and, by increasing the number of transplants, improve patient outcomes?
According to their model, a strategy to increase the number of kidneys for transplantation by five per cent (a very conservative estimate) by paying living donors $10,000 could result in an incremental cost savings of $340 and a gain of 0.11 quality-adjusted life years over a patient’s lifetime compared with the current organ donation system. Increasing the number of kidneys for transplantation by 10 per cent and 20 per cent would translate into an incremental cost savings of $1,640 and $4,030 and a quality-adjusted life year gains of 0.21 and 0.39, respectively.
‘Time is ripe for new consideration of payments’
“Such a program could be cost saving because of the extra number of kidney transplants and, consequently, lower dialysis costs. Further, by increasing the number of people receiving a kidney transplant, this program could improve net health by increasing the quality and quantity of life for patients with end-stage renal disease,” says Barnieh.
In an accompanying editorial, Matthew Allen, BA, and Peter Reese, MD, MSCE (University of Pennsylvania) have proposed a research agenda and necessary elements for a limited trial of incentives. “Current trends regarding the use of financial incentives in medicine suggest that the time is ripe for new consideration of payments for living kidney donation,” they wrote. “Reassurance about the ethical concerns, however, can come only through empirical evidence from actual experience,” they added.
Study co-authors include Scott Klarenbach, MD, MSc and John Gill, MD.