What would happen if Americans were paid to donate their kidneys?

Organ preservation forms and supplies for organ procurement stand at the ready for employees at the Fairview Southdale Hospital in Edina, Minn., Aug. 30, 2012.
Organ preservation forms and supplies for organ procurement stand at the ready for employees at the Fairview Southdale Hospital in Edina, Minn., Aug. 30, 2012. NYT

One of the strictest tenets of the U.S. transplant system is that paying for organs is forbidden. The ban, imposed by the National Transplant Act of 1984, was designed to protect the poor from being taken advantage of by the wealthy. Impassioned supporters of the law argued that compensating people for body parts is exploitative and treats donors like subhumans, and the debate was essentially closed for more than three decades – until recently.

The ethically tricky issue has come back to the public consciousness through a widely shared TEDMed talk by a woman who wanted to donate a kidney but couldn't afford to do it and through several opinion pieces published by doctors in prestigious medical journals.

The latest to jump into the debate is researcher Thomas G. Peters of the University of Florida College of Medicine at Jacksonville with a paper on kidney donation published in the journal JAMA Surgery on Wednesday.

Most kidneys transplanted in the United States come from deceased donors, and there are never enough for all the people who need one. The waiting list today has more than 100,000 patients, and, every year, thousands die while they wait. The shortage is so severe that many have begun to look at "living" donors as a possible solution. While U.S. transplant rules allow for healthy people to donate their extra kidney to someone who is sick, the process can be time-consuming and expensive, resulting in too few Americans donating.

In the new study, researchers surveyed Americans about their willingness to become living kidney donors and how being compensated for it would affect their thinking. The study involved calls to registered voters in June 2014. Nearly 17,000 Americans indicated they were willing to complete the survey, and the data from 1,011 people representative of the U.S. population were used in the analysis.

After the researchers gathered some demographic information from the respondents, they were asked how open they were to being a living kidney donor with no mention yet of the possibility of compensation. They categorized the respondents into three groups: those willing to donate to anyone including strangers, those only willing to donate to a restricted group, such as family and friends, and those unwilling to donate to anyone.

A high number – 68 percent – said they were open to donating to anyone, 23 percent said they would be open to donating to friends and family, and just 9 percent said they would not do it. There was little variance in terms of gender, age and employment status.

Then the surveyors asked respondents to consider the same thing – but if they were paid a $50,000 compensation.

For those already willing to donate to anyone, 63 percent said that the payment would make them even more likely to do it. Of those in the second group, composed of those willing to donate to a restricted group, 60 percent said they would be more likely to consider it. And in the third group that was unwilling to donate, 26 percent said they would reconsider because of the money.

The researchers also found that there were some people who would be more reluctant to donate if money was involved. In the first group 8 percent would be less willing, 9 percent in the second group, and 18 percent in the third group.

"Thus," the researchers concluded, "payment motivated more US voters to positively consider donor nephrectomy rather than to reject the notion of donating a kidney."

Peters and his co-authors wrote that too many Americans are dying because of an inadequate supply of kidneys and that paying people to donate them could increase the number available for transplant. They urged lawmakers to seriously consider the option of compensating those who donate and to start by amending the law so that pilot studies could be started.

"While many transplantation professionals still oppose direct payments in organ donation, others affirm that financial incentives should be debated in public. The attitudes of professionals opposing payment may lag behind those of the American populace, which often accepts policy changes before politicians, regulators, and judges address and modify laws and regulations," they wrote.