When Altruism Isn't Enough: The Case for Compensating Kidney Donors

248 Pages·2009·0.85 MB·English

by  Sally Satel

When Altruism Isn’t Enough

When Altruism Isn’t Enough
The Case for Compensating Kidney Donors
Edited by Sally Satel, MD
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Libraryof Congress Cataloging-in-Publication Data
When altruism isn’t enough : the case for compensating kidney donors /
edited by Sally Satel.
p. ; cm.
Includes bibliographical references.
ISBN-13: 978-0-8447-4266-3
ISBN-10: 0-8447-4266-X
1. Kidneys—Transplantation—Economic aspects. I. Satel, Sally L.
[DNLM: 1. Kidney Transplantation—economics. 2. Kidney Transplantation—
ethics. 3. Tissue Donors—ethics. WJ 368 W567 2008]
RD575.W54 2008
617.4'610592—dc22
2008045715
12 11 10 09 08 1 2 3 4 5
© 2008 by the American Enterprise Institute for Public Policy Research,
Washington, D.C. All rights reserved. No part of this publication may be used
or reproduced in any manner whatsoever without permission in writing from
the American Enterprise Institute except in the case of brief quotations
embodied in news articles, critical articles, or reviews. The views expressed in
the publications of the American Enterprise Institute arethose of the authors
and do not necessarily reflect the views of the staff, advisory panels, officers,
or trustees of AEI.
Printed in the United States of America
To Virginia and Steve Postrel

Contents
LIST OF ILLUSTRATIONS xi
ACKNOWLEDGMENTS xiii
INTRODUCTION, Sally Satel 1
Death and Suffering Mount 2
Altruism Isn’t Enough 3
The Advantages of Living Donors 4
Compensation for Living Kidney Donors 6
Calling on Congress 8
1. RISKS OF KIDNEY TRANSPLANTATION TO A LIVING DONOR,
Arthur J. Matas 10
Surgical and Perioperative Risks 12
Long-Term Outcome 13
Conclusion 17
2. THE COST-EFFECTIVENESS OF RENAL TRANSPLANTATION,
Elbert S. Huang, Nidhi Thakur, and David O. Meltzer 19
Economic Studies of Renal Replacement Therapy 20
Gathering the Data 23
The Cost-Effectiveness of Transplantation versus
No Treatment 24
Cost-Effectiveness of Transplantation versus
Hemodialysis 25
The Cost and Benefits of Kidney Transplantation and
the Value of a Kidney 30
Conclusion 31
vii
viii WHEN ALTRUISM ISN’T ENOUGH
3. OPERATIONAL ORGANIZATION OF A SYSTEM FOR COMPENSATED
LIVING ORGAN PROVIDERS, David C. Cronin II and
Julio J. Elías 34
Basic Framework for a Compensation System 36
Process of Compensated-Provider Evaluation, Allocation,
and Follow-Up 40
Models of Financial Compensation in a Market System 44
Conclusion 48
4. DONOR COMPENSATION WITHOUT EXPLOITATION,
James Stacey Taylor and Mary C. Simmerling 50
Will a Legal Market Lead to a Black Market? 52
Objections to Donor Compensation 55
Individuals Will Be Coerced into Donating Organs 56
Donors Will Not Give Informed Consent 58
Individuals Will Misrepresent Their Eligibility to
Donate 58
The Poor Will Supply the Rich 58
Donors Will Be Worse Off Financially 59
The Quality of Medical Conditions Will Be Unreliable 60
Fewer Organs for Transplantation Will Be Secured 60
Conclusion 61
5. CONCERNS ABOUT HUMAN DIGNITY AND COMMODIFICATION,
Sally Satel 63
Dying for Dignity 64
Does Money Taint? 68
Romanticizing Altruism 72
Does Donor Compensation “Vitiate the Gift”? 74
Conclusion 77
6. ALTRUISM AND VALUABLE CONSIDERATION IN ORGAN
TRANSPLANTATION, Richard A. Epstein 79
Our Uneasy Embrace of Altruism 81
Regulated and Unregulated Markets 85
Measuring the Benefit of a New Kidney 88
Crowding Out 92
Conclusion 95
CONTENTS ix
7. CROWDING OUT, CROWDING IN, AND FINANCIAL INCENTIVES
FOR ORGAN PROCUREMENT, Benjamin E. Hippen and
Sally Satel 96
Blood Procurement: Richard Titmuss’s Gift Relationship 96
Other Examples of Crowding Out 104
Relevance of Crowding-Out Examples to Compensation of
Kidney Donors 106
Impact on Procurement of Deceased-Donor Organs 108
Conclusion 110
8. RETHINKING FEDERAL ORGAN TRANSPLANTATION POLICY:
INCENTIVES BEST IMPLEMENTED BY STATE GOVERNMENTS,
Michele Goodwin 111
Origins of American Organ Transplantation Policy 112
Federalism and Organ Transplantation 113
Transplantation after NOTA 115
A Pragmatic Return to the States 116
Model Waiver Language for NOTA 118
CONCLUSION, Sally Satel 122
The Politics of Transplant Policy Reform 124
APPENDIX A: ORGAN TRANSPLANTATION IN THE UNITED STATES:
A BRIEF LEGISLATIVE HISTORY, Chad A. Thompson 131
Major Laws, Passed and Pending 132
1968 UniformAnatomical Gift Act 132
1972 Social Security Amendments 133
1984 National Organ Transplant Act 133
1986 Omnibus Budget Reconciliation Act 136
1987 UniformAnatomical Gift Act 137
1991 Patient Self-Determination Act 138
1999 Organ Donor Leave Act 138
2004 Organ Donation and Recovery Improvement Act 138
2006 Uniform Anatomical Gift Act 139
2007 Charlie W. Norwood Living Organ Donation Act 139
2007 Living Donor Job Security Act 140
2008 The Stephanie Tubbs-Jones Gift of Life Medal Act 140
Other Efforts by the States 140
x WHEN ALTRUISM ISN’T ENOUGH
Failed Federal Proposals 141
Crane Bill 141
Greenwood Bills 141
Gift of Life Congressional Medal Act 142
Living Organ Donation Incentives Act 142
Gift of Life Tax Credit Act 142
Help Organ Procurement Expand Act 142
Living Organ Donor Tax Credit Act 143
Congressional Hearings 143
Putting Patients First: Increasing Organ Supply for
Transplantation 144
Assessing Initiatives to Increase Organ Donations 146
APPENDIX B: EVOLUTION OF AN IDEA, Sally Satel 149
APPENDIX C: PUBLIC ATTITUDES, Sally Satel 154
Incentives as Policy 154
Incentives and Personal Decision-Making 155
APPENDIX D: RELIGIOUS CONSIDERATIONS, Sally Satel 158
Judaism 158
Islam 159
Catholicism 161
NOTES 163
INDEX 217
ABOUT THE AUTHORS 227