Have you ever donated spare organs to others while you were still alive? Given that there are few donations of life organs these days, it may not be.
The kidneys and nearest liver are the only body parts that can be donated by the inhabitant. A kidney works well, while the liver can grow backwards (the doctor only takes out one piece for the transplant).
Despite some short-term risks (such as any surgery) and potentially rare complications, studies have shown that the average long-term for kidney donors is just as usual and may have few long-term health effects (some studies suggest that conditions such as hypertension or diabetes may be at higher risk). The biological kidneys with deceased donors also tend to survive longer in new recipients, in some cases for more than 20 years.
Although living kidney donations have been increasing over time, they are still not commonplace. Only about 6,500 people in the United States donate a living kidney each year, and in about 25,000 kidney transplants, a total of 25,000 kidney transplants were performed.
Last December, the author Mario Macis andElizabeth Plummer published an article JAMA Internal Medicine aims to change reality. Plummer is a professor specializing in health care policy and taxation at Texas Christian University, while Macis is an applied economist at Johns Hopkins Carey Business School. Their paper is both a personal article, detailing Plummer's relatively easy experience of donating kidneys to his cousin in January 2024, and also detailing research-led exploration of other factors that prevent others from doing so.
We talked with the couple about the myths and obstacles surrounding kidney donation and how to morally convince more people to follow in Plummer's footsteps. For clarity and grammar, the following dialogue was slightly edited.
Gizmodo: What forced you to collaborate on a unique fusion of this post?
Plummer: I never thought about donating my kidneys, and the whole donation experience ended from the beginning. It's like seeing a world where most of us don't even know exist. However, there are many people who dialysis is just to keep their lives and are very needed for donors of living kidneys. This is an opportunity to raise awareness and understanding. Mario’s knowledge of the donation process and system is excellent. This seems to be a good partnership.
Macis: As an economist, I have always been very interested in understanding the markets that exist ongoing shortages. This is the case with blood donation in many countries and around the world. A key reason for these shortages is that in these cases, the price mechanism cannot operate due to moral considerations. Although financial transactions in these markets are prohibited to maintain moral values and prevent exploitation, this also brings huge costs in terms of human life and economic inefficiency.
In the case of kidney donation, banning compensation means that the number of available organs depends entirely on altruism, which is not enough to meet the demand. As a result, thousands of patients remain on the waiting list, many of whom either die or die before undergoing a transplant or are too ill. From the perspective of public finance, this shortage also puts a significant burden on taxpayers. Alternatives to transplants – dialysis – are not only taxed on patients, but are very expensive, and Medicare covers a large portion of these costs. Each kidney transplant saves about $150,000 in the health care system, but policies that cannot address donor financial barriers limit the number of transplants performed.
Eliminating financial barriers donations while stopping direct payments to organs may increase supply while respecting ethical issues. My interest is to explore these tradeoffs – how moral restrictions affect the market, their consequences, and how policies are designed to better balance moral concerns with the urgent need to save lives.
Gizmodo: What do you think is the biggest misunderstanding of living kidney donation?
Plummer: Most people remember past surgeries that “differences to donors are worse than recipients.” But now, donor surgery is laparoscopic, with most donors being discharged from the hospital after 2 to 3 nights. Although everyone's experiences were different, I had little pain and returned to work a week later. Of course, people who work physically certainly need longer working hours.
Another misconception is that you need to know someone who needs a kidney and have to be a match for that person. But that's not the case. Now, the transplant center allows kidney donor chains, which are a series of transplants, with multiple donors and recipients participating. For example, if my kidneys don't match my cousin, I can still donate to a stranger, and my cousin will receive a stranger's kidney that matches her. Donor chains can be between different transplant centers and may involve any number of donors and recipients. You can also be a completely selfless donor, that is, you don’t know anyone who needs a kidney. You just want to donate. The transplant center will find someone who matches you – there will definitely be someone.
Another misunderstanding is that you have to be young. Healthy people over the age of 60 may be excellent donors to candidates. In fact, some things are more beneficial to them. Many people retire and have no children to take care of. Their lifetime odds for kidney disease may be lower than those for young people. Donate to the medical team for a lot of work to assess whether you are medically qualified to donate, but age is not necessarily a deterrent.
Finally, the medical team that evaluates the candidate works independently from the team that evaluates the recipient. This helps prevent any pressure from being put on the donor or the donor's medical team. Several times, the medical team assured me that I could withdraw from the donation process at any time for any reason and they certainly wouldn't legally tell anyone the reason for my withdrawal.
Gizmodo: What practical steps can U.S. policy makers, such as the American Center for Political Donations, or transplant-related organizations, take to make such donations more common?
Macis: Eliminating all financial barriers to donating live kidneys is critical to increasing the number of transplants and reducing persistent shortages.
While the insurance for the organ recipient covers medical and surgical costs, donors often face substantial out-of-pocket expenses, including lost wages, travel costs, and support. These financial burdens could reach tens of thousands of dollars and prevent many willing donors from continuing. A more comprehensive system that eliminates all of these inhibitions will make living kidney donations a truly financially neutral act, thus ensuring that their decision to save lives makes any donor worse.
A key reform is to expand reimbursement to cover all direct and indirect costs of donations, regardless of the income level of donor or recipient. We should be fully compensated for lost income, relying on care and travel expenses without testing restrictions (but not including very high-income donors). Although direct payments to organs remain morally controversial, donors who pay all the fees have received extensive support from the transplant community and the public. In addition, donors should receive long-term health insurance for any complications associated with kidney donation to protect them from uncertainty about potential medical expenses [some lawmakers in the U.S. have been pushing for donors to receive free healthcare for life].
In addition to direct cost reimbursement, additional protection is needed to eliminate donor financial and non-financial risks. For example, acknowledging non-financial donation burdens such as pain, anxiety, and inconvenience should introduce a refundable tax credit to recognize the personal sacrifice involved.
Estimates show that each additional kidney transplant could save U.S. taxpayers about $150,000. Increasing the number of live kidney transplants will significantly reduce the number of dialysis patients, which can lead to billions of Medicare savings while improving health. Bold policies that eliminate all financial barriers will not only improve the lives of thousands of patients who need transplants, but will also save taxpayers’ money and strengthen the overall efficiency of the healthcare system.
Considering the extensive agreements that donors should not bear financial costs, the implementation of these changes will be consistent with ethical and practical considerations.
Gizmodo: How are Elizabeth these days? And her cousin?
Plummer: I did a great job. The whole donation process seems to be a lifetime. You almost forgot it, my lifestyle hasn't changed at all – except that I can no longer take NSAIDs (ibuprofen and Aleve, for example). I've loved those before!
My cousin did a great job, or at least her kidneys were. She no longer needs dialysis, she used to take 12 hours a night and needs her husband's help. She feels better and stronger. But sick people need new kidneys often have other medical problems, so this is a balanced behavior. She had to take several medications (anti-rejection and antibiotics) throughout her life and often appointed a doctor to test. But so far, her body seems to like its new kidney. We were both glad we did.
