Get off Dialysis: buy a kidney

In their book SuperFreakonomics, Stephen J Dubner and Steven D Levitt discuss the terrible state of kidney donations worldwide – or almost worldwide. Wherever the culture is one of altruistic donations, people are dying waiting for transplants. But in one country, Iran, things are a little different. They have a system of paid and regulated living-unrelated kidney donation.

In 1988, Iran adopted a compensated and regulated living-unrelated donor renal transplant program. As a result, the number of renal transplants performed substantially increased such that in 1999, the renal transplant waiting list was completely eliminated. By the end of 2005, a total of 19,609 renal transplants were performed (3421 from living related, 15,356 from living-unrelated and 823 from deceased donors). In this program, many ethical problems that are associated with paid kidney donation also were prevented. Currently, Iran has no renal transplant waiting lists, and >50% of patients with ESRD in the country are living with a functioning graft.

In developed countries, the severe shortage of transplantable kidneys has forced the transplant community to adopt new strategies to expand the kidney donor pool.

For example, while it is illegal to sell kidneys, it is not illegal to trade them. I wrote about Paired Kidney Exchange recently, where incompatible donors can trade kidneys with compatible recipients. This approach has expanded into chain donations, where an altruistic donor, who isn’t asking for a kidney in return, kicks off a chain of paired exchanges. Economist Al Roth’s blog post describes how one altruistic kidney donor saved 10 lives.

Other ideas include commemorative medals and pins to honour donors, shorter prison terms, reduced funeral costs for the deceased donor and having health insurance organisations make payments to live donors.  A really bizarre idea is a Dutch reality TV program, The Big Donor Show, in which three contestants compete to receive a kidney from a terminally ill donor (gross).

However, compared with the Iranian model, none of these approaches has the potential to eliminate or even alleviate steadily worsening kidney transplant waiting lists. So the SuperFreakonomics argument: set up a market in human organs that would save thousands of lives (and millions of dollars in dialysis costs) a year. Drop the altruism for economic common sense: governments pay donors $30k to $50k for their kidneys and watch the waiting lists fall.

This has triggered discussion and argument around the world, and there seems to be an evolving consensus amongst ethics committees, transplant surgeons, bioethics councils, dialysis associations and others that the organ donation process needs reform, with a focus on incentives. What kind of incentives? While probably not cold cash like the Iran model, they would still be financial, like tax breaks, guaranteed health insurance, college/university scholarships for the donor’s children, deposits in their retirement/ superannuation accounts, and so on.

So what’s the hold-up? The wave is building, let’s catch it. Contact your local kidney or transplant association and offer your help to make a case for reforming the donor process. Who has a better incentive?

5 thoughts on “Get off Dialysis: buy a kidney

  1. Greg….great post, you are so right., but as Stephen J Dubner and Steven D Levitt said, so many people feel it is repugnant to sell organs that I don’t think there will be movement in that direction anytime soon.

    My nonprofit takes a different approach. I help people who are in need of a kidney transplant pursue kidney donation.

    Take a look at my website/blog/tweets. Help me help others help themselves.


    Harvey Mysel
    Living Kidney Donors Network
    a Not-for-Profit 501(c)3 Organization
    Office 847-656-0408
    Mobile 847-912-7059


    • Hi Harvey, thanks for your comment. The Living Kidney Donors Network sounds like a great initiative. I have joined your blog and twitter feed, which is really interesting. And I would like to know more: How long has it been around? Have you had much success to date? I look forward to hearing from you!



  2. I just started Dialysis one week ago, this being my second week.Today something went wrong and blood was everywhere and my arm was so swollen they had to cut me out of my sweater.The nurse tech said maybe i had a clot my arm is black and blue and hurts,hopefully it will heal before i go back Monday.My question is how do you know if its your arm or if it was the fault of the tech? and what do you do,because i dont want to make someone angry at a place i have to go to three times a week.


    • Hi Belinda, I’m very sorry to hear about your arm. I and pretty well every other BigD member know exactly how you feel. At least you are not alone. What’s happened is called “blowing” your fistula. It happens when the needle (which is very sharp) pushes right through the fistula wall so that the blood from the machine pumps directly into the flesh and muscle around your fistula. Blow outs are painful, they are dramatically ugly and the extensive bruising lasts a few weeks until your body dissipates the blood (and mental anguish and irritation).

      Unfortunately, blow outs can be common in the early days in the life of a fistula, because the fistula walls are very soft and new. Even a small arm movement or inserting the needle a little too vigorously during cannulation will do it.

      As for who is at fault, no one does it deliberately. If it happened before you went on the machine, it may have occurred during cannulation, though as I said, it is especially tough to get the needles right during the first few weeks of dialysis. If it happened during the run, it may be that you moved your arm just a bit too much, and inadvertently pushed the needle through the fistula wall. As you say, you will be there three time a week for quite a while, so put it down to experience (unless it happens regularly, then it’s time for another unit).

      The good news is that as your fistula gets older, the walls get tougher, you get more savvy, and it is less likely to happen. Have a look at my posts on getting the needles in, so that you know what’s happening inside the fistula and how to avoid blows in the future.

      Also, from what you say, it was a few minutes before anyone noticed that it had blown. From your part, that is simple lack of experience (who knows what is normal during the first few weeks?). Unfortunately, if the dialysis staff are not nearby at the time, the blowout can be quite severe before they take action (which is why you need to be able to recognise one early and let them know ASAP).

      I think it would be a good idea to expand on this area, so I will put up a new post this week on how to react if you think you have a blow out. It’s a little late for you, but hopefully it will help minimise the drama for others.

      I hope this helps.


  3. Pingback: Get Off Dialysis: Buy Your Third-World Kidney Here « Big D and Me

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