By Phil Niles
We have a problem. Thousands of people are dying and hundreds of thousands are suffering each year because they are on kidney dialysis machines instead of receiving kidney transplants. Dialysis treatment is much MORE expensive, much more debilitating, and causes people to die much sooner than receiving a transplant. So why are people on dialysis? Because the current laws in almost every country prevent the supply of kidney transplants from meeting the sharply rising demand. And guess what? This problem was actually part-created by the most famous of TEDsters! Let me explain.
When people do not take care of their blood pressure, or experience a multitude of kidney failures, they need to find a new way to filter their blood. There are two solutions: (1) use a blood filtering, or dialysis, machine (originally developed right here at the Cleveland Clinic) or (2) get a new kidney. The dialysis machine solution involves going to a dialysis center and plugging one’s blood vessels into a large filtering machine for about four hours three times a week – it’s a terrible part-time job. Though most patients adapt to this lifestyle, it makes leading a “normal” life very difficult. Also, dialysis patients die much sooner, and, while alive, they cannot eat salty foods and are much more likely to get sick. Furthermore, it is very expensive, about $50,000 per year per person – usually paid for by the government. A kidney transplant involves receiving a kidney donated from either a live person, who is almost always a family member or a close friend of the recipient, or from a recently deceased organ donor. Typically, a recipient’s life is restored to normal, minus a few side effects from medications, soon after the surgery. There is just one problem: we don’t have enough kidneys to go around.
U.S. Organ Procurement and Transplantation Network data from the United Network for Organ Sharing
In the mid 1970s, doctors figured out how to transplant a kidney from a healthy donor to an unrelated recipient. However, in 1984, then-Senator and future TEDster Al Gore sponsored the National Organ Transplant Act to prohibit the exchange of organs for any item of “considerable value.” Every country (except Iran, strangely) has legislation to prohibit the “sale” of organs. However, since that time, the demand for kidney transplants has soared, while the supply has stayed relatively constant. It is predicted that there will be nearly 100,000 people on the US’s kidney transplant waitlist by 2010. The waitlist has grown almost every year since we started tracking data in the late 1980s, despite many efforts to increase organ donation. Several thousand people die each year while waiting for a kidney, the rest of the waitlist either suffers on dialysis or receives a transplant.
The impacts of several attempts to increase donations have been marginal at best, as the waitlist continues to grow. There are now about 7.5 people waiting for every transplant donated to a member of the waitlist (recipients from friends/family donors usually do not go on the waitlist).
I do not believe that this was the intention of one of our favorite TEDster’s legislation back in 1984. I contest that the laws limiting transplants have become outmoded in reference to kidney transplants for the following reasons:
1. Compensating heavily scrutinized and willing donors for donating a kidney would save thousands of lives each year and prevent much suffering. We must remember that we are making a choice: we will either choose inaction, leaving hundreds of thousands worldwide to have lower qualities of life (or death), or we will choose to try a new approach. We have passively chosen the former for decades, save for a few vocal kidney doctors and economists. I contest that we, as a society and a group of potential future waitlist members, should actively consider this decision
2. Kidney donors are less likely to have kidney problems than non-donors – it’s a proven fact. This is due to the very demanding selection criteria for becoming a donor; there is a selection bias, which is a good thing. Also, the surgery has become minimally invasive and has a very low complication rate
3. Every other approach thus far has not increased the number of donations nearly enough.
4. Increasing the number of registered organ donors will not help the people who are in need of a kidney now
If you read this and you think that this is primarily about a troublesome piece of legislation – you are wrong. This is about the hundreds of thousands of people who are literally dying for a kidney. Unfortunately, these people are typically socioeconomically disadvantaged, preoccupied, and lack a voice. I hope to help change the last part of that.
If I could make a TEDMED2009 (http://www.tedmed.com/) wish, this would be it. I know the TED Community can solve this problem and save thousands of lives per year just by using our voices and rolodexes – not even our pocketbooks.
Lastly, if you read this and think that it is wrong to compensate willing and able individuals for a kidney donation, then stay tuned for my next blog entry to find out why this is actually much MORE moral than the current system.
Please send me your comments/feedback. I am much more ears than mouth.
- Phil Niles, TED2009 Fellow
PN@case.edu
P.S. Sneak Preview: I especially encourage you to read my next post if your argument about why compensated donation is morally wrong is based on the following assumptions:
1. Compensated donation would be unfair to poorer individuals
2. Health policy should observe religious beliefs
3. We shouldn’t do things that are morally questionable
4. Kidney exchanges (Alvin Roth) can solve this problem without money
5. 35 years has not been long enough to find the right solution, and we just need more time
6. It would be expensive, and we can’t afford to spend more money on healthcare
7. Laws based on stubborn beliefs shouldn’t change
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