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Incentive models to increase living kidney donation: encouraging without coercing.

Ajay K Israni1, Scott D Halpern, Sheldon Zink

  • 1Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. aisrani@cceb.med.upenn.edu

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|January 8, 2005
PubMed
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To address the shortage of kidneys for transplantation, this study explores four incentive models for living kidney donation. The expense reimbursement model, with robust safeguards, is recommended to increase donation rates.

Area of Science:

  • Nephrology
  • Transplantation Medicine
  • Bioethics

Background:

  • Kidney transplantation offers superior outcomes compared to chronic dialysis for end-stage renal disease (ESRD).
  • A critical shortage of cadaveric donor kidneys necessitates exploring alternative sources, such as living donation.
  • Living kidney donation presents a viable solution to bridge the gap in organ availability.

Purpose of the Study:

  • To evaluate four distinct models for incentivizing living kidney donation.
  • To analyze the advantages and disadvantages associated with each proposed incentive model.
  • To propose a framework for increasing living kidney donation rates ethically and effectively.

Main Methods:

  • Analysis of four incentive models: market compensation, fixed compensation, no-compensation, and expense reimbursement.
Keywords:
Health Care and Public Health

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  • Discussion of the ethical considerations and practical implications of each model.
  • Identification of essential safeguards to protect living donors.

    • Main Results:

    • Each incentive model presents unique benefits and drawbacks regarding donor motivation and ethical concerns.
    • Incentives must be implemented with comprehensive safeguards to prevent coercion and exploitation of vulnerable individuals.
    • A donor registry is crucial for monitoring long-term donor health outcomes.

    Conclusions:

    • The expense reimbursement model, coupled with stringent ethical safeguards, is recommended to enhance living kidney donation rates.
    • Safeguards are paramount to ensure living donors are not objectified and vulnerable populations are protected.
    • Implementing ethical incentives and robust monitoring can improve organ availability for transplantation.