Cash For Kidneys, Part 2

[This is a followup to Cash For Kidneys, Part 1.]

One of the things that would bother me about donating a kidney is that I’m using it. Granted, living with one kidney isn’t much of a hazard. You really only need one to do the job, and having a spare isn’t all that useful since kidney diseases usually attack both of them at once. Still, I’d be more willing to donate a kidney if I was more likely to get a spare if my lone kidney started to have problems.

If other people feel that way, then there’s positive feedback in the system: The easier it is to get replacements, the more people will be willing to donate their own, which will make it even easier to get replacements, which will make people even more willing to donate. People would be giving and getting kidneys all the time.

For that to work, we’d have to have an efficient system of distributing transplant organs. You’d think we already have one, but I’m not so sure. What we have right now is UNOS, the United Network for Organ Sharing, a non-profit organization which has a federal contract to coordinate organ transplants.

An article in the Kansas City Star describes how the U.S. is divided into 11 transplant regions, and most people needing organs are listed with their regional center. Apparently, however, some people travel to other centers and get themselves listed there as well.

But the practice is expensive, requiring duplicative comprehensive medical examinations and frequent blood tests—for which Medicare pays most of the costs.

It also requires travel that not everyone can afford and the sophistication to navigate a particularly complex part of the American health-care system.

[…]

A medical evaluation—which must be done anew with each listing—costs an average of $12,300, according to a report by Milliman USA, a health-care actuarial firm. Monthly blood screenings for each listing are $250 each, according to UNOS. Medicare picks up much of those costs when private insurance does not.

From reading that, it seems that the obvious thing to do is to improve sharing of patient data between transplant centers so they don’t have to duplicate the medical evaluation and testing costs for each center. That shouldn’t be hard in the age of the internet.

A more long-term solution might be to eliminate the artificial barriers between transplant regions so that the organ network is truly a national resource. We’re a wealthy nation. We can afford stuff like this.

But that’s not how the people in the transplant business see it:

John Sadler, founder of the Independent Dialysis Foundation in Baltimore, called it “basically unfair to someone who isn’t capable of going to several different places.” It also leaves a bad impression, said Arthur Caplan, chairman of the University of Pennsylvania’s department of medical ethics.

“Clearly, those who have more resources are going to have greater access to more than one center. … People wouldn’t do it unless it increases their chances of getting an organ that would go to somebody else,” said Tarris Rosell, a bioethicist at the Center for Practical Bioethics in Kansas City.

[…]

UNOS concedes that multiple listing is unfair. In 1988 the UNOS board of directors recognized that the practice favored “the wealthy patient over a less well-to-do patient.” In 2003 it said multiple listing continued to cause inequities.

[…]

UNOS several times has considered banning or limiting multiple listing. But each effort was quashed by a coalition of patient advocacy groups and large transplant centers, observers say. Since 2003, UNOS has required that all transplant patients be told of the possibility of multiple listing.

In other words, transplant patients are trying to work around the inefficiencies of the system, and the people running the system are trying to stop them.

The people opposing multiple listing aren’t real clear about why they think it’s unfair to poor people. I’m guessing the reason is that poor people on the waiting list in one region can find wealthy people from other regions getting in line ahead of them.

That does sound unfair at first, but I’m not convinced. Organ transplant priorities are based on medical urgency and the quality of the match between donor and recipient. An organ recipient coming in from other regions can only get ahead on the list if their need is greater or their chance of success is better. Isn’t that how it should be?

In fact, isn’t that how it should be for everyone? As far as I can tell, the most unfair thing about multiple listing is that they don’t do it for everyone automatically.

Update: Part 3 is up.