Cash for kidneys? We'd rather eat worms

Would you sell one of your kidneys for $10,000? Lianne Barnieh of the University of Calgary has a study suggesting you might.

She and co-authors of a report for an upcoming issue of the Clinical Journal of the American Society of Nephrology say that both an ethical and financial case can be made for paying people for their body parts. Or failing that, at least a case for expediency.

We've known for a long time that maintaining a kidney patient on dialysis is a costly proposition. Think $60,000 a year, not counting doctor fees for office visits, plus lost time at work and other costs.

Transplanting a healthy kidney into these patients not only improves the outlook for the patient, but saves the health care system a lot of money. Think $23,000 per transplant, plus another $6,000 for other medical costs.

A successful transplant saves the health care system about $250,000 over five years. Over the last decade or so, Canada has performed just over 1,000 transplants a year.

The barrier preventing the cheaper, better treatment, of course, is a shortage of organ donations. The Kidney Foundation Canada puts the wait list at about 3,000 patients. Wait lists stretch into years — at $60,000-plus per year for dialysis — even though chances of success for a transplant operation drop steeply after a two-year wait.

The Canadian Institute for Health Information reports that for every million Canadians, 14 are kidney donors. That's half the donation rate of Americans. Alberta has one of the lowest donation rates in the country.

So it should be no surprise that professionals who study health care should explore ways to increase the donation rate. Last week, Barnieh and colleagues suggested paying people $10,000 for a kidney could be a way around that barrier.

"Our model demonstrated that a strategy where living donors are paid $10,000, with a corresponding assumption this strategy would increase the number of transplants performed among wait-listed dialysis patients by five per cent, would be less costly and more effective than the current organ donation system," Barnieh said to CBC News last week.

That's doctor-talk for freeing up $150 million a year for other health care priorities.

Last year, another U of C researcher, Dr. Braden Manns opened the discussion on paying for transplants. Barnieh's report last week is an extention of that discussion.

Manns pointed to an online survey he conducted in 2011 of 2,004 Canadians that found 70 per cent support for paid organ donations to the estates of people who have died, and 40 per cent support for financial incentives to harvest live organs from live donors.

One idea that seemed to resonate was that organ donors would be given free funeral services.

No surprise, but the officials at the top of the health care authority chain do not publicly support opening this ethical can of worms.

As an alternative, I have some additional ethical questions in the discussion on paying for organ donations.

For instance: If the financial case for increasing organ donations is so strong, why is the financial case not being made for reducing the incidence of kidney failure in the first place?

If $10,000 a pop for a kidney makes sense financially (and improves patient outcomes) why is so little spent removing the chief causes of kidney failure, namely: obesity, hypertension and diabetes?

One of three kidney failures in Canada results from diabetes. A major cause of diabetes is sedentary lifestyles combined with poor dietary habits.

Philosophers commenting on cash-for-kidneys say donors under such a program may be “inappropriately incented.” People already talk about institutions using emotionally coercive methods to convince relatives to donate for a sick family member. Cash could be just one other type of coercion.

But in Alberta, we can't even suggest having “opt-out” programs, where all people are considered donors unless they carry a card saying they refuse to be.

This is about saving lives and hundreds of millions of dollars.

Yet pennies on those dollars that could be destined for incentives toward healthier living to prevent the need for either dialysis or transplants are described — even in our recent municipal election campaigns — as a waste of money.

Truly, there are more worms in the can than we care to examine. The cost of refusing the discussion is rising, too.