KIDNEY TRANSPLANTS AND THE SHORTAGE OF DONORS: IS A MARKET THE ANSWER?

I. INTRODUCTION As of September 10, 2004, there were 86,460 people on a waiting list to receive an organ. (1) The majority of these people, 59,625, were awaiting a kidney transplant. Between January 1995 and June 2004, over 52,000 people died while waiting for an organ. And in 2003 alone, 6,256 people died waiting for an organ and another 1,603 people were removed from a waiting list because they had become too sick to receive a transplant. Table 1 shows more specific information over time on the number of transplants and the demand for kidneys, the organ in greatest demand and the focus of this article. As can be seen from Table 1, the number of kidney transplants performed has increased steadily between 1988 and 2003, from less than 9,000 kidney transplants in 1988 to more than 15,000 by 2003. The change in the waiting list, the difference between the additions and removals, could be considered the excess demand for kidneys and is shown in the fifth column of Table 1. Between 1995, the first year this information is readily available, and 2003, the excess demand for kidneys has been relatively stable. However, this figure does not take into account the reasons for people being removed from the waiting list. Most of the people were removed from the waiting list because they received a transplant. However, others were removed from the waiting list because of death or because they became too sick to receive a transplant. To get a sense of an upper bound on the excess demand for kidneys over time, in column six of Table 1 we show the difference between those added to the waiting list and those who were removed from the waiting list because they received a kidney transplant. This calculation of the excess demand includes people who were part of the demand for a kidney during the year but were removed from the waiting list due to death or because they became too sick for a transplant. Using this upper bound for the excess demand for kidneys, we see it grew over this 8-year period by more than 3,000. This information all leads to one very sad conclusion. People are dying and/or living a lower quality of life because of a lack of available organs for transplant. The question is what can we do about this? To reduce the excess demand for organs (holding total demand constant), our only option is to increase the number of organs available from live and/or cadaveric individuals. This article focuses on the impact of allowing a market for cadaveric kidneys as a possible solution. We consider only a market for cadaveric kidneys primarily due to our belief that, given the strong objections of many in the United States including the American Medical Association (AMA, 1995), the United States will not consider a market for live donations any time in the near future. Furthermore, there are clearly issues involved with living donors not present with cadaveric donors. For instance, there is a question of the potential health risks incurred by the living donor and time missed from work. Some believe that living donors, particularly family members, may be "coerced" into donating. Perhaps most importantly, there is concern about how living donations affect the allocation of organs. In October 2004, doctors transplanted the first kidney from an unrelated living donor found over the Web at http://www.matchingdonors.com/life/index.cfm. To obtain access to this Web site and post one's profile, the individual pays a membership fee. This fee varies depending on the plan chosen, but ranges from $99 for a 7-day trial period to almost $600 to keep your profile listed for as long as the Web site exists. Participating and being successful in obtaining a donor in this manner takes money, a certain amount of familiarity with the Internet, and an ability to write a persuasive profile. These are very different criteria than those used by the United Network for Organ Sharing (UNOS) to allocate organs, which focus on medical compatibility, length of time on the waiting list, and the proximity of the donor to the potential recipient. …