Scholarly Research Paper: Compensation for Living Kidney Donors
Ellysse Cruz
Texas Lutheran University Department of Nursing
Compensation for Living Kidney Donors
Selena Gomez, actress, singer, and ex-girlfriend to Justin Bieber (note: it has come to my attention that, during the process of writing this paper, they have rekindled their romance,) and best friend, actress, Francia Raisa made national news earlier this year, but not for reasons you would expect. In 2013, Gomez was diagnosed with Lupus, an autoimmune disease that would later attack her kidneys as if they were foreign invaders. In an extended interview with Savannah Guthtrie, which aired during the Today Show, Gomez recalls the scary realization earlier this summer that her kidneys had begun to fail. When she began to feel the symptoms, Gomez didn’t know where to turn; according to Becker and Elias, there are 95,000 patients on the United Network for Organ Sharing (UNOS) waiting list for kidneys alone, and Gomez would’ve had to wait an average wait time of 4.5 years (2014.) And then, like all fairytale stories, in stepped the hero.
Raisa volunteered to donate her kidney the second she found out about Gomez’s predicament. After an entire day of being tested and signing many papers, due to the urgency, Raisa and Gomez went into surgery to complete the kidney transplant. Gomez mentions in many interviews that she could never repay Raisa for her sacrifice and I’m sure Raisa, along with people who donate their organs to loved ones, would never accept it, either. But what if, instead of donating organs to loved ones, they donated them to complete strangers? Would strangers still be equally as willing to give up their kidney, or would they be more hesitant? What if we included the option of receiving compensation for living organ donors? Would things go about more smoothly?
Like every ethical situation, there are both pros and cons when you consider all aspects of the issue. For the past few years, social scientists, philosophical ethicists, medical ethicists, health professionals and lawyers alike have been debating whether compensation for living donors would be morally acceptable. Studies and trials have been done to determine whether compensation for living donors would work and succeed. Yet the question remains: should we begin compensating living donors for their kidney donations?
Review of literature
Excess Demand for Kidney Donation.
When studying any topic related to organ donation, it is important to understand the definitions of supply and demand. Supply is deemed as how much of something, in this case, donated kidneys, is available; demand is understood as how much of the supply is needed, in this case, the number of patients on the UNOS kidney transplant list. When analyzing the supply and demand of kidneys, in 2017, the demand is 96,341— 19 times higher than the supply available (OPTN, 2017.) According to Becker and Elias, last year there was nearly a six-figure amount of people on the UNOS transplant list and only 16,500 kidney transplants were successfully completed (Becker, 2014.) The statistics cannot paint a clearer picture: the supply cannot keep up with the demand.
Since 1988, when UNOS was first founded, 857,835 organs have been donated, 150,951 of those being from living donors. Looking at the numbers, this may seem like a lot, however, this is the same as saying that, of every 10 organ donations, 2 are from living donors. And, unfortunately, over the past 13 years, the numbers have only been declining. 35,239 organ transplants have been conducted this year and, of that number, 4,983 coming from living donors. UNOS has noted on their website that 2004 was the best year for living organ donation, ending the year at 7,005— more than 2,000 more than living donors in 2017. With advancements in technology and more educated health professionals, many would think that rather than declining, the number would be rising. So why aren’t people donating as much as before? Like every medical procedure, there are multiple risks that should be considered when determining whether someone should donate their organs. However, what seems to be the biggest deal breaker for many prospective donors is the time and money required to donate.
Donation Process.
Due to thorough physiological, psychosocial and medical assessments, along with paperwork, the approval process can take anytime between days to months. After being approved, surgery is usually scheduled four to six weeks in advance. According to the Johns Hopkins website, living donors can expect to spend a couple of days in the hospital for monitoring, followed by a week in town if the donor traveled to have the surgery completed. This monitoring period is followed by two to six weeks of recovery time, in which the donor is discouraged from driving and lifting objects more than ten pounds. In total, living donors typically spend about one to three months out of work, depending on the type of work they do; those with an office job can be expected to return to work quicker than those whose work is physically demanding.
Who donates? Similar to Gomez’s case, most living donors give their organs to directly benefit their own family members or loved ones.
Who receives kidney donations? In an article by Transplant News, reporters follow a kidney patient named Lisa. Diagnosed with Lupus when she was 12 years old, Lisa had been on dialysis for twenty years before she had her first transplant (Alabama, 2014.) After eleven years, her donor kidney failed and she was placed back on the transplant list, waiting and hoping for another chance. Becker and Elias go on to explain the history of organ transplant and the importance of receiving an organ when it is needed, due to short life expectancy.
How are donors affected financially? In “‘Because you can’t live on love’: living kidney donors’ perspectives on compsenation and payment for organ donation,” one donor mentioned that ‘compensating people for lost income [is] not providing a financial incentive’, it is ‘removing a financial disincentive’ (Shaw, 2014.) Another participant stated that, “I wouldn’t have been able to do it if I didn’t have sick pay,” (Shaw, 2014.) Using the period of one to three months as stated above, a donor carrying a full time job, receiving minimum wage in Texas, would be losing out on $1,160 to $3,480 while they are not allowed to work. This creates a barrier for many who want to donate their organ but simply cannot afford to, literally.
Next Step
Trials in Australia. In a country where no donor had ever been compensated for time, money or potential health hazards, Australia conducted a two-year trial in which living organ donors would be compensated during the time of their donation process (Giubilini, 2015.) In this trial, donors would receive the equivalent of six-weeks pay on the national minimum wage. This payment is made to the employers, who then transfer it to the donor in form of paid leave. Using this method, the biggest benefit for the donor is that they will not need to take unpaid leave for reasons relating to the donation process, minimizing financial stress (Giubilini, 2015.) It is important to also note that, in order to prevent exploitation, the Australian government founded this trial on two constraints:
1) only donors who have an at least minimum wage job can be compensated for donation; if donors are unemployed, they are not eligible.
2) the compensation is based on the national minimum wage (Giubilini, 2015.)
Interviews in New Zealand. While there is no actual compensation program enforced in New Zealand, Rhonda Shaw and Lara Bell analyzed and examined experiences of 25 living kidney donor from the donors’ own perspectives. Conducting a qualitative study, Shaw and Bell analyzed each donors’ work-up and post-operative recovery and the financial consequences these donors experienced during the donation process (Shaw, 2014.) The researchers then asked the living donors their thoughts and feelings towards being compensated for their organ donation. Of the 25 participants, 15 donors favored compensation and 9 favored reimbursement for specific costs.
In the United States, there is a higher demand for kidney transplants than there is a supply of kidneys. According to Becker and Elias, 4,500 people died last year alone waiting for a kidney transplant, in hopes that someone, somewhere would donate.