The case of gift of kidney while you are still alive

Would you ever donate a reserve organ to someone else while you are still alive? Probably not, given how little live organ donations happen these days.

The kidneys and recently the liver are some of the only parts of the body that can be donated by someone who lives. Our bodies can function perfectly with one kidney, while the liver can grow (doctors only remove a piece of transplant).

Although there are some short-term risks-as on any surgery-and potential rare complications, studies show that the average kidney donor Live as long as they would usually have and probably with a little, if any, long -term health effects (some studies suggest a Higher risk of conditions such as hypertension or diabetes). Living kidneys also tend to survive longer in their new recipients than those of the deceased donor, Lasts over 20 years In some cases.

Although living kidney donations increase over time, they are still not very common. Only around 6,500 people In the United States, donate a live kidney every year, of about 25,000 kidney transplants in total.

Last December authors Mario Machis and Elizabeth Plummer published article in Jama’s internal medicine aims to change this reality. Plummer is a professor specializing in health and taxation policy at Texas Christian University, while Makis is an economist at John Hopkins’ Business School. Their document is at the same time a personal essay, detailing Plummer’s relatively easy attempt to donate a kidney to his cousin in January 2024, and a study of a study of factors that discourage others to do the same.

We talked to the couple about myths and barriers around the live gift of the kidneys, as well as how to convince more ethically more people to follow in Plummer’s footsteps. The next conversation is slightly edited for clarity and grammar.

Gizmodo: What forced you to unite for this unique combination of an article?

Plummer: I had never considered donating a kidney, and the whole experience of donation was opening my eyes – from the beginning to finish. It was like seeing in a world that most of us don’t even know it exists. But there are so many people who are on dialysis just to stay alive and there is a huge need for living kidney donors. It was an opportunity to raise awareness and understanding. And Mario’s knowledge of the donation process and the system are exceptional. It looked like a great partnership.

Makis: As an economist, I have always been very interested in understanding markets where there is a constant shortage. This is the case of blood donations in many countries and organ donations around the world. One of the main reasons for these shortages is that in these contexts the price mechanism is not allowed to operate for ethical reasons. Although the ban on financial transactions in these markets aims to maintain moral values ​​and prevent exploitation, it also comes with considerable costs – as in terms of human life and economic inefficiency.

In the case of kidney donation, the compensation prohibition means that the number of organs available depends entirely on altruism, which is not sufficient to satisfy the demand. As a result, tens of thousands of patients remain on waiting lists, many of which will either die or get too ill for transplantation before receiving one. From the point of view of public finances, this shortage also necessitates considerable weight for taxpayers. The alternative to transplantation – dialysis – is not only physical tax for patients, but also extremely expensive, with Medicare covering a significant part of these costs. Each kidney transplant saves the health system of about $ 150,000, but policies that fail to cope with financial disorders for donors, limit the number of transplants committed.

The elimination of financial violations of donation, while stopping direct payments to bodies, may increase supply while respecting ethical problems. My interest is in the study of these compromises – how ethical restrictions shape markets, what consequences they have and how policies can be created to balance the moral problems with the urgent need to save lives.

Gizmodo: What are some of the biggest misconceptions that people have about the live gift of the kidneys, in your opinion?

Plummer: Most people remember the old times when the surgery was “worse for the donor than the recipient.” But now the donor surgery is laparoscopic and most donors are discarded after 2 to 3 nights in the hospital. While everyone’s experience was different, I had a little pain and returned to work a week later. People who have physically decisive jobs will have to be unemployed longer.

Another misconception is that you need to know someone who needs a kidney and you need to be a coincidence for that person. But this is not the case at all. Transplantation centers now allow a chain of kidney donor, which is a series of transplants involving multiple donors and recipients. For example, if my kidney had not coincided with my cousin, I could still donate to a stranger who coincides, and my cousin would get a kidney from a stranger who coincided with her. Donor chains can be between different transplant centers and may include any number of donors and recipients. You can also be a completely altruistic donor – that is, you do not know someone who needs a kidney. You just want to donate. Transplantation centers will find someone you match – and there will definitely be someone.

Another misconception is that you have to be young. Healthy people over 60 can be excellent donor candidates. In fact, some things are even more in their favor. Many are retired and have no children to take care of. Their coefficients of kidney disease can be less than those of a younger person. Donor medical teams carry out extensive processing to assess whether you are medically qualified to donate, but age is not necessarily deterrent.

Finally, medical teams that evaluate the donor candidates work regardless of the teams that evaluate the recipients. This helps prevent the pressure from applying the donor or the medical team of the donor. Several times the medical team assured me that I could withdraw from the donation process at any time and for some reason, and they were legally bound not to say to anyone the reason for withdrawing.

Gizmodo: What are some practical steps that US politicians or transplantation organizations, such as the National Center for Support Donors of Living Donors, could take to become more common these types of donations?

Makis: The elimination of all financial disorders to donate live kidneys is essential to increase the number of transplants and reduce the constant shortage.

While organic recipient insurance covers medical and surgical costs, donors are often facing significant pocket costs, including lost salaries, travel costs and dependent care. These financial burdens can amount to tens of thousands of dollars and impede many willing donors from production. The more explicit system, which eliminates all these deterrents, would make the live donation of the kidneys a really financially neutral act, ensuring that no donor worsens from their decision to save lives.

It is a key reform to expand the recovery of recovery in order to cover all direct and indirect donation costs, regardless of the level of donor or recipient income. We must provide full compensation for lost profits, dependent care and travel expenses without restrictions on testing (but with the exception of donors with very high income). Although direct payments to authorities remain ethically contradictory, the reimbursement of donors for all costs enjoys wide support from the community of transplantation and the public. In addition, donors should receive long -term health insurance for any future complications related to kidney donation, preventing them from uncertainty about potential medical expenses (some US legislators are urging donors to receive the donors Free health care for life).

In addition to the direct costs to recover, additional protection is needed to eliminate financial and non -financial risks for donors. For example, recognizing non -financial weights, such as pain, anxiety and inconvenience, a tax credit must be introduced in order to recognize the personal victim.

Forecasts show that any additional kidney transplant saves US taxpayers around $ 150,000. An increase in the number of live transplants of the kidneys would significantly reduce the number of dialysis patients, which will potentially lead to billions of Medicare savings while improving health results. A bold policy that eliminates all financial violations would not only improve the lives of thousands of patients in need of transplantation, but also save taxpayer money and increase the overall effectiveness of the healthcare system.

Given the widespread agreement that donors should not bear financial costs, the application of these changes will be aligned with both ethical and practical reasons.

Gizmodo: How is Elizabeth doing these days? And her cousin?

Plummer: I’m doing great. The whole donation process seems like a lifetime. You almost forget about it and my lifestyle has not changed at all – except that I can no longer accept NSAIDs (eg ibuprofen and AUV). I loved these!

My cousin is doing very well – or at least her kidney. She no longer needs dialysis, which took 12 hours before and demanded the help of her husband. It feels better and stronger. But people who are sick enough to need a new kidney often have other medical problems, so it’s a balancing act. She should take several medicines for the rest of her life (anti -rejection and antibiotics medicines) and have frequent appointments as a test doctor. But for now, her body seems to love her new kidney. We are both happy that we did it.