Iran's market for kidneys in the NY Times

Tina Rosenberg writes about the Iranian kidney market: Need a Kidney? Not Iranian? You’ll Wait.

Here's a part:

"Iran’s system has many deficiencies — not least that the very idea clashes with ethical norms observed in many other countries — and the program varies greatly from region to region. But its chief advantage is this: People who need kidneys get them rapidly, rather than die on the waiting list.

In the vast majority of cases, donors know in advance what they will be paid and receive appropriate screening and good medical care before and during the operation. And by getting patients new kidneys instead of keeping them on dialysis, the society saves a lot of money and avoids much misery.

The Iranian model suffers from insufficient funding, lack of follow-up for donors and other problems. But as waiting lists for kidneys grow around the world, Iran offers an important lesson: With good design and regulation, a system that pays donors need not be exploitative or immoral. In Iran, the legal kidney market has prevented the development of the abusive black markets and kidney tourism seen in other countries. As the kidney crisis intensifies, governments should look closely at what Iran has achieved.

For many people, the specifics of how a kidney market works are beside the point — the very idea of paying people to donate organs ends the debate before it starts.

One reason the idea of organ-selling is repugnant is that the human body has a special dignity. But if there’s an ethical barrier to selling the pieces, it was crossed long ago. We sell blood products, sperm and eggs. We pay people to do weird things to their bodies in risky clinical trials.

Perhaps kidney donation is different because kidneys do not grow back (although one healthy kidney is sufficient), and donation requires surgery. It is very safe surgery, but there is always some risk for donors. Perhaps the biggest moral issue in economically unequal societies is that a paid donor is almost always in dire straits, willing to do desperate things for money.

Yet people, especially poor people, take risks for money all the time. “We should ask ourselves why some people find accepting money to donate a kidney and save a life repugnant, but accepting money for being a policeman or miner or soldier — all of which are statistically riskier than donating a kidney — is O.K.,” said Mohammad Akbarpour, a research fellow in the Becker-Friedman Institute of the University of Chicago. “Is there a fundamental difference?”

Ben Hippen on the economics of transplantation and dialysis

Dr Hippen replies to an earlier article suggesting that incremental changes in current transplant practice could remove the need to radically increase the supply of kidneys, e.g. through financial incentives...

Debating Organ Procurement Policy Without Illusions

Benjamin Hippen, MD American Journal of Kidney Diseases

"For poor patients, the primary payor for dialysis is Medicare, Medicaid, or some hybrid, unless they are ineligible for these programs. The profit margins of dialysis facilities with an average payor mix of Medicare, Medicaid, and commercial insurance is 3% to 4%.12 Crucially, a facility composed entirely of patients with Medicare and/or Medicaid as the primary payor is financially unsustainable because payments to facilities on a per-treatment basis are, depending on local labor and other overhead costs to the facility, frequently less than the cost to the facility to provide the treatment. Although a dialysis facility requires a minimum number of patients to cover labor and operational overhead costs, the total net margin of a typical facility is achieved through cross-subsidization from collections from commercially insured patients."
...

"A staple of opponents of financial incentives is that incentive proposals would not even bear consideration if transplantation professionals would just stop wasting perfectly good kidneys. Citing a 19% rate of organ discard in the United States, the authors argue that if only we biopsied more kidneys before turndown, made more use of organs with a Kidney Donor Profile Index > 85% (previously known as expanded criteria donors), and increased use rates of organ donation after circulatory death just like many European centers, we would be a long way toward solving the problem.

These arguments betray a lack of understanding of the extant regulatory burdens and financial constraints on US transplantation centers. In the United States, the expected risk-adjusted rate of death-uncensored transplant survival for a deceased donor kidney at 1 year is 96% (14; Fig 6.2), and 1-year expected patient survival is 98% to 99%. These outcomes represent the expectations of transplantation centers by CMS regulators, and failure to achieve these outcomes invites intense regulatory scrutiny under threat of involuntary closure.15 In the last several years, nearly 100 transplantation programs in the United States have gone through expensive stressful “mitigating factors” applications with CMS to avoid involuntary closure because of reported outcomes that were below risk-adjusted expected outcomes, although the data and veracity of the methodology used to calculate risk adjustment has been heavily criticized.16 With some frequency, scrutinized centers are required to enter into a Systems Improvement Agreement, essentially a contract with CMS to put oversight of the transplantation program into a multiyear third-party receivership, at extravagant expense to the transplantation center, until reported outcomes improve.

Regulatory scrutiny of programs that fall below expected outcomes is typically accompanied by denial of Center of Excellence status by CMS. Loss of this designation often causes commercial insurers to cancel insurance contracts and direct referrals to other programs. This is a profound incentive to embrace risk aversion.16 and 17 Refashioning insurance agreements and changing ingrained referral patterns is a slow process and can pose significant medium-term challenges to the financial stability of a transplantation program long after the quality issues have been resolved to a regulator’s satisfaction."

Journal of Human Trafficking, Issue 1, 2015, on kidneys

Issue 1 of the Journal of Human Trafficking contains this article by Alexander Capron and Frank Delmonico. I've highlighted in the abstract two points worth noting--the first involves some untested, but testable empirical claims about what would happen if countries in the first world allowed compensation for donors. (It would be nice to have some empirical evidence...)  The second point is that it is now agreed by everyone that financial disincentives for donating should be removed. (Let's get organized on that, shall we?)

Preventing Trafficking in Organs for Transplantation: An Important Facet of the Fight Against Human Trafficking

DOI:10.1080/23322705.2015.1011491

Alexander M. Caprona & Francis L. Delmonico

pages 56-64

Published online: 28 Apr 2015

Abstract

Most countries now have national legislation that outlaws both human trafficking and organ trafficking. However, international conventions and domestic laws alone have not been enough to stop the trade in organs. As of 2007, a conservative estimate was that 5% of the approximately 100,000 organs transplanted annually were derived from exploiting the poorest and most vulnerable people in society; anti-trafficking efforts have since reduced, though not eliminated, this practice. The Declaration of Istanbul (DoI) was created in 2008 to engage medical professional societies to collaborate with governments and others in combating organ sales, transplant tourism, and trafficking in human organs. In 2010, the Declaration of Istanbul Custodian Group (DICG) was formed to actively promote and to monitor the implementation of the DoI principles. The removal of prohibitions on organ purchases, which is now being promoted in some wealthy nations, is unlikely to shorten transplant waitlists (because organ sales crowd out voluntary, unpaid donation) and would be based on the false view that such sales do not exploit the sellers. To combat such exploitation, the DICG advocates for ratification and enforcement of the new “Council of Europe Convention against Trafficking in Human Organs,” as a complement the Palermo Protocol to the United Nations organized crime convention that prohibits human trafficking for organ removal. To increase ethical organ donation by living related donors, the DICG encourages countries to adopt means to cover donors’ financial costs, which now discourage donation. It also works with the World Health Organization to encourage ministries of health to develop deceased donation to its maximum potential toward the goal of achieving national self-sufficiency in organ transplantation so that patients do not need to travel to foreign destinations to undergo organ transplantation using kidneys and partial livers purchased from poor and vulnerable people. Success in combating human trafficking for organ removal and organ trafficking will be greatly enhanced through organizations like the DICG forging strong relationships with human rights organizations.

Financial support for organ donors in New Zealand? A new bill proposed...

New Zealand's parliament will debate a bill to increase the financial support offered to organ donors.

Member’s Bill will boost financial support for organ donors Thursday, 25 June 2015, 2:43 pm Press Release: New Zealand National Party

Chris Bishop

National List MP based in the Hutt Valley

25 June 2015

Member’s Bill will boost financial support for organ donors

Chris Bishop, National List MP based in the Hutt Valley, is delighted the Financial Assistance For Live Organ Donors Bill, a Member’s Bill in his name, has been drawn from the ballot and will be debated by Parliament.

The purpose of the Bill is to increase the financial assistance provided to people who, for altruistic reasons, donate kidney or liver tissue for transplantation purposes.

The Bill will increase the support for donors from the equivalent of the sickness benefit to the equivalent of 80 per cent of the donor’s pre-operation earnings – the same formula applied to income support for ACC recipients. The Bill also provides for the payment of childcare assistance for those who require it during their convalescence.

“I was inspired to pick up this Member’s Bill, which was originally put forward by Hon Michael Woodhouse, after talking to Sharon van der Gulik at one of my first meetings as a candidate in the election last year,” Mr Bishop says. “She had been living with renal failure for more than two years and needed 15 hours of dialysis a week – before her son donated one of his kidneys to her.

“At the public meeting, Mrs van der Gulik spoke of the financial hardship that her son faced in the six weeks he spent recovering from the procedure. She argued he deserved more. I agree.

“If this Bill passes into law, greater support will be available to people like Mrs van der Gulik’s son.

“Organ donation rates in New Zealand are improving, but are still too low. It’s important they increase - live kidney donation is the least expensive form of treatment for end-stage renal failure, and significantly improves life expectancy.

“This Bill is a small but important and helpful step to increasing the number of people who donate organs.

“Wider work to increase the number of donors is being led by the Minister of Health. Budget 2014 allocated $4 million over four years to set up a National Renal Transplant Service to increase the number of live kidney donor transplantations. The funding covers donor liaison co-ordinators and continuation of the New Zealand Kidney Exchange programme. Last year's funding increase builds on the $4 million invested in Budget 2012 to raise awareness and encourage more people to donate organs,” says Mr Bishop.

Maine hospital goes through with kidney donation despite donor raising funds online

Long story short: woman in need of kidney posts a sign on a car, seen by a stranger who agrees to donate and is compatible. Then he uses social media to raise some money to pay his expenses, and raises more than he anticipated. Hospital delays surgery, worrying that maybe he's breaking the law against getting "valuable consideration" for his donation, but eventually goes ahead. Both donor and recipientt are doing well.

Maine man sees plea on car window, to donate kidney to stranger
Maine donor says kidney transplant OK'd for next week
"Joshua Dall-Leighton of Windham said the surgery will take place June 16 at Maine Medical Center in Portland. Hospital spokeswoman Matt Paul confirmed on Monday that the living kidney donation is scheduled for that day.
 
"Dall-Leighton responded to the plea for a donor on South Portland resident Christine Royles' car. But the surgery was delayed by medical and legal hurdles, including crowdsourced donations to Dall-Leighton aimed at defraying his expenses. Paul said those concerns have been addressed.
...
"Hospital officials said in April they needed time to determine if the donation violated the National Organ Transplant Act, which forbids potential donors from profiting from a donation. A crowdfunding website set up for the donation has raised more than $49,000. Royles also organized fundraisers to pay bills and reimburse Dall-Leighton's time away from work.
 
"Paul said an external legal review confirmed that the transplant "will comply with federal laws that are designed to regulate organ transplants and protect living donors."
    ******************

From Bill of Health: Fundraising and the Delayed Kidney Transplantation: A Loophole in the Ban against Commercialization?
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And here's the happy ending
Car-window wish for kidney rewarded: Maine woman receives lifesaving transplant--Both patient and donor are reported to be doing well after surgery, capping an unusual story of strangers and sacrifice.

"Josh Dall-Leighton, 30, a corrections officer at the Southern Maine Re-entry Center in Alfred, saw the sign on Royles’ car last fall and immediately contacted her.

“He saw that sign and said, ‘I need to do this,’ ” his wife said.

Royles, whose kidney failure was caused by an autoimmune disease, was placed on a waiting list of more than 100,000 in need of kidney transplants in 2014, but decided to try to find a donor on her own.

The surgery was almost derailed after a GoFundMe effort raised nearly $50,000 for the couple. The account was set up by a friend of Josh Dall-Leighton with a goal of raising $6,000 to cover expenses for the six weeks he was expected to take off work to recover from the surgery.

But after a story about the transplant was published in the Press Herald and was widely picked up by other media outlets, the donations far exceeded the original goal.

Maine Medical Center put the potential transplant on hold until lawyers could sort out legal and ethical issues regarding the large sum of money. Federal and international laws prohibit the sale of organs, but hospital officials have said it was clear that there was no intent to profit from donating the organ.

Last week the hospital announced that the donation was not a legal impediment, and the surgery would go forward.

“If we didn’t have as strong a voice about this as we did, I don’t believe we would be here right now,” Ashley Dall-Leighton said.

She has said they are considering donating the money to a kidney foundation and the neonatal intensive care unit at Maine Med, where their twins were patients when they were born. They wanted to wait until after the surgery and recovery period to have a true accounting of their expenses – as opposed to an estimate – before determining how much and where to donate, she said."

Review of living kidney donor outcomes, in The Lancet

In The Lancet
Volume 385, Issue 9981, 16–22 May 2015, Pages 2003–2013

Living kidney donation: outcomes, ethics, and uncertainty
Dr Peter P Reese, MD,  Prof Neil Boudville, MD, Prof Amit X Garg, MD

Here's the summary:
"Since the first living-donor kidney transplantation in 1954, more than half a million living kidney donations have occurred and research has advanced knowledge about long-term donor outcomes. Donors in developed countries have a similar life expectancy and quality of life as healthy non-donors. Living kidney donation is associated with an increased risk of end-stage renal disease, although this outcome is uncommon  (less than .5 percent increase in incidence at 15 years). Kidney donation seems to elevate the risks of gestational hypertension and pre-eclampsia. Many donors incur financial expenses due to factors such as lost wages, need for sick days, and travel expenses. Yet, most donors have no regrets about donation. Living kidney donation is practised ethically when informed consent incorporates information about risks, uncertainty about outcomes is acknowledged when it exists, and a donor's risks are proportional to benefits for the donor and recipient. Future research should determine whether outcomes are similar for donors from developing countries and donors with pre-existing conditions such as obesity."


And this...
"In many countries, living kidney donation is the only affordable treatment for kidney failure. This is evident across large regions of India and Pakistan, for example, where chronic dialysis is rationed in units supported by government or community donations, or is only available with payments that are prohibitive for most patients. In this respect, chronic dialysis is viewed as a bridge to a life-saving kidney transplant from a living donor. In many developing countries, the infrastructure to procure deceased-donor organs does not exist.

"Unrelated and incompatible donors
Living kidney donation in unrelated donors (eg, friends, spouses, or distant relatives of the recipient) are becoming more common. In the USA, the proportion of living kidney donations from unrelated donors increased from 30% to 57% between 1999 and 2013. Similar trends are evident in Europe, Australia, and New Zealand.

"This rise in unrelated living kidney donation is largely associated with a declining emphasis on close HLA matches between donor–recipient pairs. With advances in immunosuppressive therapy, the longevity and function of the transplanted organ is now less dependent on the genetic donor–recipient relationship than in the past. The rise in unrelated donors has also been helped by so-called kidney paired donation, a strategy used to overcome donor–recipient incompatibility if the transplant candidate has antibodies to the donor's blood or HLA type. Such antibodies greatly increase the risk of donated-organ rejection and, in the case of anti-HLA antibodies, might develop because of previous pregnancies, blood transfusions, or transplants. As shown in figure 2, registries of incompatible donor–recipient pairs have enabled transplantation to proceed through paired exchanges, or donation chains in which each donor provides a kidney to an unrelated compatible recipient. Paired exchange has been helped by the transportation of living-donor kidneys between centres and by non-synchronous transplants, in which one or more donors wait to donate until new pairs enter the chain. In some cases, a transplantation chain begins when an individual with no relationship to any recipient donates a kidney (termed non-directed donation). In 2012, this type of altruistic donation enabled a 30-transplant chain to proceed."

The Shi'a religious jurisprudence behind Iran's legal market for kidneys

An anthropology graduate student named Elham Mireshghi is studying the market for kidneys in Iran, and includes in her study some interesting observations about the Shi'a fatwas on donation, brain death, and donor compensation that give the market its religious justification.

I haven't seen her paper yet, but she is presenting a paper in Chicago at the U. Chicago Program on Medicine and Religion's
2nd Annual Islamic Bioethics Workshop--Dissecting the Ethics of Organ Donation (June 5-7). Her tantalizing slides are here.

She writes that concern whether transplantation itself was permissible loomed larger than the issue of sales, and that Ayatullah Khomeini initially prohibited transplantation, but that this ruling was changed after it became accepted that the transplanted organ became part of the body of the recipient once blood flowed through it.

Regarding compensation of the donors, she argues that the distinction between a gift and a sale was avoided by framing the question not as

“Can a kidney be bought and henceforth removed and transplanted into a new body,”

but rather as

 “now that a kidney has been removed for the legitimate purpose of being transplanted, can the owner of the kidney receive payment for it?”

I'm looking forward to reading the paper...


HT: Jim Childress, Mario Macis

Everything for Sale? The Ethics and Economics of Compensation for Body Parts (Video of the panel discussion)

Here's the video of the panel discussion I participated in at Johns Hopkins on May 7, Everything for Sale? The Ethics and Economics of Compensation for Body Parts: the panelists were James Childress, Michele Goodwin, Alvin Roth and Debra Satz

The video, including introductions before and questions after, is an hour and 20 minutes. The introduction by Mario Macis starts around minute 6:40, and includes audience voting on questions of whether they would be in favor of regulated markets for kidneys, for hearts, for blood, for human eggs and sperm, and for breast milk. The panel discussion, moderated by Jeff Kahn, starts at minute 14, with each of the panelists, in alphabetical order, giving an 8 minute opening statement. (Mine begins at 33:20, and ends at 41:41, pretty close to the 8 minute guideline:) .)

The Guardian on Iranian kidney sales

The Guardian reports on a bad outcome in Iran's market for kidneys--the recipient dies, and the donor isn't doing well: Kidneys for sale: Iran’s trade in organs

"Iran is the only country in the world where it is legal to sell a kidney. Donors get money from the buyer and from the state, a system which eradicated waiting lists but, detractors say, exploits the poor and vulnerable. Here, we follow one terrible story"

Sally Satel: more on compensating kidney donors

April 18 in The Pacific Standard: Sally Satel on The case for compensating kidney donors

"The current system is a qualified failure. For the past decade, transplant operations for all organs have hovered between 27,000 and 29,000 annually, and, in 2014, was the lowest it's been in 11 years.The European model of "presumed consent," wherein a person's organs are taken posthumously unless an individual has specifically forbidden their retrieval, is not a potent solution as less than one percent of deceased individuals are medically eligible to donate.

"Hence, there is a desperate organ shortage in the United States. The situation in other countries, especially poorer countries without good access to dialysis — a death sentence without immediate transplant — is even worse. As a result, the overseas black market is burgeoning. The World Health Organization estimates that 10 percent of all transplants are performed under shadowy, illicit conditions where the risks are high: Corrupt brokers deceive impoverished and illiterate donors about the nature of surgery, cheat them out of payment, and ignore their post-surgical needs. For the recipient, organ quality can be poor and post-operative management dicey. (The exception appears to be Iran, where organ sales are monitored by the government. There, potential donors exceed the number of needy patients.)
...
"Compensating organ donors is not a new idea. In 1983, Al Gore, who championed NOTA, explicitly suggested rewarding donors if altruistic volunteering did not keep up with demand. Moreover, NOTA's legislativehistory implies that the law's felony provision against "valuable consideration" in exchange for an organ was intended to prohibit brokered or direct cash sales between buyer and seller. It is silent regarding a system of in-kind, third-party compensation.

Here is a plan for donor benefits: A governmental entity, or a designated charity, would offer in-kind rewards, like a contribution to the donor's retirement fund, an income tax credit, or a tuition voucher worth roughly $50,000 in value. (This is the amount typically proposed by advocates of incentives.) To enhance deceased donation, a funeral benefit could be offered.

With a third party providing the reward, all recipients, not just the financially secure, will benefit. An imposed waiting period of at least six months would help limit impulsive live donation and, most important, any subsequent remorse. Prospective donors would be carefully screened for physical and emotional health, as is done for all donors currently. Their kidneys could be distributed, according to exiting allocation policies now in place for cadaver organs.

Donors would be guaranteed follow-up medical care for any complications, which is not ensured now. And the cost of the benefits could be underwritten by the enormous savings from dialysis.

Will rewarded donation attract only low-income prospective donors? Perhaps. One option is to require a minimum income for donors, but that strategy prevents all interested parties from participating. Better to start with the assumption that low-income people are capable of making decisions in their own interest. In the end, regardless of who ends up donating, a sound plan ensuring that donors are thoroughly informed, their health protected, and their sacrifice amply rewarded is an ethical one.

How to achieve this? We should start with pilot projects. The Department of Health and Human Services probably could initiate pilot trials, if motivated. The Center for Medicare and Medicaid Innovation has impressively broad authority. In theory, the Center could issue NOTA waivers to academic medical centers interested in administering a pilot program wherein living donors would be rewarded with five years of Medicare coverage.

States should also get involved. The late Pennsylvania Governor Robert P. Casey, who had received a heart and liver transplant a year earlier, signed a 1994 law that would enable a bereaved family of an organ donor to get a burial benefit of up to $3,000 paid by the state directly to the funeral home. State health officials ended up with cold feet, fearing that the law flouted NOTA, but some bold state should proceed with a funeral benefit and force the Department of Justice to action, spurring a vital national debate in the process.

Congressional action is another approach. Lawmakers could amend NOTA to permit pilot trials of incentives by clarifying the intent of the law as a restraint on cash exchange between buyer and seller with or without a broker. The need for a new approach to expanding the supply of donors should resonate with lawmakers on several levels. The first is public health (needless deaths), the second is fiscal (the enormous cost to Medicare — roughly seven percent of its budget is spent on dialysis and its complications), the third is human rights (the global black market); and the fourth is race (minorities are disproportionately disadvantaged by the organ shortage as they are less likely to be referred for transplant)."

Contagion, for good and ill

Frank Bruni had a recent NY Times column that reminded me of the chain of high school suicides:
"Between May 2009 and January 2010, five Palo Alto teenagers ended their lives by stepping in front of trains. And since October of last year, another three Palo Alto teenagers have killed themselves that way, prompting longer hours by more sentries along the tracks. The Palo Alto Weekly refers to the deaths as a “suicide contagion.”

Sometimes something similar happens with good acts, and I was reminded of that by this recent story from Israel (about a different kind of chain of kidney donations than I usually write about):

Chain Reaction of Good Will
"Avraham Shapira donated a kidney to a stranger and set off a series of altruistic gestures. A few months later his cousin, Yehuda Rabinovich, was inspired by Shapira and also donated a kidney to a stranger. From there the movement spread around the Shomron region. So far six people have donated kidneys to complete strangers."

Expanding non-directed kidney donation: the Renewal model

An article in the Forward talks about attempts to expand the successful organ donation program of Renewal beyond the Jewish community:
Can an Orthodox Charity Help Save Lives in This Man's Church?

"Although 90% of Renewal’s donors are ultra-Orthodox, about half their recipients are people like Sarna, who come from the broader Jewish community.

"The average wait time for a kidney through Renewal is six to nine months.

"Because many ultra-Orthodox rabbis believe that organ donation from dead bodies is against Jewish law, Renewal focuses solely on live donors. That puts Renewal’s donors in an extremely rare group of several hundred Americans who, each year, donate their kidney altruistically to a stranger.
...
"Researchers are studying Renewal’s model to see whether it can be replicated in other race- and faith-based communities. Meanwhile, one African-American transplant surgeon is setting up a group modeled on Renewal in a prominent Harlem church.

"Anthony Watkins, an assistant professor of surgery at Weill Cornell Medical College, has witnessed Renewal’s work firsthand, ever since he began his transplant fellowship six years ago. “I’ve always thought that what Renewal does is spectacular and fantastic and [that] maybe this could be duplicated in other communities,” he said.

"Watkins thinks that by using Renewal’s model — appealing to African Americans to help fellow African Americans — he can persuade people to donate in greater numbers. “I think once you establish a good rapport and knowledge and education… you can get altruistic donors to step forward,” Watkins said. But how many people are willing to donate a live organ to a stranger?
...
"Renewal facilitates an average of about 50 kidney transplants a year. About three-quarters of those transplants are ultra-Orthodox donors giving to a Jewish stranger.

"Ultra-Orthodox Jews account for just 0.2% of America’s population. Yet last year, by the Forward’s estimates, they accounted for up to 17% of the people who donated a kidney to strangers.

"Rees realized that if Renewal’s model of communally focused organ donation could be extrapolated to the general population, it could create tens of thousands of additional kidney donors. The waiting list could be reduced to zero. “That’s what Renewal has achieved,” Rees said, “and that is nothing short of amazing.”

"Rees contacted Duke University to see if researchers there could investigate whether Renewal’s model could be replicated in Christian communities.

"Last year, two Duke professors, David Toole and Kim Krawiec, put together an interdisciplinary team of faculty and students, including lawyers, physicians, sociologists and theologians, to examine new methods of increasing living kidney donation.
...
"Renewal leads donors and recipients through every stage of the transplant process. It is particularly important for kidney donors, who receive very little financial support from insurance companies and the state. Renewal covers lost wages, transportation and any necessary hotel costs. It also offers domestic support such as house cleaning, laundry services and catering. Reiner said that the average cost of a transplant, including the group’s administrative overhead, is about $20,000.
...
"The United Network for Organ Sharing, which tracks donations nationally, counts a kidney donation as “altruistic” only if the donor does not specify to whom the kidney is given. Last year it tracked 180 such altruistic donations.

"Because Renewal’s donors choose the recipient of their kidney — even though they have no personal relationship with them — UNOS categorizes them in a larger pool of 1,273 living donors who directed their kidney to a “non-relative.”

"Based on this method, Renewal’s donors account for about 2% or 3% of living donations to non-family members.

"But Duke University’s Toole says that it is unfair to compare Renewal’s donors to most other donors in this larger pool because most of those donors know the recipient of their kidney. Renewal’s donors give to strangers. “What makes the model so interesting,” Toole said, is that “it’s some in-between space” between directed donations and altruistic donations."
**************

See my earlier post on Renewal here.