Baylor University Medical Center Proceedings April 2014, Volume 27, Number 2 | Page 95

kidney transplant operations were performed that year. Taking
into account the number of people who die while waiting for
a transplant, this figure implies an average wait of 4.5 years for
a kidney transplant in the USA. This situation surprisingly is
far worse than it was just 10 years ago, when nearly 54,000
people were on the waiting list, with an average wait of 2.9
years. Finding a way to increase the supply of organs would of
course reduce wait times and deaths, and it would greatly ease
the suffering that many sick individuals now endure while they
hope for a transplant. The most effective change, these authors
believe, would be to provide compensation to people who give
their organs.
The first kidney transplant and indeed the first successful
organ transplant was in 1954 at the Brigham and Women’s
Hospital in Boston. Kidney transplantation did not really take
off, however, until the 1970s with the development of immunosuppressive drugs that could prevent the rejection of transplanted organs. Since then, the number of kidney and other
organ transplants, of course, has grown rapidly, but not nearly
as rapidly as the growth in the number of people with defective
organs who need transplants. Many of those waiting for kidneys
are on dialysis, and life expectancy while on dialysis is not long.
People, for example, aged 45 to 49 on average live an additional
8 years if they remain on dialysis, but they live an additional
23 years if they get a kidney transplant. Almost 4500 people
died in 2012 while waiting for a kidney transplant, and most
died because they were unable to replace their defective kidneys
quickly enough. Most of those on dialysis cannot work, and
the annual cost of dialysis averages about $80,000. The total
cost over the average 4.5-year waiting period before receiving
a kidney transplant is about $350,000, which is much larger
than the $150,000 cost of the transplant itself.
Individuals can live a normal life with only one kidney, so
about 35% of all kidneys used in transplants come from live
donors. Most kidney transplants come from parents, children,
siblings, and other relatives of those who need transplants. The
rest come from individuals who want to help those in need of
transplants.
Exhortations and other efforts to encourage more organ
donations have failed to significantly close the large gap between
supply and demand. Some countries use an implied consent
approach, in which organs from cadavers are assumed to be
available for transplant unless, before death, individuals indicate that they don’t want their organs to be used. The US
continues to use informed consent, requiring people to make
an active declaration of their wish to donate. Switching to implied consent would unlikely lead to a large enough effect to
eliminate the sizeable shortfall in the supply of organs in the
US. That shortfall, however, is not just an American problem.
It exists in most other countries as well, even when they use
different methods to procure organs and have different cultures
and traditions.
Paying donors for their organs would, in the authors’ opinions, eliminate the supply-demand gap. In particular, sufficient
payment to kidney donors would increase the supply of kidneys
by a large percentage, without greatly increasing the total cost
April 2014

of kidney transplantation. The authors opine that a very large
number of both live and cadaveric kidney donations would
be available by paying about $15,000 for each kidney. Few
countries, however, have ever allowed the open purchase and
sale of organs. Iran perm