Reforming Organ Donation

 Alvin E. Roth and Greg Segal at STAT:

In September 2020, the U.S. Department of Health and Human Services (HHS) increased financial reimbursement for individuals willing to make living donations of a kidney or part of the liver to recipients who would die without them. Living-donor expenses such as lost wages and childcare can now be covered by the government as the payer of last resort.

Removing financial disincentives to donation is both the right thing to do and financially prudent — Medicare costs for dialysis dwarf the costs of making donation less expensive for generous living donors.


More can be done to facilitate living donation. Donors may not be compatible with their intended recipients, so kidney exchange has become a standard form of transplantation in the U.S. and some other countries. It allows patient-donor pairs to exchange with one another so each patient gets a compatible kidney from another patient’s intended donor. Many of these transplants come from exchange chains, begun by non-directed living donors, who are essentially generous living donors willing to donate a kidney to a stranger.
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In November, HHS followed its announcement about living donors with reforms for organ procurement organizations — the government contractors charged with recovery of transplantable organs from deceased donors. These reforms are projected to save more than 7,000 lives each year, as well as $1 billion saved to taxpayers in foregone dialysis costs.

In December, Congress righted another wrong in organ transplantation: extending the coverage of immunosuppression for kidney transplants, which previously — and nonsensically — stopped after three years, contributing to numerous graft failures each year as some patients could no longer afford their immunosuppressive drugs. Not only will this save lives, it’s projected to save Medicare $400 million over 10 years.

Organ donation reform has met with bipartisan Congressional support, with champions as ideologically diverse as Rep. Karen Bass (D-Calif.), the chair of the Congressional Black Caucus, and Sen. Chuck Grassley (R-Iowa). Both the Senate Finance Committee and the House Committee on Oversight and Reform are also actively engaged in separate investigations into the nation’s organ donation contractors, and leaders from both committees have urged the Biden Administration to undertake swift implementation of organ donation reform.