A regulated system of incentives for living kidney donation: why can't we agree to do a trial?

Abstract

In 1980, when there was approximately a one-year wait for a standard criteria donor kidney (young trauma victim), there was little rationale for considering incentives for donation. Today, however, in the United States, there are over 100,000 candidates on the waiting list for a deceased donor kidney transplant. Yet, in spite of numerous attempts to increase the donation rate, there has not been an increase in the last seven years. As a result, the waiting list and the resultant waiting time continue to grow, leading to an increased number of deaths (or removals from the list because of development of comorbidity) while waiting. A number of concerns have been raised about incentives. However, the real question is that - on balance - do these concerns justify continuing a ban on incentives (and the resultant thousands of deaths per year) or should we develop trials of incentives to determine whether or not incentives increase donation while simultaneously not increasing short- and long-term donor or recipient risks over those seen with today's conventional donation?