On Friday, New York State Sen. James Skoufis (D–Woodbury), introduced a bill that would provide kidney donors with free health insurance for life. Skoufis' bill, S.B. 6827, would establish a kidney donor insurance fund from which the payouts would come. The new incentives would not apply retroactively to people who have already donated kidneys.
"In New York State, there are 8,006 individuals who are candidates for a kidney transplant as of October 2019, but in 2018 just 521 people in the state who chose to serve as live kidney donors," Skoufis notes in the bill's memo. "Clearly, additional incentives are required to encourage people to give the gift of life."
The shortage of live donors—who are preferable to cadaver donors since live donor kidneys tend to last much longer—for those with kidney failure, also called end-stage renal disease, is a problem nationwide. As I've written before:
Researchers Frank McCormick, Philip J. Held, and Glenn M. Chertow estimate that 43,000 people die each year in the United States because of our shortage. Their math goes like this: about 126,000 people are diagnosed with end-stage renal disease annually (not all of those people are candidates for kidney donation, but many are). Half of those people would benefit from a donated kidney (so in the ballpark of 60,000). About 20,000 get a donated kidney, whether from a dead or living donor, which leaves approximately 43,000 people who would benefit from a new organ but are unable to get one.
Mass shootings, which have a much smaller death toll annually, regularly elicit all sorts of calls for action. But as the study's authors put it, preventable deaths from kidney failure startlingly equal "the same death toll as from 85 fully loaded 747s crashing each year." Despite this, we're squeamish about allowing cash compensation for donors, as many people fear that such an approach will lead to poor people essentially stripping their bodies for parts.
As Antonin Scalia Law School professor Ilya Somin argues, "Many people oppose legalizing organ markets because they believe it would lead to exploitation of the poor. But most of them have no objection to letting poor people perform much more dangerous work, such as becoming lumberjacks or NFL players." If people want to voluntarily donate a part of their body, they're allowed to do so, yet many people believe there's a warranted stigma to voluntarily giving up part of your body for cash.
Currently, kidney selling is illegal in the U.S., though people are allowed to donate their kidneys to strangers or family members, or take part in chain or domino donation, a multi-way donation when a family member is not a suitable match for his or her loved one, but is a suitable match for someone else in need who has someone who will donate in turn—quid pro quo, if you will. Non-directed donations, or donations to strangers, are very rare: A little more than 3 percent of all kidney donations in 2014 were non-directed. Insurance companies pay for all medical costs, but donors do not receive compensation for lost wages incurred during the one or two weeks of recovery time. There are not significant health drawbacks to going through life with just one kidney and those who donate typically get screened for early signs of kidney disease more regularly. Otherwise, kidney donors lead normal lives.
Vox's Dylan Matthews, himself a non-directed kidney donor, writes that this bill "is just an attempt by the kidney coalition to get around people's hang-up about just giving cash. Cash is a nonstarter so we have to resort to other stuff like health insurance and debt relief. It would be much simpler to just do it with money." Economists call organ selling an example of "repugnant transactions," or transactions for which bringing markets into the mix is considered immoral or wrong. As Stanford economist Alvin Roth told NPR, "It's universally acknowledged that you own your kidneys, but you're not allowed to sell the kidney nor am I allowed to buy one."
New York's law, if passed, could change that—sort of. Though donors would not be directly compensated with cash, a lifetime of healthcare that's paid for by the state would amount to a significant cost-savings, which could be a worthwhile enough incentive to nudge people toward organ donation.
Cold hard cash would still be better, of course.