When organ donations after death are a topic, the altruism argument is easily made. But during life, it is more complex.

Kidney transplantation is the best treatment for patients with kidney failure. Unfortunately, there's a shortage of kidneys available to those in need of a transplant, and donation rates from both living and deceased donors have remained relatively unchanged over the last decade.  Some people aren't going to have willing donors or even matching ones but when the notion of paying for donations is introduced, the implication is this will be a new front in the class war - organs of poor people will be harvested for the rich.

Yet when those philosophical arguments were first made, one thing was not anticipated; sooner rather than later, science will be able to grow organs using a patient's own stem cells.

Until then, there needs to be a better solution. A paper in the Clinical Journal of the American Society of Nephrology found that says that paying living kidney donors $10,000 would increase the number of transplants performed by 5% or more and be less costly and more effective than the current organ donation system.

A paid living donor strategy is attractive from a cost-effectiveness perspective, even under conservative estimates of its effectiveness, they conclude. By estimating the likely costs and consequences of paying donors, experts can determine whether a strategy of paying donors is worth pursuing with the goal of clarifying these remaining issues. 

The researchers asked whether a government or third party administered program of paying living donors $10,000 would be cost-effective. In other words, would it save money and, by increasing the number of transplants, improve patient outcomes?  

According to their model, a strategy to increase the number of kidneys for transplantation by 5% (a very conservative estimate) by paying living donors $10,000 could result in an incremental cost savings of $340 and a gain of 0.11 quality-adjusted life years over a patient's lifetime compared with the current organ donation system. Increasing the number of kidneys for transplantation by 10% and 20% would translate into an incremental cost savings of $1,640 and $4,030 and a quality-adjusted life year gains of 0.21 and 0.39, respectively.

"Such a program could be cost saving because of the extra number of kidney transplants and, consequently, lower dialysis costs. Further, by increasing the number of people receiving a kidney transplant, this program could improve net health by increasing the quality and quantity of life for patients with end-stage renal disease," said lead author Dr.  Lianne Barnieh.

In an accompanying editorial, the  proposed a research agenda and necessary elements for a limited trial of incentives. "Current trends regarding the use of financial incentives in medicine suggest that the time is ripe for new consideration of payments for living kidney donation," they wrote. "Reassurance about the ethical concerns, however, can come only through empirical evidence from actual experience," they added.

Citation: Lianne Barnieh, John S. Gill, Scott Klarenbach, and Braden J. Manns, 'The Cost-Effectiveness of Using Payment to Increase Living Donor Kidneys for Transplantation', CJASN CJN.03350313; published ahead of print October 24, 2013, doi:10.2215/CJN.03350313