UW-Madison: Policy analysis suggests system for kidney transplant allocation

CONTACT: David Weimer, (608) 263-2325, [email protected]

MADISON – Designing and regulating a system through which nonprofit organizations can purchase kidneys for transplantation would increase the number of transplants and ultimately reduce federal expenditures, according to new research by cost-benefit analysis expert David Weimer of the Robert M. La Follette School of Public Affairs at the University of Wisconsin-Madison.

Weimer, La Follette graduate Lara Rosen, and Simon Fraser University faculty member Aidan Vining developed a plan that would allow for the purchase of kidneys to be used to seed transplant chains involving willing but incompatible donors.

Published in the August 2011 Journal of Health Politics, Policy and Law, their analysis shows how such commodification could be designed and regulated to reduce ethical concerns about exploitation of potential donors and unfair advantage in allocation.

“Transplantation is the treatment of choice for those suffering from kidney failure,” Weimer says, “but the waiting list is long, growing, and unlikely to be substantially reduced through the use of kidneys from cadavers. Not only does transplantation offer improved quality of life and increased longevity relative to dialysis, it reduces end-stage renal disease program expenditures, providing savings to Medicare.”

One conservative estimate is that each live kidney transplant saves Medicare’s end-stage renal disease program more than $114,000, says Weimer, who teaches cost-benefit analysis for the La Follette School.

Medical ethicists oppose direct purchase of kidneys from living “donors” or vendors, the authors note. However, much of the ethical debate has been in terms of commodification through market exchange – buying and selling kidneys for profit in an open market. Weimer and colleagues designed and assessed three alternative institutional arrangements for the commodification of kidneys that would regulate transactions to reduce ethical concerns.

Forty percent of kidney transplants come from live donors wanting to help a relative or friend. However, the altruistic donor might be incompatible. An innovation has been to match an incompatible dyad with another pair.

“My sister would donate her kidney to a stranger, and the stranger’s wife would give me her kidney,” says Rosen, who worked with Weimer on the project while completing her master of public affairs degree. She is now a project assistant with the Wisconsin Department of Transportation and is completing her double degree in urban and regional planning.

Paired exchanges like these have grown into “chain exchanges” in which a kidney in one dyad is passed to a second pair, which passes its donor kidney to another pair, and so on.

“In a chain exchange, if the wife and I were incompatible, her kidney would go to a second stranger, whose friend would give his kidney to a third stranger, and so on down the line,” Rosen explains.

“Seeding” these chain exchanges is an element of a more efficient transplantation system, the authors recommend.

“Our policy analysis argues for establishing a nonprofit organization that sets prices and purchases kidneys that it then gives to the transplant centers that can organize the longest ‘chains’ of transplants,” Weimer says. “Of the arrangements we analyzed, this alternative best balances the goals of promoting equity, efficiency, fiscal advantage and human dignity.”