Most US Voters Approve of Paying Kidney Donors, Survey Finds

Marcia Frellick

March 23, 2016

Most US voters view living kidney donations positively, according to a telephone survey, and most also said they would be motivated toward such a donation if they received $50,000 in compensation.

A quantitative survey of 1011 registered US voters likely to vote found that 689 people (68%) would donate a kidney to anyone, and 235 (23%) would donate only to certain people; 87 (9%) would not donate.

Moreover, 59% said being paid $50,000 would make them even more likely to donate a kidney, 32% said the compensation did not sway them, and 9% were negatively influenced by payment.

Thomas G. Peters, MD, from the University of Florida College of Medicine in Jacksonville, and colleagues report the survey results in an article published online March 23 in JAMA Surgery.

Given their findings, Dr Peters and colleagues conclude that, "because thousands of lives might be saved should compensation increase the number of transplantable kidneys, laws and regulations prohibiting donor compensation should be modified to allow pilot studies of financial incentives for living kidney donors."

"Our findings refute the assertion that the US public, and particularly the American voter, holds payment for living kidney donation in disdain," they said.

The researchers wanted to gauge interest in donations and the potential influence of compensation, given the dire numbers behind the shortage of kidneys available for transplants, which has resulted in tens of thousands of preventable deaths. From 2004 to 2013, the authors note, 63,742 patients died or became too sick for a transplant while waiting for a kidney.

The current US kidney transplantation list has more than 100,000 names. There are risks with living kidney donations, but the adverse events have been minimal, the authors say. With living donations, the survival rate of the graft is almost twice that of deceased donors.

But such donations currently depend on altruism, because paying any donor is illegal under the National Organ Transplant Act.

There are legal programs that reimburse for donor costs such as lost wages, travel expenses, and follow-up care, but many donors do not qualify. More controversial is the practice of providing financial services such as a contribution to the donor's retirement fund or a tuition voucher.

To learn what US voters think of compensation for kidney donations, the authors had the survey professionally designed and conducted by an international polling firm. They used random digit dialing that selected respondents via both landlines and mobile telephones to improve representation. They also gathered information such as age, sex, and education level.

Young Most Likely to Approve of Pay

Results showed that 53 (78%) of 68 voters aged 18 to 29 years favored payment, which was a significantly higher percentage than in all other age groups (P < .05). However, 68 (63%) of 108 respondents aged 30 to 44 years and 266 of 459 respondents (58%) aged 45 years and older also favored paying living kidney donors.

In an accompanying invited commentary, Marco Del Chiaro, MD, PhD, from the Division of Surgery, Department of Clinical Science, Intervention, and Technology at Karolinska University Hospital in Stockholm, Sweden, and colleagues note that the size of the telephone survey was small, but even so, they found it interesting that the generally favorable attitude toward compensation and current laws do not match.

"Different reasons may account for this gap between legislation and perception (eg, effect of cultural background and different perception of ethics)," they write, "but an important influence may be knowledge of the risk related to kidney donation and the life-saving nature of transplantation in general. Based on the results of this survey, we will probably not witness a change in the current legislation on organ transplantation in the upcoming months, but it certainly carries an important message to society in general, the medical profession, legislators, and ethicists."

The study was supported by the Fair Allocations in Research (FAIR) Foundation, where Dr Peters serves as president and served as a director for more than a decade. The FAIR Foundation promotes access to organ transplants and the equitable distribution of biomedical research funds for all diseases. Dr Peters also worked closely with Penn Schoen Borland staff on statistical content analysis and administrative, technical, and material matters. One coauthor serves as vice president of the FAIR Foundation. The other authors have disclosed no relevant financial relationships.

JAMA Surg. Published online March 23, 2016. Article full text, Commentary extract

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