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US survey shows public support for kidney sales
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A United States–based survey indicates that adults would consider legalizing payments for kidneys — up to $100,000 — if it led to a significant increase in making more kidneys available for transplant.
“We found strong polarization, with many participants supporting or opposing payments regardless of potential transplant gains,” wrote Julio J. Elías, MD, of the Universidad del CEMA in Buenos Aires, Argentina, along with colleagues Nicola Lacetera, MD, University of Toronto, CESifo, and Mario Macis, MD, of Johns Hopkins University. “However, about 18% of respondents would switch to favoring payments for sufficiently large increases in transplants.”
The randomized survey was sent to 2,666 U.S. residents recruited online through a survey firm. The sample was constructed to match the U.S. population on sex, age, race and education, and was fairly representative also on other socio demographics, the authors wrote. “Our [survey] design included two main sources of experimental variation. First, we randomly assigned each respondent to one hypothetical paid-donor kidney procurement and allocation system and asked them to consider it as an alternative to the current system. The features that characterized a system were the nature of compensation (cash or noncash), the amount of the payment ($30,000 or $100,000), and the identity of the payer (a public agency or the organ recipient).”
Each respondent made multiple choices to indicate whether they would support the proposed system or if they would prefer to keep the current one. The authors then established a second source of variation, randomly assigned to half of the participants within each system to express their moral judgments about the current system and the paid-donor system at each hypothesized supply level.
“We considered six principles: autonomy of choice, undue influence, exploitation of the donor, fairness to the donor, fairness to the patient and human dignity,” the authors wrote.
The survey results showed 57% of respondents on average would support a paid-donor system if there were no transplant gains, and about 70% would favor compensation when the system is meeting 100% of demand.
“The relationship between rate of support and transplant increases is roughly linear, with a 10 percentage-point hypothesized increase in transplants leading to a two to three percentage-point increase in support for compensating donors (similar across the different systems),” the authors wrote.
The level of support, however, was dependent on the payer’s identity.
“Systems with payments from organ recipients receive support that is about 15 percentage points lower than systems where payment is from a public agency, at all levels of supply. In other words, although most respondents are in favor of donors being paid, there is strong opposition to patients paying. The nature and amount of compensation did not have an effect on support for compensating donors,” the authors wrote.
About 21% of respondents said they were opposed to payments to donors regardless of its effects on transplants. - by Mark E. Neumann
Disclosure: The authors report no relevant financial disclosures.