Researchers Examine Barriers to Organ Donation and Possible Remedies

April 16, 2018

Every 10 minutes, someone is added to the national organ transplant waiting list, and about once every hour, someone on the list is removed — either because they died while waiting or grew too ill for surgery.

The number of Americans on the waiting list totals more than 114,000 as of this writing, and about 30,000 transplants will be performed this year. In part, that’s because there are not enough organ donors.

Two new collaborative papers by UC Merced Economics Professor Kurt Schnier reveal that increasing the incentives and eliminating barriers for donors — both living and deceased — would greatly improve other people’s chances of receiving life-saving transplants.

One collaboration, involving a transplant surgeon and two other economists, focused on increasing people’s willingness to be deceased organ donors. The other collaboration, involving two transplant surgeons and a public health researcher, investigated a government policy targeted at increasing living organ donation by lowering donor-related costs.

Both interdisciplinary collaborations revealed that people don’t need to be paid to be donors (which is illegal and unethical anyway) — all they really need is a reduction in the current disincentives.

“As a living donor, you don’t get a lot of the donation related costs covered,” Schnier said. “Your incidental costs of being a living donor and days off work are not covered. You don’t get additional health insurance in case you need it after surgery. You don’t get any tax breaks.” All those benefits are labeled “valuable consideration” and considered payment for organ donation — a violation of the National Organ Transplant Act (NOTA).

In “Subsidizing Altruism in Living Organ Donors,” in the journal Economic Inquiry, the researchers examined a program run by the National Living Donor Assistance Center (NLDAC). Using funds from the Department of Health and Human Services, NLDAC alleviates the travel and lodging costs for low-income live kidney donors.

That relief alone increased the number of donations by 14 percent at participating U.S. transplant centers.

“Just that little bit of help raised the rates by that much,” Schnier said. “The program costs about $2 million a year but has a net benefit to society of about $250 million a year.”