Incentivizing kidney donation may be more effective

How much money would it take for you to donate a kidney to a stranger?

Researchers at Penn Medicine asked just that in the first study of how financial incentives affect a healthy person’s decision to donate his or her kidney.

The study was conducted in response to a nationwide shortage of organs for transplantation, according to Rachel Kohn, a third-year Penn medical student who collected data for the study.

It tested for two major ethical objections to offering financial incentives for donations: disparately swaying the poor to donate and blinding donors to potential surgery risks, according to Peter Reese, the senior author of the study and a professor of medicine and epidemiology.

“We found that people across income levels were equally swayed by money, meaning that someone who made $100,000 a year would be just as affected by a financial incentive as someone who made $15,000,” Reese said.

In response to the second concern, Reese explained that “despite the levels of payment that were offered, people were still sensitive to the risks of donating a kidney.”

The study showed that willingness to donate by individuals of all economic levels was actually more associated with having a family member as a recipient, lower risk of complications and higher monetary incentive.

The conclusions were made after surveying hundreds of passengers riding Philadelphia public transportation, who were presented with different scenarios that included varying financial incentives and risks of kidney failure from donation.

Reese, who has spent most of his career addressing the persistent shortage of kidneys for transplantation, said while waitlisted transplant patients keep increasing, kidney donations have not been meeting the demand.

“We wanted to use our creativity to see if we could expand access to transplants,” he said. Since more than 90 percent of donors give their kidney to a family member or a friend, finding donors in the general public could be a way to increase donations substantially.

Reese said before the study, he couldn’t guess what the experiment’s outcome would be.

“We call it clinical ‘equipoise’ when in your heart, you’re not really sure what the answer is. And I think those are the best hypotheses to test,” he said.

He stressed the importance of using data studies such as this one to make informed ethical policy decisions.

“You might find that someone who’s a great debater might win an ethical argument, but in reality their points may never be manifested,” he said.

The study, however, “doesn’t settle the question” for Reese. “The next logical step would be to fund a controlled trial in which patients are actually offered financial incentives for donations,” he said, to see if these results would remain true outside of hypothetical situations.

“Most people will know someone with kidney disease at some point throughout their lives, and will be faced with such discussions and decision-making,” Kohn said.

The study was published in the March 16 issue of The Annals of Internal Medicine, and did not receive any outside funding.

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