The Kidney Dialysis Patient Protection Act, which is likely to appear on the state’s November ballot, is a well-intentioned but inefficient way for California voters to help dialysis patients. The initiative would try to restrain kidney dialysis costs by limiting the profit margins of dialysis corporations to 15 percent. The group has collected more than 450,000 signatures to put the initiative on the ballot and will soon submit them to election officials. A much better policy option, however, is to encourage more kidney donations, which save lives and get patients off dialysis once and for all.
Kidney dialysis uses a machine to keep alive people whose kidneys don’t work. If you know someone who has been on dialysis, you know that it is an exhausting, time-consuming ordeal. Some patients must stop working and suspend other normal activities. And ultimately, dialysis is only a stopgap, not a cure. Without a kidney transplant, dialysis patients often die years or even decades prematurely.
Dialysis is also costly — up to $150,000 a year for patients covered by private insurance. A 1972 law mandated the federal government pay for dialysis for people whose private insurance does not cover it. The government’s bargaining power enables it to pay substantially lower prices, but that does not help anyone who needs a kidney transplant get it sooner. An estimated 7,000 people died in 2016 while awaiting kidney transplants, according to the United Network for Organ Sharing. About 95,000 Americans, including 18,000-plus Californians, are on the waiting list for kidney transplants.
We share the goal of easing the costly burden of dialysis, but addressing and ending the kidney shortage would ultimately be much better for patients and taxpayers. One step to ending the shortage would be for Congress to repeal a 1984 federal law forbidding “valuable consideration” to organ donors. The law, passed with good intentions, has limited the organs available to patients and left far too many deaths.
Compensation and markets can be part of the solution. The water we drink, the food we eat, and the medicines we take are provided by people, mainly strangers, who are compensated for providing it. We can apply similar principles to kidneys. And Californians have led the way on donor compensation. Nobel Prize-winning economist Alvin Roth of Stanford University, who improved the system for matching kidney donors with patients, is studying how markets could encourage healthy people to donate organs in ways that don’t exploit low-income donors. Similarly, a University of California-San Francisco researcher co-authored an academic study that estimated paying $45,000 to living kidney donors, and $10,000 to the heirs of donors whose organs are used after their deaths, could end the shortage of kidneys. The study found that because kidney transplants are cheaper than dialysis over the long-term, paying donors would save about $12 billion a year in federal spending and produce $66 billion a year in societal benefits.
Most people have two healthy kidneys and can donate one while still leading a normal life with the remaining kidney. At present, kidney donors are overwhelmingly the relatives and friends of recipients. There are very few stranger-to-stranger donations. The patients who need those hard-to-get donations are disproportionately from minority groups. In California, nonwhites and Hispanics make up 80 percent of the patients awaiting transplants, nearly twice their share of the population.
New Zealand and Israel, among other countries, already allow a degree of compensation for donors. The country that has gone farthest is, surprisingly, Iran, which has no shortage of kidneys. In 2016, Rep. Matt Cartwright, D-Pennsylvania, introduced a bill to allow experimentation with compensation for organ donors in the US. Congress did not pass it, but we understand Cartwright plans to re-introduce it this year.
The goals of the proposed ballot initiative are admirable, but Californians should aim to save thousands of lives by ending the kidney shortage, not just reducing the costs of dialysis.
This column originally ran in The Orange County Register.