Kidney Vending

Danovitch, Gabriel M.; Leichtman, Alan B.

doi:10.2215/cjn.03030906

Cited by 68 publications

(28 citation statements)

References 16 publications

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“…Despite this, the warning that a regulated market could be counterproductive to efforts to increase altruistic donation [78] must be considered carefully. The reported decrease in the proportion of living donor transplants in Hong Kong following the transfer of sovereignty from Britain to China may support this contention [77] .…”

Section: Iranian Modelmentioning

confidence: 93%

“…It also undermines altruistic donation of cadaveric organs, encourages exploitation of kidney donors by unscrupulous middlemen and endangers the lives of donors undergoing nephrectomy in poor, unregulated conditions [74,76,77] . Rothman et al [78] speculate that the introduction of cash payments may weaken the moral obligation to donate.…”

Section: Legalised Market In Organ Procurementmentioning

confidence: 99%

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Key issues in transplant tourism

Akoh¹

2012

WJT

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Section: Iranian Modelmentioning

confidence: 93%

Section: Legalised Market In Organ Procurementmentioning

confidence: 99%

Key issues in transplant tourism

Akoh¹

2012

WJT

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“…(14) Additionally, 'crowding out' may lead to a reduction in altruistic donations; this was observed in Hong Kong after its reunification with China made it easier to purchase kidneys from China. (15) In light of this, outlawing kidney sales under the Human Organ Transplant Act (HOTA), (16) as well as punitive measures against medical and allied health personnel facilitating such transplants, helps Singapore to avoid many of the negative repercussions of an organ market.…”

Section: Regulated Financial Incentives For Living Donorsmentioning

confidence: 99%

Policy options for increasing the supply of transplantable kidneys in Singapore

Chong

2016

smedj

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C o m m e n t a r y INTRODUCTIONChronic kidney disease (CKD) is a worldwide public health problem that is increasing in incidence, prevalence, morbidity and cost.(1) In Singapore, CKD is the ninth leading cause of death, (2) while the incidence of end-stage renal disease (ESRD) increased from 680 cases in 1999 to 1,405 cases in 2010. Due to Singapore's ageing population, this number is projected to increase sharply.(4) Among the treatment options for ESRD patients, kidney transplantation is the treatment of choice for medically eligible patients, as it is more cost-effective than dialysis.(2,5) However, there are insufficient available, transplantable kidneys to meet demand and the median waiting time for a kidney transplant can be as long as nine years in Singapore, compared to 3-5 years in the United States, Australia or the United Kingdom.(6) Fig. 1 provides an overview of the dynamics behind Singapore's supply and demand of transplantable kidneys and suggests reasons for the lack of transplantable kidneys.(7) Detailed explanations are available in the online supplementary document (http://www.smj.org.sg/ sites/default/files/CO-policy-Supplementary.pdf). In this article, I explored policies that could engage potential donors and key individuals through incentives or their sense of altruism in the Singapore context. Financial incentives for deceased donors and their familiesProponents of market-like schemes often assert that altruism is fixed in supply or that the cost of appealing to altruistic motivations is prohibitively high.(8,9) However, introducing posthumous financial incentives may paradoxically lead to relatives imputing a weaker preference for organ donation on the part of the deceased, hence increasing the likelihood that relatives refuse to consent to organ harvesting.(10) Furthermore, such legislation is unlikely to be feasible in Singapore due to societal repugnance toward 'organ-selling'.(11) Non-financial incentives for deceased donors and their familiesNon-financial incentives may still be feasible to potential donors and their relatives. Israel, for example, has achieved measurable success (e.g. increasing from 7.8 to 11.4 donors per million population in 2010 and 2011, respectively) through its policy of encouraging deceased donation by giving priority on the organ transplant list to registered/actualised donors and close relatives who consent to successful posthumous donation, should they themselves ever require donated organs. (12) In Singapore, such measures could apply to the relatives of terminally ill patients (with no hope for survival) who agree to donation through controlled terminal extubation. Regulated financial incentives for living donorsProponents of self-interest-based incentives argue that waiting lists for kidney transplantation could disappear with the formation of a government-controlled market similar to the Iranian model. (13) In this model, there would be no middleman or exploitation of low-income countries and their populations, as only health-screened citizens are a...

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“….it is clear that the benefits of a regulated system of compensated donation (chiefly, increasing the number of donated kidneys) outweighs any risks', and ' Allowing the sale of kidneys from living donors would greatly increase the supply of kidneys and thereby save lives', from whence comes forth such confidence [24 ]? It is now widely known by a current experience in Hong Kong and Israel that markets have negatively impacted noncommercial living and deceased donation [28]. The notion that organ market would do otherwise defies sensibility and this experience.…”

Section: The Impact Of Commercialization On Noncommercial Living and mentioning

confidence: 99%