The Kidney Lottery: How Can We Increase Live Donation and Make People Whole Again With Incentives?

Imagine the pain of the excruciating wait. Deep down in places no one wants to talk about, there is a reality: Mothers, fathers, brothers, sisters, friends, pray for the right person to die the right way with the perfect organ match to save their loved one. Can you even imagine waiting maybe 10 years, watching your friend, your family member, move closer to a deadline that looms over them just waiting with little comfort, little hope? It’s a morbid luck of the draw whether an organ can even get to the person who needs it most, just maybe the closest person geographically.

Every day, thirty people die waiting for an organ that never arrives. Nationally, approx. 80% of the people waiting for an organ are waiting for a kidney: approx. 101,000 candidates. Every ten minutes a name is added to the waiting pool for an organ. These aren’t just numbers. They are people.

What will it take for us to start saving those more than 100,000 lives in limbo? We’re not waiting for research to catch up. This doesn’t need a 5k fundraiser or a bike ride along the California coast to get us closer to an answer. Amazingly, seventy- nine organ transplants happen every day in the US, but it’s not enough. How are we not exploring every avenue to close the gap between supply and need?

Money may just be the answer.

As of now, organ sale is explicitly illegal in the US according to the FDA. Fears of corruption and manipulation are well-founded, and a cursory look at the black market can let one know that imbalance of the rich preying on the poor is rampant. Only the rich can pay the average price of a kidney on the black market, $150,000, and the “donor” in some third-world countries may get as little as a few thousand dollars for the kidney with brokers in some countries making $60,000.

Person-to-person sale is and should be illegal. There are just too many moving parts, and the battle is too long. The argument can and has been made for legalization on grounds of freedom to choose what we to do with our bodies. It’s mine, and same as with a woman’s right to choose, I want to sell my kidney. I can respect that argument, and used it as a premise in any earlier draft, but maybe there’s a simpler and more straightforward way to encourage donation without legalizing the sale of organs; a way to get paid without a sale.

Though family and friends are the first stop for finding matching donors today (and are the majority of live donations that take place), what we need to incentivize are more of the very rare anonymous donations (often termed “angel donations”). These are donations from a complete stranger who seeks out being a donor with no motivation but a desire to give of themselves. How weird is that? I couldn’t believe it even when I heard it, but this happens, and is as suspect from the transplantation community as it seemed to me.

Arguably the closest thing to a selfless act one can think of, among doctors and the transplant community there is a social suspicion of this kind of altruism. Angel donors are questioned as much, if not more so, than friends and family. Why would a complete stranger with no windfall, no thanks, no recognition, no tangible benefit, voluntarily give a life-saving organ to a stranger? That kind of selfless act not only makes us uncomfortable, but is suspect in the medical community. Monetary compensation eliminates suspicion. No reason to be wary of goodness in man if the motivations are tangible.

Let’s say you donate your old car to charity. You get an itemized tax deduction. You receive the “fair market value” of said donation. Why not get some money involved if it leads to more donations? We aren’t putting a price on a life, but on an organ. The fair market value for your kidney donation can be written off on your taxes to the tune of an amount we determine. No longer should the donor be penalized for the gift of life nor are they legally allowed to be discriminated against for future insurance or life insurance policies; we reward the donation, creating a more supportive environment for finding the right donors in a growing pool.We ReallyNeedMoreKidneys


Right now, the recipient’s benefit is intrinsic, but the donor’s benefits are simply, ridiculously nonexistent. It’s a wonder there is any angel donation at all with all of that’s stacked against them. Altruism should not cost someone any more than the sacrifice made.

The charitable donation of an organ currently comes with not only no windfall or tax incentive, but potential short- and long-term losses. According to, the donor can have a difficult time financially. Insurance billing, denial, reimbursement, is a convoluted and confusing situation to be sure, but in the case of donor/recipient coverage, it can be even worse. Donors are paying out of pocket for gas, airfare, food or lodging incurred through evaluation and the transplant process (“Estimates of out of pocket expenses associated with [living] donation range from $550 to $20,000” -livingdonor101). Living donation is often categorized as an elective surgery, voluntary. Elective surgery is not treated by insurance companies the same as emergency surgery. The living donor may have no means to recuperate lost wages, coverage for potential complication or extended post-op care if needed, and donors have been charged higher premiums for life and medical insurance in the past. “A 2005 survey of 10 major insurance companies found that liver donors would experience either higher premiums or an inability to find an underwriter.” -livingdonor101.

AIDS, cancer, Parkinson’s won’t be cured tomorrow even if we tripled funding. Those aren’t problems of money, but research and scientific progress. There aren’t many issues we can fix in this world by throwing money at them, but this is one that we can, so why not? We’re not $100,000 away from curing AIDS, but we have a cure for needing a kidney…it’s a kidney. Though a windfall of any kind for such a donation is a moral issue, it is not a medical one. Live kidney donors live completely normal lives with no ill-effects after surgery in the overwhelming majority of cases, but “not going to die from it” isn’t enough of a reward.

What are the arguments against compensation for kidney donation? A recent NPR-Thomson Reuters Health Poll found that 60% of Americans support some kind of financial incentive to organ donors (DonateLifeNW). “It feels wrong” is not an argument. There is nothing standing between us and saving more than 100,000 lives besides feeling icky? That’s not enough for me.

I’m not saying this is the right choice for everyone. Just as is giving money to breast cancer research, a pile of clothes to a local charity, or donating a service or goods to better society out of the goodness of your heart, live organ donation is voluntary. Lest we forget that everything I just mentioned comes with an incentive for the donor. Are those donations sullied by this money received? Is the goodness inherent in those donations any less for the incentive donors were given in return?

But for a greater sacrifice of live donation, we not only don’t reward the good will of men and women giving so generously, we leave them in the cold for potential losses and some narrow their eyes at the inherent goodness, trying to find their angle. They didn’t run a marathon, unload the spoils of spring cleaning, or write a check…they saved one life. One person chooses to save one life for less incentive than donating a block of basketball tickets to the Boys and Girls Clubs of America.

A donor’s pain and sacrifice shouldn’t come with just an atta-boy and a loss of wages. If offering a tax deduction or credit persuades just a few people to donate, wouldn’t it be worth it? Do you think recipients and their families care? They don’t care. They want their lives back. You think it taints the donation because the donor will be able to put a down payment on their first home, pay off their student loan debt, or set up a trust fund for their only child to go to college with the spoils of donating a kidney? Is the recipient’s life tainted by finding a perfect match who received $100,000 in tax relief for taking on the dangers of major surgery? Hell, maybe it’s not enough. Maybe we need to offer $200,000 in incentives, but we can argue over the number and disbursal periods once we all decide that we can’t do everything, but we can do this.

Don’t tell me it’s unconscionable to, let’s face it, sell your kidney to save a life. We drew this weird line in the sand years ago. We sell plasma.. saves lives. We sell surrogacy…nurtures life. We sell sperm, eggs… makes life. Bone marrow? More life. Oh, but the living donation of a kidney, partial liver, partial lung, partial pancreas, or partial intestinal transplant (all but the former are relatively rare procedures)? Nope, can’t compensate someone for that incredible sacrifice. Sure, you can’t make more kidneys like you can sperm or plasma, but women can’t make more eggs, so what’s the problem here? Why is this the thing we took a stand on for a lousy tax incentive or a few measly buck in the face of impending death? I know why we don’t sell organs, I get the arguments, but is this a possible alternative we can revisit?

This is a question society needs to ask itself and no one can speak intelligently for society; society even has a hard time doing it sometimes.

Signing up as a post mortem donor is a wonderful choice to make and lifts the burden of that choice off your family upon your death. It’s a choice more than 117 million Americans have made as organ, eye, and tissue donors. That’s 48% of the country, but that isn’t getting us the live donations we need now, and if money is how we get there I’ll search my soul for what’s right and wrong later, and so can a recipient; they’ll have the time.

Out there, with no data to support my theory, of the more than 300 million Americans, there simply has to be 101,076 perfect kidney matches just walking around, living their lives ignorant to the fact they have the very thing that could save a life. The key is to figure out if there is a tangible number to get them interested in living donation; and we simply have to get the word out that overall risks of donating a kidney are considered very low and properly evaluated donors can live healthy lives with just one kidney; donation does not affect your life expectancy (DonateLifeNW), but maybe $250,000 in tax incentives can change countless lives.

I’ve been told this will never work, and hasn’t before as some 17 states have tried with little success. That was then, this is now, and I think we need to try again with real money this time; life-changing money. I’m 29, I’ve seen legalized gay marriage, legalized recreational marijuana sales, and the first black President of the United States…I’ve seen a lot of nevers already.

According to OPTN data, since 1995 (the waiting list has grown from 27,000 to over 120,000 in that time), more than 72,000 candidates have been removed from the kidney waiting list because of death. Approximately 155 names will be added today while 109 will be removed (combined number of successful transplants, 79, and unfortunate deaths, 30). I’m not above paying for kidneys to save lives. It’s changing our thinking, a tax code or two, and attempting to reward donation somewhere near the level of sacrifice which is standing between recipients and their donors, not scientific breakthroughs. More than 100,000 lives wait in limbo as we decide if profit belongs in living donation, if the cost is too high, or if this is just morally wrong. Those aren’t the questions I ask. I ask: If this is wrong, then what is it costing us to be right?

Educate yourself:

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