Would You Give Up Your Kidney for $50,000?

[Log]

https://youtu.be/2EXeP7x1Fi0?si=PmCX0JzolYMFUvH3

Interesting new podcast from the Atlantic. There is a bill in the works to give kidney donors a $10,000 tax credit for 5 years after donation. This would not only would save many lives by making more kidneys available, it could apparently even save the government money on dialysis.

If this bill passes, I might quite plausibly be one of the people to be swayed by this incentive.

[Tasse]

Is it a refundable tax credit?

I believe there's a member of this forum who's given away a kidney to a stranger for free, but I'm not finding the username in the @ dropdown.

ETA: https://forum.mrmoneymustache.com/journals/hemi-demi-semi-fire-and-kidney-donation-journey/

[Log]

Is it a refundable tax credit?

Yes.

[LennStar]

No (original question).

Pretty sure it would be illegal here in Germany btw. The human dignity point. Which is also why we don't "pay" for blood donations (you might get something to eat or "expenses" of 10€).

[Michael in ABQ]

No. Add another 0 and I might consider it.

I suspect that replacement organs will be able to be grown in a lab setting within a decade or two - potentially making the whole issue moot. I'm sure there's already a black/gray market for people who can afford it to fly to a poor country and pay someone far less than $50k for a kidney.


From my commercial real estate days I do know that dialysis clinics make a lot of money. They could afford to build nice properties and pay very high lease rates. A coworker's husband was on dialysis and the stories she told made it sound pretty terrible. But the government is willing to pay for it, so the industry responds to that incentive.

[GuitarStv]

I thought buying a human organ was prohibited in the US?

To answer the question - nope.  I would maybe give a kidney to a family member or close friend.  I would never sell a kidney.  The reduction to my own life and chance of complications is not worth it.

[HPstache]

They can have the one that always gets kidney stones, ha!

[Tasse]

I thought buying a human organ was prohibited in the US?

That's why it's couched as a tax benefit. It's an attempt to solve the problem that paying for organs is widely considered morally disgusting and risks creating a coercive system, but at the same time, paying for organs would both save money and save lives.

Yes, I'd consider it. I probably would consider it without the tax benefit, too. But the one complication that's remotely likely is increased risk of preeclampsia in pregnancy, so I'm keeping both kidneys until after having kids.

[Tasse]

To answer the question - nope.  I would maybe give a kidney to a family member or close friend.

If you were not a match for your hypothetical loved one, would you trade a kidney to a stranger in exchange for getting a matched kidney for your loved one?

[GuitarStv]

To answer the question - nope.  I would maybe give a kidney to a family member or close friend.

If you were not a match for your hypothetical loved one, would you trade a kidney to a stranger in exchange for getting a matched kidney for your loved one?

Yeah.  That's effectively the same thing as donating your own kidney in my mind.

[Tasse]

To answer the question - nope.  I would maybe give a kidney to a family member or close friend.

If you were not a match for your hypothetical loved one, would you trade a kidney to a stranger in exchange for getting a matched kidney for your loved one?

Yeah.  That's effectively the same thing as donating your own kidney in my mind.

Donating a kidney to a stranger gives you access to "family vouchers" that gives your loved ones priority as kidney recipients, should they ever need one. Is that effectively the same thing?

[GuitarStv]

To answer the question - nope.  I would maybe give a kidney to a family member or close friend.

If you were not a match for your hypothetical loved one, would you trade a kidney to a stranger in exchange for getting a matched kidney for your loved one?

Yeah.  That's effectively the same thing as donating your own kidney in my mind.

Donating a kidney to a stranger gives you access to "family vouchers" that gives your loved ones priority as kidney recipients, should they ever need one. Is that effectively the same thing?

No.  If your family doesn't need a kidney, then you're just giving away your kidney for nothing in that case.

[Tasse]

Well, not for nothing. Just not for someone you know.

[GilesMM]

For fifty grand you can have my kidney and lll throw in a gall bladder.

[GuitarStv]

Well, not for nothing. Just not for someone you know.

Fair enough.  I meant nothing I value enough to give up a kidney for.

Don't get me wrong, I'm signed up for organ donation when I die.  But while I'm using the organ there has to be a very, very good reason (to me) to give it up.

[MustacheAndaHalf]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

[GuitarStv]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

Historically we made it fair for the poorest and most likely to be taken advantage of by preventing any people from selling their organs.  Return to the spirit of the law and stop trying to to a run around it and the problems will go away again.

[Morning Glory]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

Historically we made it fair for the poorest and most likely to be taken advantage of by preventing any people from selling their organs.  Return to the spirit of the law and stop trying to to a run around it and the problems will go away again.

This is a sticky one. It has been harder for working poor people who want to donate to family members because of lack of paid time off or short term disability or childcare, so this may be an attempt to even it out. I don't like it though...better to just offer universal short term disability.

A better way to save money on dialysis would be to prevent renal failure in the first place.  Provide BP meds and insulin at no cost to everyone who needs them. Mandate shade and hydration breaks for workers in hot environments. Control the use of nephrotoxic chemicals. Etc.

[Psychstache]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

One unorthodox solution could be to make it a nonrefundable credit of $25,000 for 2 years. This would mean that the credit is only valuable to those with a high tax burden, which generally does not include the most financially vulnerable in society. Though, this would limit the pool of people who are now incentivized to donate, which is counter to the goal of increasing supply.

[Tasse]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

Historically we made it fair for the poorest and most likely to be taken advantage of by preventing any people from selling their organs.  Return to the spirit of the law and stop trying to to a run around it and the problems will go away again.

Yeah, but more people will die waiting for kidneys.

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

One unorthodox solution could be to make it a nonrefundable credit of $25,000 for 2 years. This would mean that the credit is only valuable to those with a high tax burden, which generally does not include the most financially vulnerable in society. Though, this would limit the pool of people who are now incentivized to donate, which is counter to the goal of increasing supply.

And it's sort of weird to identify the problem of poor people being coerced to donate their organs and conclude that the solution is to only offer money to rich people. I see what you're going for, but the result is weirdly regressive. Poor person donating to save their spouse has to do it for free, but rich person doing the same gets a $50k bonus!

Actually, is the proposed credit for any kidney donation, or only for non-directed donations? I suppose most people who want the credit probably don't have a relative in renal failure so the idea is that most of the increase would be non-directed anyway...

[Tasse]

I've also heard proposals that try to disconnect the organ from the payment even further. For example, the donor gets free Medicare, or some other arrangement to pay for their healthcare for x years. It doesn't put dollars in their pocket, but it's still a genuine financial benefit.

[Log]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

This is addressed in the podcast. Plasma donation is painful, but no one who's sold their plasma when they came upon financial hard times wishes that they hadn't been allowed to. Some countries ban compensation for plasma donation, and instead of the demand for plasma being met by people donating altruistically, those countries have to import plasma from countries that do compensate donors. So by outlawing it, they're not preventing plasma from being bought and sold, they're simply outsourcing the "exploitation" to other countries, while preventing their own poorer citizens from making a tradeoff they might wish they were allowed to make.

It is akin to compensation for work: more privileged people won't take riskier work or work that's harder on the body, like roofing or picking strawberries. But we don't ban people from working on roofs or picking strawberries, because somebody's gotta do it! A lot of people need healthy kidneys. There could be plenty to go around, if people could be compensated for the time and hardship associated with donating.

Would I donate my kidney for $50,000 in 20 years when I'm in a much more financially comfortable position? Probably not. But would I make that tradeoff right now in the accumulation phase, as a $50k head start in life? Sure. Is it exploitation for an upwardly mobile middle class person with a healthy emergency fund and a maxed out Roth IRA to "sell" their kidney? No, it's just a tradeoff. Which ends up being net positive for society, as it gets someone off dialysis, vastly improving their health and quality of life while costing us less money. If someone who is more financially desperate than me decides to make that tradeoff, I'd say that's even more positive for society, because they benefit from the marginal dollar more than I do.

The other major difference between this and an open market for organs is that all kidneys donated through this system would be allocated in the order of regular donor allocation procedures, not sold off to the highest bidder. The donations might disproportionately come from the less well off, but they would be distributed in a non-market manner, based on health considerations and wait lists and whatever else goes into that process.

[ChpBstrd]

I made over $200,000 in gains in the bond and stock markets over the past 12 months, so it's hard to get too excited about risking my life in surgery, spending 6 mos recuperating from surgery, plus having potential long-range health risks, for $50k.

I wonder though, what my answer might have been 20 years ago, when my net worth was less than $100k. Back then, $50k could plausibly have freed up 5-10 more years of post-FIRE life.

There are many people around the world in situations where they or their loved ones might die for lack of money. I've always been fascinated by Western ethical systems that deny them a way they would willingly choose to escape starvation poverty because it might be exploitative. Off to the chocolate plantations / lithium mines with you! But I'm not going to exploit you by allowing trade.

[Tasse]

I made over $200,000 in gains in the bond and stock markets over the past 12 months, so it's hard to get too excited about risking my life in surgery, spending 6 mos recuperating from surgery, plus having potential long-range health risks, for $50k.

The recovery is only a few weeks and there are limited long-term health risks. Kidney donors don't appear to have shorter life expectancy than non-donors, for example.

It's true that any invasive surgery does come with risk. It's a small risk, but non-zero.

[Psychstache]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

One unorthodox solution could be to make it a nonrefundable credit of $25,000 for 2 years. This would mean that the credit is only valuable to those with a high tax burden, which generally does not include the most financially vulnerable in society. Though, this would limit the pool of people who are now incentivized to donate, which is counter to the goal of increasing supply.

And it's sort of weird to identify the problem of poor people being coerced to donate their organs and conclude that the solution is to only offer money to rich people. I see what you're going for, but the result is weirdly regressive. Poor person donating to save their spouse has to do it for free, but rich person doing the same gets a $50k bonus!

Actually, is the proposed credit for any kidney donation, or only for non-directed donations? I suppose most people who want the credit probably don't have a relative in renal failure so the idea is that most of the increase would be non-directed anyway...

Yeah, I would assume the donation is only for non-directed donations, to build a 'kidney pool' as it were.

In regards to only offering the incentive to rich people, that may not be the most unreasonable thing. I don't have any data one way or another, but I would venture a guess that rich people are more likely to receive an organ donation than poor people (as money is a bright dividing line in healthcare access and quality in the US), so perhaps it makes sense that they should also disproportionately make up the pool of donors.

[Morning Glory]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

One unorthodox solution could be to make it a nonrefundable credit of $25,000 for 2 years. This would mean that the credit is only valuable to those with a high tax burden, which generally does not include the most financially vulnerable in society. Though, this would limit the pool of people who are now incentivized to donate, which is counter to the goal of increasing supply.

And it's sort of weird to identify the problem of poor people being coerced to donate their organs and conclude that the solution is to only offer money to rich people. I see what you're going for, but the result is weirdly regressive. Poor person donating to save their spouse has to do it for free, but rich person doing the same gets a $50k bonus!

Actually, is the proposed credit for any kidney donation, or only for non-directed donations? I suppose most people who want the credit probably don't have a relative in renal failure so the idea is that most of the increase would be non-directed anyway...

Yeah, I would assume the donation is only for non-directed donations, to build a 'kidney pool' as it were.

In regards to only offering the incentive to rich people, that may not be the most unreasonable thing. I don't have any data one way or another, but I would venture a guess that rich people are more likely to receive an organ donation than poor people (as money is a bright dividing line in healthcare access and quality in the US), so perhaps it makes sense that they should also disproportionately make up the pool of donors.

It is true that rich people are more likely to receive an organ because they can afford to travel and stay close to transplant centers, or even be on multiple regional lists if they have a private jet on standby. They are also more likely to be able to take extended time off or work remotely, which makes it easier to accomplish a directed donation for both donor and recipient.

Directed donations still add to the kidney pool by taking the recipient off the list and moving the next person in line up a place.  Providing some subsidy to help poorer people with the logistics isn't a bad idea, I just don't know that a tax rebate is the best way to go about it.

[twinstudy]

I wouldn't do it for $5 mil. That said, I have no issues with there being a transparent and free market when it comes to people's organs.

[LennStar]

I've always been fascinated by Western ethical systems that deny them a way they would willingly choose to escape starvation poverty because it might be exploitative. Off to the chocolate plantations / lithium mines with you! But I'm not going to exploit you by allowing trade.

The reason is clear: They could just be paid a living wage. Or the plantations coudl hire the parents of the children working there and the children coudl go to school.

Kidney donors don't appear to have shorter life expectancy than non-donors, for example.

That is contrary to what I have read. You are more likely to require a dialyses, just for the easiest example, which generally is not a good indicator for a long life.
Granted, the difference is small in comparison to e.g. only using a car instead of a bike, but there is a difference.

[Morning Glory]

I've always been fascinated by Western ethical systems that deny them a way they would willingly choose to escape starvation poverty because it might be exploitative. Off to the chocolate plantations / lithium mines with you! But I'm not going to exploit you by allowing trade.

The reason is clear: They could just be paid a living wage. Or the plantations coudl hire the parents of the children working there and the children coudl go to school.

Kidney donors don't appear to have shorter life expectancy than non-donors, for example.

That is contrary to what I have read. You are more likely to require a dialyses, just for the easiest example, which generally is not a good indicator for a long life.
Granted, the difference is small in comparison to e.g. only using a car instead of a bike, but there is a difference.

It's hard to measure whether donors have a shorter or longer life than they would otherwise because people chosen to be donors are usually much healthier than the general population, so it's not a fair comparison.  There are also genetic diseases that affect kidney function,  so it can happen that you donate a kidney to an older relative with the knowledge that you will probably develop kidney failure in 20 years either way.

[BlueMR2]

No to the original question.  There's a non-zero chance I may need that one and the surgery is not completely risk free.  I don't need the money that bad...

I'm not an organ donor upon death as the ethics of it all are pretty disturbing.  There doesn't seem to be any way to do it without moral complications in our current system.  Getting paid to donate body parts (whether dead or alive) is a slippery slope (not good to give someone a reason to want you dead for example) even though it makes sense in the context of the "my body, my decision" argument.  Under our current system of NOT getting paid for the body parts only to have surgeons and hospitals rake in big $$$ doing the transplant is pure exploitation on their part, which I simply cannot support.

[MustacheAndaHalf]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

This is addressed in the podcast. Plasma donation is painful, but no one who's sold their plasma when they came upon financial hard times wishes that they hadn't been allowed to. Some countries ban compensation for plasma donation, and instead of the demand for plasma being met by people donating altruistically, those countries have to import plasma from countries that do compensate donors. So by outlawing it, they're not preventing plasma from being bought and sold, they're simply outsourcing the "exploitation" to other countries, while preventing their own poorer citizens from making a tradeoff they might wish they were allowed to make.

It is akin to compensation for work: more privileged people won't take riskier work or work that's harder on the body, like roofing or picking strawberries. But we don't ban people from working on roofs or picking strawberries, because somebody's gotta do it! A lot of people need healthy kidneys. There could be plenty to go around, if people could be compensated for the time and hardship associated with donating.

Would I donate my kidney for $50,000 in 20 years when I'm in a much more financially comfortable position? Probably not. But would I make that tradeoff right now in the accumulation phase, as a $50k head start in life? Sure. Is it exploitation for an upwardly mobile middle class person with a healthy emergency fund and a maxed out Roth IRA to "sell" their kidney? No, it's just a tradeoff. Which ends up being net positive for society, as it gets someone off dialysis, vastly improving their health and quality of life while costing us less money. If someone who is more financially desperate than me decides to make that tradeoff, I'd say that's even more positive for society, because they benefit from the marginal dollar more than I do.

The other major difference between this and an open market for organs is that all kidneys donated through this system would be allocated in the order of regular donor allocation procedures, not sold off to the highest bidder. The donations might disproportionately come from the less well off, but they would be distributed in a non-market manner, based on health considerations and wait lists and whatever else goes into that process.

I suspect many posters didn't watch the 50 minute podcast, but appreciate you sharing what you learned from it.

Checking online, frozen plasma can be stored for a year, which is enough time to fly anywhere in the world.  Kidneys degrade after 24-36 hours outside the body, which limits how far they can be transported.  The U.S. can ship plasma to Europe, while a kidney might not arrive in time (especially with connecting flights).  Plasma can be traded between any two countries, but kidneys are high risk the farther away they travel.

I would claim that picking fruit and vegetables is semi-legal.  Half the workers are undocumented/illegal, but a crackdown would destroy the industry (Georgia tried this a decade or so ago, and lost a year's crop.  Even prisoners wouldn't do it for time off their sentences).  That status allows them to be underpaid despite their hard labor (unlike people who pick up garbage bins daily, or who work on oil rigs).  If the payment for kidneys is supposed to be similar to strawberry pickers, I would expect a semi-legal market that doesn't compensate people appropriately.

[MustacheAndaHalf]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

One unorthodox solution could be to make it a nonrefundable credit of $25,000 for 2 years. This would mean that the credit is only valuable to those with a high tax burden, which generally does not include the most financially vulnerable in society. Though, this would limit the pool of people who are now incentivized to donate, which is counter to the goal of increasing supply.

And it's sort of weird to identify the problem of poor people being coerced to donate their organs and conclude that the solution is to only offer money to rich people. I see what you're going for, but the result is weirdly regressive. Poor person donating to save their spouse has to do it for free, but rich person doing the same gets a $50k bonus!

Actually, is the proposed credit for any kidney donation, or only for non-directed donations? I suppose most people who want the credit probably don't have a relative in renal failure so the idea is that most of the increase would be non-directed anyway...

Yeah, I would assume the donation is only for non-directed donations, to build a 'kidney pool' as it were.

In regards to only offering the incentive to rich people, that may not be the most unreasonable thing. I don't have any data one way or another, but I would venture a guess that rich people are more likely to receive an organ donation than poor people (as money is a bright dividing line in healthcare access and quality in the US), so perhaps it makes sense that they should also disproportionately make up the pool of donors.

Kidneys don't last long enough to be put into a pool - they need to be matched with a donor immediately, and that donor has to be available for surgery within hours.  People rich enough to own a private jet can fly anywhere on short notice, which allows them to sign up in various (every) state.

One definition of rich is the top 1%, which starts with a net worth of $13.7 million.  Will someone with that level of wealth care about a $50k tax credit?  Dropping down to the top 10%, the threshold is around $2 million.  I guess I'm not seeing why people that rich would trade their kidney for $50k in tax credits.  And more generally, I'm not sure what the government could reasonable offer in exchange for kidneys, when someone has significant assets.

I guess the approach has to be more appealing to poor people, since it is a fixed benefit.  To make that fairer, maybe the tax credit could be non-refundable but also not expire.  Very poor people who pay almost no tax wouldn't find the benefit useful, while those making slightly more might use up the credit in a matter of several years.

[iris lily]

 No, I would not give up a kidney for $50,000. 50,000 is a paltry sum in actuality. But I am at an advanced age, so they probably wouldn’t want my kidney anyway.

I have polycystic kidney disease in my family, so I’m going to preserve any kidney function I have

The sister of a friend gave away a kidney in a non directed way. The kidney failed. I don’t know how often that happens

[iris lily]

The contributions I've made to my donor advised fund exceeded $50,000.  Since I'm already giving away more than $50,000 I wouldn't be interested by an offer of $50,000 for a kidney.

I suspect people are drawn to FIRE because they have incomes and net worth that are in the upper quartile.  For people with higher net worth, it is easier to turn down $50,000.

Compare that to people who have a credit card balance but no assets, and they will be far more likely to give up a kidney for $50,000.  I'm not sure how to make that fair - to avoid disproportionally interesting people who are financially worse off.

This is addressed in the podcast. Plasma donation is painful, but no one who's sold their plasma when they came upon financial hard times wishes that they hadn't been allowed to. Some countries ban compensation for plasma donation, and instead of the demand for plasma being met by people donating altruistically, those countries have to import plasma from countries that do compensate donors. So by outlawing it, they're not preventing plasma from being bought and sold, they're simply outsourcing the "exploitation" to other countries, while preventing their own poorer citizens from making a tradeoff they might wish they were allowed to make.

It is akin to compensation for work: more privileged people won't take riskier work or work that's harder on the body, like roofing or picking strawberries. But we don't ban people from working on roofs or picking strawberries, because somebody's gotta do it! A lot of people need healthy kidneys. There could be plenty to go around, if people could be compensated for the time and hardship associated with donating.

Would I donate my kidney for $50,000 in 20 years when I'm in a much more financially comfortable position? Probably not. But would I make that tradeoff right now in the accumulation phase, as a $50k head start in life? Sure. Is it exploitation for an upwardly mobile middle class person with a healthy emergency fund and a maxed out Roth IRA to "sell" their kidney? No, it's just a tradeoff. Which ends up being net positive for society, as it gets someone off dialysis, vastly improving their health and quality of life while costing us less money. If someone who is more financially desperate than me decides to make that tradeoff, I'd say that's even more positive for society, because they benefit from the marginal dollar more than I do.

The other major difference between this and an open market for organs is that all kidneys donated through this system would be allocated in the order of regular donor allocation procedures, not sold off to the highest bidder. The donations might disproportionately come from the less well off, but they would be distributed in a non-market manner, based on health considerations and wait lists and whatever else goes into that process.

I don’t know that plasma donation is painful. I did it when I was in graduate school regularly and it was no big deal. I suppose if one really hates the idea of needles then it’s not a good option.

[Morning Glory]

No, I would not give up a kidney for $50,000. 50,000 is a paltry in actuality. But I am at an advanced age, so they probably wouldn’t want my kidney anyway.

I have polycystic kidney disease in my family, so I’m going to preserve any kidney function. I have

The sister of a friend gave away a kidney in a nondirect way. The kidney failed. I don’t know how often that happens

PKD is autosomal dominant so if one of your parents has it, you have a 50% chance of inheriting it, and you would start developing symptoms in your 30s. You are unlikely to develop it without an affected parent, and if your parent or sibling has it youve probably been tested.  I agree that it doesn't make sense to donate to a non relative if there is a high chance that one of your close relatives will need one, as there is less chance of rejection with a closely matched donor.  Age cutoffs vary by institution but I know of at least one parent in their 60s who was able to donate to their adult child.

[Tasse]

Kidney donors don't appear to have shorter life expectancy than non-donors, for example.

That is contrary to what I have read. You are more likely to require a dialyses, just for the easiest example, which generally is not a good indicator for a long life.
Granted, the difference is small in comparison to e.g. only using a car instead of a bike, but there is a difference.

I'm certainly not an expert, but I did attempt to do a bit of research before claiming this. For example, this study of over 80,000 donors noted short-term surgical risks but that "long-term risk of death was no higher for live donors than for age- and comorbidity-matched NHANES III participants": https://jamanetwork.com/journals/jama/fullarticle/185508

There's a smaller 1997 study I've seen a lot of people cite showing that kidney donors actually live longer than the average population, but that's most likely because only healthy people are accepted as kidney donors, so it doesn't really tell you if the kidney donation affected their longevity (as @Morning Glory alluded to above). The "age and cobmorbidity" matching of the study above is important for avoiding that.

This paper does show an increase in the risk of end-stage renal disease after kidney donation (although it's worth noting that it compares observed risk among donors to projected risks among non-donors): https://www.nejm.org/doi/full/10.1056/NEJMoa1510491 The discussion talks about using their predictive tool to screen people at risk for renal disease from the donor pool. For example, "Our estimates suggest that healthy older adults may be appropriate donor candidates with respect to their risk of ESRD. It is relatively unlikely that ESRD would develop in a healthy older adult, who has lived to an older age without the development of high-risk health conditions."

[Omy]

They can have the one that always gets kidney stones, ha!

Agreed. I would pay somebody to take that one.

[BECABECA]

I’m already FIRE’d but personally would be much more likely to donate a kidney if there was this $50k credit in place because it would make me much less concerned about kidney availability down the road on the off chance that my single remaining kidney failed. I’d be 100% willing to donate a kidney today if there was also an assurance in place that someone who donated a kidney would have the option to jump to the front of the kidney transplant line if they ended up needing a kidney down the road.

[GuitarStv]

I’m already FIRE’d but personally would be much more likely to donate a kidney if there was this $50k credit in place because it would make me much less concerned about kidney availability down the road on the off chance that my single remaining kidney failed. I’d be 100% willing to donate a kidney today if there was also an assurance in place that someone who donated a kidney would have the option to jump to the front of the kidney transplant line if they ended up needing a kidney down the road.

Not sure I get this reasoning.  You have to perfectly functioning kidneys and want to give one up in case the one you don't give up has a problem?  But . . . nature already provided you with a backup, one that you don't need to get in line for!

[iris lily]

No, I would not give up a kidney for $50,000. 50,000 is a paltry in actuality. But I am at an advanced age, so they probably wouldn’t want my kidney anyway.

I have polycystic kidney disease in my family, so I’m going to preserve any kidney function. I have

The sister of a friend gave away a kidney in a nondirect way. The kidney failed. I don’t know how often that happens

PKD is autosomal dominant so if one of your parents has it, you have a 50% chance of inheriting it, and you would start developing symptoms in your 30s. You are unlikely to develop it without an affected parent, and if your parent or sibling has it youve probably been tested.  I agree that it doesn't make sense to donate to a non relative if there is a high chance that one of your close relatives will need one, as there is less chance of rejection with a closely matched donor.  Age cutoffs vary by institution but I know of at least one parent in their 60s who was able to donate to their adult child.

My father had it. I have not been tested. I’m 70 years old.

[jeninco]

No, I would not give up a kidney for $50,000. 50,000 is a paltry in actuality. But I am at an advanced age, so they probably wouldn’t want my kidney anyway.

I have polycystic kidney disease in my family, so I’m going to preserve any kidney function. I have

The sister of a friend gave away a kidney in a nondirect way. The kidney failed. I don’t know how often that happens

PKD is autosomal dominant so if one of your parents has it, you have a 50% chance of inheriting it, and you would start developing symptoms in your 30s. You are unlikely to develop it without an affected parent, and if your parent or sibling has it youve probably been tested.  I agree that it doesn't make sense to donate to a non relative if there is a high chance that one of your close relatives will need one, as there is less chance of rejection with a closely matched donor.  Age cutoffs vary by institution but I know of at least one parent in their 60s who was able to donate to their adult child.

I have a friend with pkd, and I’m sort of holding a kidney for him. (We are at least the same blood type) probably wouldn’t donate to a random person for $$, though…

[Wolfpack Mustachian]

No to the original question.  There's a non-zero chance I may need that one and the surgery is not completely risk free.  I don't need the money that bad...

I'm not an organ donor upon death as the ethics of it all are pretty disturbing.  There doesn't seem to be any way to do it without moral complications in our current system.  Getting paid to donate body parts (whether dead or alive) is a slippery slope (not good to give someone a reason to want you dead for example) even though it makes sense in the context of the "my body, my decision" argument.  Under our current system of NOT getting paid for the body parts only to have surgeons and hospitals rake in big $$$ doing the transplant is pure exploitation on their part, which I simply cannot support.

What after death organ donation ethics concerns you?

[BECABECA]

I’m already FIRE’d but personally would be much more likely to donate a kidney if there was this $50k credit in place because it would make me much less concerned about kidney availability down the road on the off chance that my single remaining kidney failed. I’d be 100% willing to donate a kidney today if there was also an assurance in place that someone who donated a kidney would have the option to jump to the front of the kidney transplant line if they ended up needing a kidney down the road.

Not sure I get this reasoning.  You have to perfectly functioning kidneys and want to give one up in case the one you don't give up has a problem?  But . . . nature already provided you with a backup, one that you don't need to get in line for!

?? The reasoning is that someone needs this second kidney right now, and I don’t. So I could lend it to someone that needs it right now so that they could use it while they needed it, but if I ever ended up needing that extra kidney again, I could get one back. I guess you’re confused because you’re only looking at what’s best for me personally, instead of optimizing for putting all kidneys to maximum use when they’re needed.

[Tasse]

I’m already FIRE’d but personally would be much more likely to donate a kidney if there was this $50k credit in place because it would make me much less concerned about kidney availability down the road on the off chance that my single remaining kidney failed. I’d be 100% willing to donate a kidney today if there was also an assurance in place that someone who donated a kidney would have the option to jump to the front of the kidney transplant line if they ended up needing a kidney down the road.

This exists. If you donate a kidney, you and your family members get priority if you need a kidney in the future. (Although I think you can only use the priority for a single family member, so hope you don't have two that need one.)

[cpa cat]

One unorthodox solution could be to make it a nonrefundable credit of $25,000 for 2 years. This would mean that the credit is only valuable to those with a high tax burden, which generally does not include the most financially vulnerable in society. Though, this would limit the pool of people who are now incentivized to donate, which is counter to the goal of increasing supply.

The problem with a non refundable credit is twofold:
1. The average person does not have a solid understanding of the difference between a refundable and non refundable credit, so a non refundable credit could mislead people into agreeing to kidney donation, thinking they’d be getting $50,000, when in reality they get less than that.

2. We would be compensating rich people for altruistic kidney donation: people in this income bracket would only be giving their kidneys out of the kindness of their hearts, because the $50k is not a significant reward for someone that would use the credit; whereas poorer people who donate kidneys altruistically get nothing (or very little) from a non refundable credit.

As for me, I would not donate my kidney for $50,000. There’s a lot of things I won’t do for an extra $10,000 a year, and potentially compromising my health is one of them. But I don’t have a problem with people being rewarded in this way. I think there are some ethical issues with allowing people to auction their kidneys to the highest bidder, but the idea of compensating them for doing society a favor doesn’t bother me at all.

[ATtiny85]

I made over $200,000 in gains in the bond and stock markets over the past 12 months, so it's hard to get too excited about risking my life in surgery, spending 6 mos recuperating from surgery, plus having potential long-range health risks, for $50k.

The recovery is only a few weeks and there are limited long-term health risks. Kidney donors don't appear to have shorter life expectancy than non-donors, for example.

It's true that any invasive surgery does come with risk. It's a small risk, but non-zero.

I donated one (obviously one…) about eight years ago. General recovery (back to desk work) took about a week, back to running in a month. So far so good with my health, though I will say I remain pretty nervous while waiting for my annual bloodwork to come back. Was mid-40s when I did it.

I had several hours of interstate driving to the hospital. Four trips total in the process. Likely way more risk in that travel than in the OR.

[Tasse]

Thanks for sharing, and for donating!

Just to clarify, I'm not trying to convince anyone in this thread to donate a kidney. I doubt it's even possible to change someone's mind over something that significant via internet forum; if you don't want to do it, you're not going to do it. I just want the risks and drawbacks to be discussed accurately.

[MustacheAndaHalf]

One unorthodox solution could be to make it a nonrefundable credit of $25,000 for 2 years. This would mean that the credit is only valuable to those with a high tax burden, which generally does not include the most financially vulnerable in society. Though, this would limit the pool of people who are now incentivized to donate, which is counter to the goal of increasing supply.

The problem with a non refundable credit is twofold:
1. The average person does not have a solid understanding of the difference between a refundable and non refundable credit, so a non refundable credit could mislead people into agreeing to kidney donation, thinking they’d be getting $50,000, when in reality they get less than that.

That can be explained to someone who volunteers to donate, before their surgery.

Tax credits prevent fraud and extortion in the market.  If someone donates a kidney and receives $50,000 cash in the future, they could be coerced to donate and coerced to give up their money.  By turning the benefit into an IRS tax credit, the person can't actually cash out their benefit.  They simply have to wait for the $50,000 to be applied against future taxes.  That's an important measure for preventing criminal behavior involving donations.

2. We would be compensating rich people for altruistic kidney donation: people in this income bracket would only be giving their kidneys out of the kindness of their hearts, because the $50k is not a significant reward for someone that would use the credit; whereas poorer people who donate kidneys altruistically get nothing (or very little) from a non refundable credit.

Why is compensating altruism a problem?

You mention only two categories, "rich" and "poorer", which paints with too broad a brush.  People who pay nothing in taxes will get no benefit.  But many people who aren't rich pay taxes, and they will see a benefit to a tax credit.  The very poorest won't, but the middle class will.

[Dicey]

She's not active these days, but @HappyCheerE is the generous kidney donor.

[BlueMR2]

No to the original question.  There's a non-zero chance I may need that one and the surgery is not completely risk free.  I don't need the money that bad...

I'm not an organ donor upon death as the ethics of it all are pretty disturbing.  There doesn't seem to be any way to do it without moral complications in our current system.  Getting paid to donate body parts (whether dead or alive) is a slippery slope (not good to give someone a reason to want you dead for example) even though it makes sense in the context of the "my body, my decision" argument.  Under our current system of NOT getting paid for the body parts only to have surgeons and hospitals rake in big $$$ doing the transplant is pure exploitation on their part, which I simply cannot support.

What after death organ donation ethics concerns you?

Hospitals and Surgeons making bank on it while the family is left with nothing...