Can a tax credit increase the number of kidney donors?

Nov. 13, Michael Davis, economics professor at the Cox School of Business, SMU Dallas, for an op-ed advocating that more people donate kidneys to save needy dialysis patients, and explaining the personal and national positive ramifications of doing so. Published in the Dallas Morning News under the heading Can a tax credit increase the number of kidney donors? https://tinyurl.com/3s44jd9f 

I just read a fascinating essay written by a guy who donated his left kidney to a total stranger.

Really.

He had himself examined by a team of super-competent kidney specialists who confirmed that he had two good kidneys and was otherwise in great shape for a surgery. Once he got that news he said, “OK, slice me open, take whichever one you like and give it to whomever needs it.”

Over half a million people are under dialysis in the United States. We need more good Samaritans.

By Michael L. Davis

I just read a fascinating essay written by a guy who donated his left kidney to a total stranger.

Really.

He had himself examined by a team of super-competent kidney specialists who confirmed that he had two good kidneys and was otherwise in great shape for a surgery. Once he got that news he said, “OK, slice me open, take whichever one you like and give it to whomever needs it.”

Would you do that? Probably not. Last year there were only about 300 or so of these so-called good Samaritan donations.

That’s not enough. In the U.S. over 550,000 people are on kidney dialysis but less than 100,000 have even managed to get on a waiting list for a transplant, according to the National Kidney Foundation. That’s not because those who didn’t make the cut wouldn’t benefit from a transplant — about half of them will die within five years — there was just no point in trying. There are only enough donors for about 25,000 transplants every year.

Maybe someday scientists will perfect an implantable artificial kidney. Right now, what’s called “end” stage renal disease, or ESRD, ends in only one of two ways, death or transplant. Transplants are better. Those lucky few who get a kidney transplant have an 80% survival rate after five years, as reflected in a recent study in The New England Journal of Medicine, and a dramatically better quality of life as compared to those with ESRD who are tied to dialysis.

There are only three ways to increase the supply of kidneys: collect more kidneys from people who die, collect more live donations from friends or relatives of the recipient, or collect more from the good Samaritans. The first two sources are close to maxed out, but is there any chance of more good Samaritan donations?

You might not think so, but remember the weird and wonderful thing about kidneys: you have two but you can live a full and happy life with just one. There are probably at least 100 million Americans who could donate a kidney to a stranger. The surgery itself hurts and it takes a bit of time to recover, but for someone in good health there’s very little risk of surgical complications. Going through life with one kidney might seem like a bad idea, but in fact about 99% of people without the redundant backup never have issues — and if they do and they’re good Samaritan donors, they go to the front of the transplant line.

I’m pretty sure there are a lot more really good and generous people out there than TikTok and the nightly news might lead you to expect. Maybe if some of these people knew how easy it is to help someone who is desperately ill, they’d step up.

There’s also one more very big thing we could do to help: amend the National Organ Transplant Act so as to make it possible to give donors a significant tax credit. One organization “The Coalition to Modify NOTA,” wants to do exactly that. Big time. They’re pushing to give donors a $100,000 tax credit that would be paid out over 10 years. If you donated a kidney, you’d get a $10,000 check every year for the next 10 years.

That might seem like crazy talk until you dig into the proposal and realize two things.

First, the coalition is not made up of a bunch of crazy talkers. Just the opposite, the advocates are among the most respected physicians, ethicists, scientists and Nobel laureates you could find. Pretty much everyone who is anyone has signed on to the idea.

Second, a significant increase in the number of kidney transplants not only saves lives, it saves money. Right now the federal government spends about $50 billion per year on chronic kidney care. That’s about 3% of all health care spending and 1% of “mandatory spending.” A National Institutes of Health study reports that a successful kidney transplant would save taxpayers about $400,000 over the recipient’s lifetime.

We all know that life is often hard. Bad things happen to good people, and sometimes there’s just nothing to be done. No one makes it out alive. But kidney disease is a bad thing that has some potentially great solutions. Not perfect solutions, of course; there will still be suffering and death. But there’s a good chance that through a combination of education and bold government policy we can make this corner of human suffering much smaller. Why not try?

If this sounds like something you’d like to do, contact the National Kidney Registry.

Michael L. Davis is an economics professor at the Cox School of Business, SMU Dallas. He wrote this column for The Dallas Morning News.

​