How to stop losing 17,500 kidneys
Failures and inefficiencies in the U.S. organ transplant system, particularly around kidney allocation and logistics, are drawing scrutiny as reports suggest a substantial share of donated kidneys are never transplanted. Commenters debate whether fixes should come from better regulation and technology (e.g., tracking, new perfusion methods, systemic reform of UNOS/OPTN) or from introducing market mechanisms such as compensation for donors or their estates. Ethical concerns loom large, especially around exploiting poor people, creating “organ markets,” and how to fairly balance incentives, access, and preventative healthcare.
System design and UNOS / OPTN performance
- Some see current U.S. organ allocation as a “regulated monopoly” rather than real central planning or a real market, and argue that such structures predictably fail users.
- Others cite transplant clinicians claiming the critique is overstated: many recovered kidneys are discarded because they are clinically unsuitable; organs are often GPS‑tracked; waiting lists are regularly updated; and prior living donors already get priority.
- These counterclaims are themselves disputed: GPS tracking is not universal; the reported 17% of offers going to deceased patients is backed by published data; and there is concern about lack of code audits and outdated crypto.
- Commenters note 17 days of OPTN downtime since 1999 and debate whether old crypto “algorithms” are inherently insecure.
Market vs central planning for organs
- Strong disagreement over introducing explicit markets:
- Pro‑market voices argue kidneys are a textbook fit for market design; everyone has two; failure is rare; and structured markets (often with the state as monopsony buyer) could be “win‑win” and reduce deaths.
- Opponents cite Afghanistan‑style sales as examples of exploitation: desperate poor people selling kidneys for little money and facing lifelong health risks.
- Some emphasize that economists have designed non‑cash “markets” (e.g., paired kidney exchange) that increase matches without direct payment.
Paying donors and ethical concerns
- Several people resist donating because all intermediaries are paid while donors/estates get nothing; they’d donate if families were compensated or if organs were tradable assets.
- Others argue non‑donors should be ineligible or deprioritized for receiving organs.
- Fears raised:
- Incentivizing suicide or murder for organ money.
- Systemic transfer of longevity from poor (sellers) to rich (buyers).
- Growth of black markets and trafficking, analogous to prostitution or pandemic plasma markets.
- Counterarguments:
- Living kidney donation risk is comparable to other dangerous but permitted jobs.
- Banning compensation doesn’t remove poverty; it just removes an option.
- Compensation could be in kind (lifetime healthcare, tax breaks, program priority), not simple cash.
Donation behavior and incentives
- Debate over opt‑out vs opt‑in: opt‑out alone may not increase donations much because hospitals still seek family consent, and refusals are common when wishes aren’t explicit.
- Some propose tax deductions or other benefits for long‑registered donors, or priority access if they ever need a transplant.
Medical practice, risk, and technology
- Clinicians’ selection behavior is criticized: some transplant teams may avoid higher‑risk organs or patients to protect their success statistics, potentially wasting usable kidneys.
- Commenters note that not all removed organs are clinically viable; rejecting marginal kidneys can be medically defensible.
- One transplant recipient urges reconsideration of “no donation” stances; others with chronic conditions stress prevention and maintaining original organs over reliance on transplants.
- New technologies like organ perfusion and xenotransplantation (e.g., pig kidneys) are highlighted as promising ways to expand usable supply, though regulatory and institutional red tape may slow adoption.