Regulated Payments for Living Kidney Donation: An Empirical Assessment of the Ethical Concerns
Halpern, Scott D.
Asch, David A.
Annals of Internal Medicine 2010 March 16; 152(6): 358-365
BACKGROUND: Although regulated payments to encourage living kidney donation could reduce morbidity and mortality among patients waiting for a kidney transplant, doing so raises several ethical concerns. OBJECTIVE: To determine the extent to which the 3 main concerns with paying kidney donors might manifest if a regulated market were created. DESIGN: Cross-sectional study of participants' willingness to donate a kidney in 12 scenarios. SETTING: Regional rail and urban trolley lines in Philadelphia County, Philadelphia, Pennsylvania. PARTICIPANTS: Of 550 potential participants, 409 completed the questionnaire (response rate, 74.4%); 342 of these participants were medically eligible to donate. INTERVENTION: Across scenarios, researchers experimentally manipulated the amount of money that participants would receive, the participants' risk for subsequently developing kidney failure themselves, and who would receive the donated kidney. MEASUREMENTS: The researchers determined whether payment represents an undue inducement by evaluating participants' sensitivity to risk in relation to the payment offered or an unjust inducement by evaluating participants' sensitivity to payment as a function of their annual income. The researchers also evaluated whether introducing payment would hinder altruistic donations by comparing participants' willingness to donate altruistically before versus after the introduction of payments. RESULTS: Generalized estimating equation models revealed that participants' willingness to donate increased significantly as their risk for kidney failure decreased, as the payment offered increased, and when the kidney recipient was a family member rather than a patient on a public waiting list (P
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