Here\’s a nice question to kick around the classroom or the lunch-table: \”If we pay football players, why not kidney donors?\” Philip J. Cook and Kimberly D. Krawiec argue that both should be paid in Regulation magazine (Spring 2018, pp. 12-17).

In the context of football, players receive compensation for actions that benefit others–specifically, those who enjoy watching for entertainment–but also impose risks of both short-term and long-term negative health outcomes. In the context of kidney donations, potential living donors are forbidden from receiving compensation for actions that can be literally life-saving for others–specifically, donating a kidney–on the grounds that it may increase a risk of poor health outcomes. The authors write: 

\”Although living kidney donation is a common medical procedure and donors usually enjoy a full recovery, the loss of a kidney poses long-term health risks, in particular that of renal failure if the donor’s remaining kidney fails. In the United States and most every other country (with the notable exception of Iran), kidney donation is permitted but financial compensation for donors is prohibited. Not only is there no legal market for kidneys, donors in the United States are often not even reimbursed for their full out-of-pocket cost in making the donation. 

\”The ban on compensation may protect potential donors from the temptation of easing their financial situation by giving up a kidney, a choice they may regret in later years. But this regulation has dire consequences. 

\”The need for transplantable kidneys is great, far exceeding current availability from deceased and living donations. The official waiting list of Americans with renal failure is now approximately 100,000, with a typical wait time of five years or more. Those on the waiting list are kept alive by dialysis, which is both costly to taxpayers (because Medicare pays for a large percentage of the costs) and debilitating to the patients. Even with dialysis, thousands of renal-failure patients die each year for want of a suitable kidney. This wait could be largely eliminated by easing the current ban on compensation for donors. An adequate supply of living donors would be especially valuable because living donors tend to provide higher quality kidneys with greater opportunity for developing a close tissue match, thus reducing the chance of rejection … 

\”While the recent evidence on the long-term medical damage from concussion has caused widespread concern, there is no prominent voice calling for a ban on professional football. Indeed, a ban is unthinkable in the foreseeable future. That observation helps illustrate the importance of history, custom, and established  interests in shaping the debate over regulating risky activity. But if we could start fresh, the current configuration of activities for which compensation is banned would seem very odd. 

\”If ethical concerns persuade thoughtful people that the “right” answer is to ban compensation for kidney donation, then the same logic would suggest that compensation should also be banned for participation in violent sports. If the “right” answer is to permit compensation for participation in violent sports, then compensation for kidney donation should also be permitted. We see no logical basis for the current combination of banning compensation for kidney donors while allowing compensation for football players and boxers.\”

Like a lot of useful analogies, the value of this question isn\’t to parse details about whether football and kidney donations are literally identical, but to use the question to explore attitudes about bodily risk, benefits, and monetary payments.  Cook and Krawiec also point out that annual revenues for the National Football League are about $13 billion, while one cost-benefit study of paying for kidney donation suggests that such a policy could save taxpayers about $12 billion per year in expenses for people with kidney disease awaiting a donation, in addition to saving thousands of lives and improving the quality of life for tens of thousands of those with severe kidney disease.

For some previous posts on paying kidney donors and on programs to facilitate kidney exchanges, see: 

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