title: In defense of a regulated system of compensation for living donation.
abstract: OBJECTIVE
  The organ shortage is the major problem in kidney transplantation today. Despite aggressive organ procurement efforts, the supply of donated kidneys, living and deceased, has not matched the growing demand; as a consequence, more and more qualified candidates are suffering on dialysis and then dying before being transplanted. Herein, we provide justification for a regulated system of compensation for donation.
  
  
  RESULTS
  The main argument in favor of compensation is simple-financial incentives will increase donation, so fewer transplant candidates will suffer and die while waiting. In addition, development of a regulated system of compensation is the most effective means of crippling the core economic support for transplant tourism. Because dialysis is so much more expensive than a transplant, compensated donation could be cost-neutral to the healthcare system. Importantly, opinion polls suggest that the public would support compensation. As uncompensated kidney donation is widely accepted, persuasive arguments against compensation must explain why such a system would be morally distinguishable from uncompensated donation.
  
  
  CONCLUSIONS
  We suggest that the potential advantages of a regulated system of compensation for donation far outweigh any potential disadvantages. It is time to advocate for a change in the law so that trials can be done.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, Minnesota 55455, USA. matas001@umn.edu
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Matas
authors.forename: Benjamin
authors.initials: B
authors.lastname: Hippen
authors.forename: Sally
authors.initials: S
authors.lastname: Satel
mesh_terms: D000533:Altruism; D003362:Cost-Benefit Analysis; D003415:Crime / Q000517:prevention & control; D005381:Financing, Organized / Q000331:legislation & jurisprudence* / Q000458:organization & administration; D037921:Gift Giving; D033161:Government Regulation; D017048:Health Care Costs; D006291:Health Policy / Q000191:economics*; D006297:Health Services Accessibility / Q000191:economics / Q000331:legislation & jurisprudence; D006301:Health Services Needs and Demand / Q000191:economics / Q000331:legislation & jurisprudence; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics* / Q000331:legislation & jurisprudence; D019520:Living Donors / Q000331:legislation & jurisprudence* / Q000600:supply & distribution; D009042:Motivation; D009937:Organizational Objectives; D011639:Public Opinion; D006435:Renal Dialysis / Q000191:economics; D009927:Tissue and Organ Procurement / Q000191:economics* / Q000331:legislation & jurisprudence / Q000458:organization & administration; D014481:United States; D014850:Waiting Lists