Regulated payments for living kidney donation: an empirical assessment of the ethical concerns.
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.


METHODS
Cross-sectional study of participants' willingness to donate a kidney in 12 scenarios.


METHODS
Regional rail and urban trolley lines in Philadelphia County, Philadelphia, Pennsylvania.


METHODS
Of 550 potential participants, 409 completed the questionnaire (response rate, 74.4%); 342 of these participants were medically eligible to donate.


METHODS
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.


METHODS
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 < 0.001 for each). No statistical interactions were identified between payment and risk (odds ratio, 1.00 [95% CI, 0.96 to 1.03]) or between payment and income (odds ratio, 1.01 [CI, 0.99 to 1.03]). The proximity of these estimates to 1.0 and narrowness of the CIs suggest that payment is neither an undue nor an unjust inducement, respectively. Alerting participants to the possibility of payment did not alter their willingness to donate for altruistic reasons (P = 0.40).


CONCLUSIONS
Choices revealed in hypothetical scenarios may not reflect real-world behaviors.


CONCLUSIONS
Theoretical concerns about paying persons for living kidney donation are not corroborated by empirical evidence. A real-world test of regulated payments for kidney donation is needed to definitively show whether payment provides a viable and ethical method to increase the supply of kidneys available for transplantation.


BACKGROUND
None.
University of Pennsylvania School of Medicine and Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania 19104-6021, USA. scott.halpern@uphs.upenn.edu
Scott D
SD
Halpern
Amelie
A
Raz
Rachel
R
Kohn
Michael
M
Rey
David A
DA
Asch
Peter
P
Reese
D000328:Adult; D003362:Cost-Benefit Analysis; D003430:Cross-Sectional Studies; D005190:Family; D005260:Female; D006801:Humans; D007182:Income; D016030:Kidney Transplantation / Q000191:economics* / Q000941:ethics*; D019520:Living Donors / Q000941:ethics* / Q000523:psychology / Q000600:supply & distribution; D008297:Male; D009042:Motivation; D015143:Philadelphia; D010865:Pilot Projects; D012307:Risk Factors; D014850:Waiting Lists; D055815:Young Adult