Virginia Postrel, herself a kidney donor, explained in another piece for this magazine. Let's look at the context she provided:
In the United States, more than 80,000 people are on the official waiting list,
all hoping that someone will die in just the right circumstances and
bequeath them the "gift of life." Last year, only 16,517 got
transplants: 10,550 with the cadaver organs allocated through the list,
and 5,967 from living donors. More than 4,000 on the list, or about 11 a
day, died. And the list gets longer every year.
...With 300 million people in the United States, the numbers shouldn't be so daunting. Eighty thousand people wouldn't even fill the Rose Bowl.
Surely we could find enough kidney donors to end the list. But solving
that problem demands creativity, daring, and, above all, a sense of urgency--a
radical break with the fatalism fostered by dialysis culture. Kidney
patients ought to command the kind of outrage that demanded a cure for
AIDS. The list doesn't have to exist. It is a result not of medical
necessity or economic constraints but of public ignorance, conscious
policy, and complacent institutions. Too many people are suffering
Her whole piece is worth your time. For our purposes, however, let's skip right to the solutions she proposes:
1) "...one way to end the list would be to find more altruists. With, say,
50,000 new living donors, deceased donation could easily pick up the
slack. Again, the numbers aren't that big. The Southern Baptist Convention includes 42,000 member churches; the United Methodist Church, whose Web site
earlier this year featured the quote, "As United Methodists, we're life
savers," counts more than 34,000 U.S. congregations. If each
congregation produced just one new living donor, the waiting list would
disappear. But kidney donation is a more visceral mission than
mainstream religious groups want to contemplate. The only sect to adopt
kidney donation as a formal cause is a tiny Australia-based group called
Jesus Christians; instead of lauding them, critics point to their
donations as evidence that they're a cult."
2) Donor chains.
3) Cash incentives:
Altruistic blood donors often receive freebies like movie tickets or
paid vacation hours that would be illegal for kidney donors. Plasma and
sperm donors routinely receive cash, as do egg donors and surrogate
mothers, who get tens of thousands of dollars.. If transplant centers
could pay $25,000 or $50,000 to each living kidney donor, many more
people would line up to contribute.
Such payments could even save taxpayers billions of dollars. Long-term
dialysis is a federal entitlement. Under a special law, Medicare covers
everyone, regardless of age, who has made minimal Social Security tax
payments--about 319,000 of the country's 400,000 dialysis patients.
Compared with dialysis payments, every transplant from a living,
unrelated donor saves an expected present value of almost $100,000 in
medical costs, according to a 2003 American Journal of Transplantation
article by Matas and Mark Schnitzler, an economist then at Washington
University in St. Louis and now at the Saint Louis University Center for
Eliminating the waiting list would thus save taxpayers $8 billion, or
$4 billion if each living donor received a lump-sum payment of $50,000. That purely financial estimate ignores the enormous benefits for the
patients' quality of life, of course. It also excludes the economic
gains from returning to productive work--only about 10 percent of
dialysis patients are employed even part-time--and the fiscal effects of
paying taxes rather than receiving disability payments.
Obviously there is some controversy about compensating donors, especially the notion of a recipient doing so directly. So imagine only indirect compensation for now. See how easy it is to sidestep controversy in the interest of immediate reform? The main obstacle to improving the system isn't entrenched interests, ideological disagreements, or the inherent intractability of the problem -- it's just apathy:
Kidney disease is a low-profile, unglamorous problem, a disease that
disproportionately strikes minorities and the poor. Its celebrity
spokesman is blue-collar comedian George Lopez, who received a kidney from his wife.
"It's not AIDS, it's not cancer," says Jack Daly, who worked on
kidney-related legislation when he was counsel for the Senate Judiciary
Committee. "Kidney donation is not a very sexy issue." Even
uncontroversial bills sit around for years without action.
The failure to better address this problem doesn't say much for our political system. Congress spends so much time arguing about hot button issues of little actual import, tweaking complicated laws in ways that advantage special interests, and obsessing over grand legislation that passes once in a generation, like the health-care bill. In doing so, it ignores a lot of smaller bore legislation that would save money for all of us and improve life for a lot of suffering people.