How much is a kidney worth in America today?

Are your kidneys available to me? - Sixth in a series

A general understanding of chronic kidney disease (CKD) and its treatment is important for any who would pass judgment on whether kidney transplants are ethical, so let’s take a look.

Some forms of kidney disease stem from heredity or environmental factors, but most CKD results from diabetes, high blood pressure and old age. A number of medications can harm our kidneys including pain meds, aspirin, ibuprofen, antibiotics; and alcohol and street drugs like heroin and cocaine are culprits, too. (ref)

Our kidneys remove waste from our bodies including drugs, balance our fluids, help to regulate blood pressure, control production of red blood cells, and manufacture a form of vitamin D that contributes to bone health. (ref)

Diabetes and hypertension are the leading causes of kidney failure for adults. Kidney failure is called end-stage kidney disease (ESRD), leaving a person three options: 1. No treatment, but adjust diet or take medication to help symptoms; 2. Dialysis (two forms); and 3. a transplant.

Undoubtedly, any of us who has a loved one with ESRD would want the best option for their overall health. It would be beyond sad to see them suffer without relief. We probably would initially embrace transplantation as wise and desirable.

transplantation statisticsMany facts about the prevalence of ESRD and CKD are on the internet, and we find that CKD moved from 27th in the list of causes of death worldwide in 1990 to 18th in 2010. This advance up the list was second only to that for HIV and AIDS. Kidney failure statistics rise in countries where the number of older people is increasing. (ref)

It is worth noting that CKD can be slowed or stopped with early diagnosis and treatment, and today there are over-the-counter tests for the condition.

In the graphic, we see that about 117K people need a lifesaving organ transplant and only about 17K organ transplants have been performed so far as of mid-August, 2017. Statistics do not make clear from where or whom organs for transplant are received. But we can see that there is a wide gap between supply and demand.

It is stated that —

About 30 Americans a day either die on the waiting list or are removed from it because they have become too ill to receive a transplant. Taxpayers also bear a significant burden in the case of kidneys because of the special status of renal dialysis within the Medicare program. In 1972, Congress mandated that Medicare cover the costs of care for end stage renal disease regardless of patient age. In 2011, over 500,000 people took advantage of this benefit at a cost of over $34 billion, which is more than 6% of Medicare’s entire budget. (ref)

With such staggering costs, it is easy to see why a cost-benefit analysis of government compensation of kidney donors has been researched. A summary of the study follows.

From 5000 to 10,000 kidney patients die prematurely in the United States each year, and about 100,000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys. To reduce this shortage, many advocate having the government compensate kidney donors. This paper presents a comprehensive cost-benefit analysis of such a change. It considers not only the substantial savings to society because kidney recipients would no longer need expensive dialysis treatments—$1.45 million per kidney recipient—but also estimates the monetary value of the longer and healthier lives that kidney recipients enjoy—about $1.3 million per recipient. These numbers dwarf the proposed $45,000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list. From the viewpoint of society, the net benefit from saving thousands of lives each year and reducing the suffering of 100,000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3. In addition, it would save taxpayers about $12 billion each year. (ref)

Chronic kidney disease is widespread, expensive, and projected to afflict nearly 17% of our population by 2030. Curing it is a medical priority. WaitListZero has lots of statistics that underscore the great need for donors, and its leaders have donated a kidney — They lead by example.

All around, we see pressures building to solve this societal dilemma.

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Asking the right questions

Are your kidneys available to me? - Fifth in a series

Are your kidneys available to me – or to the pastor or friend in their 60s – or to a child on dialysis, like the little boy in the picture?

If you have signed your driver’s license then you can say, “Yes.” But would you, if you are a healthy adult, donate a kidney to help a fellow human live longer?

And what if you were asked to give an opinion, to help another person make a decision? It’s best to know in advance what you would answer.

Up to this post, we have reviewed position statements by churches on organ donation, noting or providing links to web pages that show:

  • All religions and Christian churches generally are in favor of organ donation
  • Christian church statements do not differentiate between the living and dead donor
  • Many churches see organ donation as a matter of individual conscience
  • There are altruistic living donors of kidneys and many kidney sellers, mostly found among the poor and ignorant in the world.

We have also noted that church position statements should distinguish between living and presumably dead donors. I realize that using the word “presumably” adds another layer to work through, but Christians need to understand that the current definition of death is debatable, and most Bible-believing Christians would not accept it. We believe that death occurs when people breathe their last. However, once that occurs, organs cannot be used for transplantation. This is a topic for a different blog series.

Our country may be moving toward a program of payment for organs from live donors, requiring a change in current law.

Would you expect your church to take a stand for or against this? Would you sell or buy a kidney? This is a new dilemma from whether you would donate one.

How would you advise your church, if you were on a committee to write a position statement?

Here are some topics to look at, to get the facts and insights needed for a personal viewpoint:

  • How do kidneys from around the world find their way to the operating tables of the USA? Would this practice end if we have a paid donor program here? Would the Donor Bill of Rights help?
  • How would changing our laws to permit payment for human organs affect our society?
  • Would payment for organs be supported or opposed in Christian doctrine?
  • What types of questions in the Christian life are bonafide matters for individual conscience?

These questions are different from the ones asked by the health authorities, who want to know:

  • How many kidney donors are needed to supply the current demand and what is the demand curve?
  • What are current and projected costs for dialysis, and who pays?
  • How can we get more donors?

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Angel fish
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...and every living creature that moveth, which the waters brought forth abundantly, after their kind, and every winged fowl after his kind ... the living creature after his kind, cattle, and creeping thing, and beast of the earth after his kind ...the beast of the earth after his kind, and cattle after their kind, and every thing that creepeth upon the earth after his kind: and God saw that it was good. -Genesis 1

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A SistersSite eBook

Flesh and Bone and The Protestant Conscience is an e-book on Amazon.com. It is 99¢ and in the Amazon lending library as well. It is also available here in PDF format. The book description follows.

Would you let your conscience be your guide?

Does God care if the skin and bone of the dead are passed along to the living for medical uses? Is organ donation OK with God? Should you sign a Living Will?

Did you know that dead organ donors are often anesthetized before their organs are removed? Do you know the current definition of death? The conscience cannot function without facts.

As we ponder the ethics of in vitro fertilization, stem cell research and man-made chimeras, our thoughts trail off. How then should we live? (Ez 33:10)

How should a Christian think about euthanasia by starvation when doctors and the state attorney general all agree it is time to withhold feeding from a brain injured patient? Some things are family matters, but someday it may be our family.

Here is a small book to help you think about whether you want to sign your driver's license, donate a kidney, cremate your loved one, and many other practical questions that may arise in the course of your healthcare decisions or watch over others.

It offers a special focus on the doctrine of the Resurrection that is related to such decisions. Sunday School classes and Bible Study groups could use this book to facilitate discussion about the issues covered.