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I’ve Waited So Long, I Could Die

It has been a year since waiting lists at VA hospitals made international headlines, as our American veterans struggled to access timely health care. In the months since, The Associated Press has found that the number of medical appointments delayed 30 to 90 days has largely stayed flat. Appointments taking longer than 90 days to complete have nearly doubled in number, and patients typically get sicker during the wait.

However, our veterans’ waiting list isn’t our only worrisome one. Another is just as onerous- the list of those patients with End Stage Renal Disease (ESRD) awaiting donation of a kidney for transplant. Congress approved an exclusive benefit for citizens with ESRD in 1972, authorizing Medicare to fully fund patient dialysis- the only treatment that can prolong their lives. This technology and the benefit making it affordable resulted in a 260 percent growth in the number of those awaiting kidney transplants. Meanwhile, there was only a 16 percent growth in kidney supply. This explosive demand parallels such at the VA. In a country of enormous abundance, these waiting lists are killing our citizens.

There is a way to attack this waiting list, just as the VA is working to better serve its veterans. It takes a to-do list- not a waiting list- to achieve a creative solution. That solution is one supported by ethicists, scholars and the medical community; there has been wide consensus that now is the time to test the model for a regulated market for the sale of kidneys for transplant.

The current problem with such a proposal is that it’s against the law. Congress approved the National Organ Transplant Act (NOTA) in 1984, prohibiting the sale of organs and criminalizing such action with a prison term and fine. With no other scalable solution proposed, Congress explicitly outlawed organ sales.

In the 30 years since NOTA’s passage, the transplant waiting list has come to be known as a “waiting list to die,” ballooning to more 100,000 candidates who hope to receive one of 13,000 available kidneys each year. On average, between seven and 12 people awaiting a kidney die each day. In a country with such abundance, this reality is unconscionable.

In a country of enormous abundance, these waiting lists are killing our citizens.

Congress must authorize a pilot program for a regulated market in which live and deceased donors can be compensated to provide kidneys to unrelated candidates. We don’t need to categorically rescind portions of NOTA, but we do need to allow a test to determine whether providing payment for kidneys could ethically reduce the waiting list so that thousands won’t die due to a wait each year.

Altruistic donation is a selfless act and has been the only source of kidney supply. As wonderful as it is, altruism will never meet the demand. It is outrageous that our ESRD patients are regularly allowed to die while highly regarded ethicists, transplant surgeons and scholars are poised to support a proposal for such a regulated market test.

To be sure, there could be abuses in a system of financial incentives. However, these potential abuses are no morally worse than not trying financial incentives in a regulated market. A policy of financial incentives will produce fewer unfortunate results than the current system. Our veterans are heroes, and those who provide organs are, too. Let’s try on their behalf.

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