Foreword: Organs and Inducements

Philip J. Cook & Kimberly D. Krawiec Special Editors The Organs and Inducements symposium originated from two developments: (1) the large and growing gap between kidney supply and need for people with end-stage renal disease and (2) the failure of recent policy and medical innovations to reverse that trend. The gap between kidney need and supply became visible after the United Network for Organ Sharing data system first went online in 1995 and has been growing ever since.1 Over the next decade through 2006, transplants increased but the number of patients in need of kidneys grew faster than the supply of kidneys available for transplantation. Since 2006 the need for kidneys has continued to increase, albeit slowly, but the number of suitable kidneys available for transplantation has plateaued, resulting in a still-further widening of the gap.2 Today, over 7500 patients with end-stage renal disease die each year while awaiting a transplant or become too sick to transplant, while many more languish on the kidney waiting list, which passed 100,000 persons for the first time this year.3 Although recent advances in kidney transplantation, such as kidney paired donation and nonsimultaneous, extended, altruistic donor (NEAD) chains hold great promise, the number of transplants performed using such techniques remains small and has failed to stem the trend of unmet need.4 Most of those on the waiting list are on dialysis, a costly and time-consuming procedure that is far less satisfactory than transplantation in sustaining either the quality or duration of life for renal patients.5 From one perspective, this great loss of life is tragic in that it is foreseeable but unnecessary. Recent evidence suggests that if kidney donors were offered a reasonable payment, enough of them could be recruited to close the current gap, thereby saving thousands of lives and reducing the overall public expenditures on renal disease.6 From another perspective, paying someone to donate a body part is immoral per se, even if the medical consequences to the donor are minimal and the choice to donate is deliberate and carefully administered. This latter view is incorporated in current law in the United States and all but a handful of other nations in the world.7