Public Release: 

Selling a kidney does not benefit the seller

JAMA study raises doubts about value of using financial incentives to increase supply of organs for transplantation

Case Western Reserve University

CLEVELAND - Individuals who sell a kidney do not receive a long-term economic benefit from the sale and may have a worsening of their health, according to a new study in the Oct. 2, 2002 issue of The Journal of the American Medical Association (JAMA).

The investigation involved 305 individuals in southern India who had sold a kidney an average of six years earlier for about $1000 apiece (about twice their annual family income). The study compared the sellers' current economic and health status with their economic and health status before they sold a kidney. The income of the sellers declined by one-third after selling a kidney, and 86 percent had a worsening of their health status.

Because nearly every country has a shortage of organs for transplantation, providing financial incentives to donate is often proposed or justified as a way to benefit recipients by increasing the supply of organs and to benefit donors by improving their economic status. In the United States, most organs for transplantation come from brain dead individuals whose families have consented to donate. Providing financial incentives such as payment for funeral expenses has been proposed as a way to increase the supply of organs.

In many developing countries such as India, most organs come from living donors, and the sale of kidneys is widespread. This practice is justified as a way to both increase the supply of kidneys for transplantation and to benefit the seller economically.

However, critics argue that purchasing kidneys amounts to exploitation of the poor and that the poor do not overcome poverty as a result of the sale.

The researchers, led by Madhav Goyal, M.D., from Geisinger Health System in State College, Pa., and Ashwini Sehgal, M.D., from Case Western Reserve University School of Medicine in Cleveland, Ohio, sought to determine whether individuals who sell a kidney actually benefit from the sale.

"We were surprised by our findings," said Goyal. "The sellers' economic and health status appeared to worsen after selling a kidney. Most of them would not recommend that others sell a kidney."

"These findings undercut arguments in favor of financial incentives," said Sehgal. "Even modest financial incentives such as those proposed in the United States may be perceived by the general public as taking advantage of poor families. If this happens, such incentives may actually lead to fewer total organ donations."

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Goyal is an internist at Geisinger Health System. Sehgal is an associate professor of medicine, biomedical ethics, and epidemiology and biostatistics at Case Western Reserve, and a member of the Division of Nephrology and Center for Health Care Research and Policy at MetroHealth Medical Center, also in Cleveland. Other collaborators include Ravindra Mehta, M.D., of the Division of Nephrology, and Lawrence Schneiderman, M.D., of the departments of Medicine and Family and Preventive Medicine, at the University of California, San Diego, School of Medicine.

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