Abstract
Transplantation remains the modality of choice for patients with end stage renal disease (ESRD). However, while there has been a steady rise in the number of patients with ESRD the supply of donors (combine living and deceased) has fallen far behind the need, resulting in an increasing number of qualified patients remaining on the wait-list, and thousands being removed from the list every year because of death or becoming too sick for transplantation. This has also fed to transplant tourism around the world. Several countries have implemented a variety of policies to overcome their organ shortage that are presented in this article. There is an urgent need for developing policies geared to the cultural norms of different societies and universally accepted ethical principles to remedy this public health issue.
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References
USRDS (2017) Annual data report. Accessed in August 31, 2018. https://www.usrds.org/adr.aspx. 2017; Available from: https://www.usrds.org/adr.aspx
Organ Procurement and transplantation network-national data (2018) Accessed in August 31, 2018. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#
United Network for Organ Sharing (2018) Accessed in August 31, 2018. https://unos.org/data/
US Department of Justice, Drug Enforcement Administration (2018) Diversion control division—opioid addiction resources for dea registered practitioners—March 16, 2018. DEA_DCD@public.govdelivery.com
National Institute on Drug Abuse—overdose death rates (revised in September 2017). Accessed in March 23, 2018. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
Rodrigue JR, Schold JD, Mandelbrot DA (2013) The decline in living kidney donation in the united states: random variation or cause for concern? Transplantation 96(9):767–773
Kidney Allocation system—professional education—OPTN. Accesed in March 1, 2018. https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf
Muzaale AD et al (2014) Risk of end-stage renal disease following live kidney donation. JAMA 311(6):579–586
Mjoen G et al (2014) Long-term risks for kidney donors. Kidney Int 86(1):162–167
Grams ME, Garg AX, Lentine KL (2016) Kidney-failure risk projection for the living kidney-donor candidate reply. N Engl J Med 374(21):2094–2095
OPTN/SRTR 2016 annual data report: kidney. Accessed in March 27, 2018. https://srtr.transplant.hrsa.gov/annual_reports/Default.aspx
Khamash HA, Gaston RS (2008) Transplant tourism: a modern iteration of an ancient problem. Curr Opin Organ Transplant 13(4):395–399
Havoscope: Global Black Market Information. Accessed in April 2, 2018. https://www.havocscope.com/biggest-consumers-of-illegal-organs/
Shimazono Y (WHO December 2007) The state of the international organ trade: a provisional picture based on integration of available information. Accessed in November 19, 2013. http://www.who.int/bulletin/volumes/85/12/06-039370/en/
Organ trafficking prices and kidney transplant sales (2018). Accessed in August 30, 2018. https://www.havocscope.com/black-market-prices/organs-kidneys/
Gill J et al (2008) Transplant tourism in the United States: a single-center experience. Clin J Am Soc Nephrol 3(6):1820–1828
Prasad GV et al (2006) Outcomes of commercial renal transplantation: a Canadian experience. Transplantation 82(9):1130–1135
Merion RM et al (2005) Deceased-donor characteristics and the survival benefit of kidney transplantation. JAMA 294(21):2726–2733
Ruiz-Ramon P, Hunsicker L, Steiner RW (ed) (2004) Educating, evaluating, and selecting living kidney donors, 35–49 © 2004 Kluwer Academic Publishers. The Netherlands. ISBN-13: 978-1402012716
The 2016 USRDS annual data report. Volume 2, chapter 7—transplantation. Accessed in March 23, 2018. https://www.usrds.org/2016/view/Default.aspx
Meier-Kriesche HU, Kaplan B (2002) Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: a paired donor kidney analysis. Transplantation 74(10):1377–1381
Roger WE, Terasaki P, Barry Jacob’s Testimonies (1984) Hearings before the subcommittee on health and the environment of the committee on energy and commerce, house of representatives. In: 98th Congress, 1st session, on H.R. bill 4080. Serial no. 98–70, 50–72:59. Also see a related article in New York Times (1983). https://www.nytimes.com/1983/09/24/us/buying-of-kidneys-of-poor-attacked.html
Organ procurement and transplantation network (OPTN) Data: data on donation and transplantation in 2017. Accessed in August 31, 2018. http://www.aopo.org/related-links-data-on-donation-and-transplantation/. 2017
Sheehy E et al (2003) Estimating the number of potential organ donors in the United States. N Engl J Med 349(7):667–674
Al Sebayel M et al (2014) Donor organ shortage crisis: a case study review of a financial incentive-based system. Transplant Proc 46(6):2030–2035
Boulware LE et al (2006) Public attitudes toward incentives for organ donation: a national study of different racial/ethnic and income groups. Am J Transplant 6(11):2774–2785
Chkhotua A (2012) Incentives for organ donation: pros and cons. Transplant Proc 44(6):1793–1794
Fisher JS et al (2015) Between Scylla and Charybdis: charting an ethical course for research into financial incentives for living kidney donation. Am J Transplant 15(5):1180–1186
Harris CE, Alcorn SP (2001) To solve a deadly shortage: economic incentives for human organ donation. Issues Law Med 16(3):213–233
Matas AJ (2006) Why we should develop a regulated system of kidney sales: a call for action! Clin J Am Soc Nephrol 1(6):1129–1132
Omar F, Tufveson G, Welin S (2010) Compensated living kidney donation: a plea for pragmatism. Health Care Anal 18(1):85–101
Matas A et al (2012) A realistic proposal–incentives may increase donation–we need trials now! Am J Transplant 12(7):1957–1958
Matas AJ (2013) A regulated system of incentives for living kidney donation: why can’t we agree to do a trial? Clin Transplant 26:227–234
Matas AJ, Hays RE (2014) A regulated system of incentives for living kidney donation: it is time for opposing groups to have a meaningful dialogue! Am J Transplant 14(8):1944–1945
Salomon DR et al (2015) AST/ASTS workshop on increasing organ donation in the United States: creating an “arc of change” from removing disincentives to testing incentives. Am J Transplant 15(5):1173–1179
Working Group on Incentives for Living, D et al (2012) Incentives for organ donation: proposed standards for an internationally acceptable system. Am J Transplant 12(2):306–312
Abouna GM (2008) Organ shortage crisis: problems and possible solutions. Transplant Proc 40(1):34–38
Bastani B (2015) The worsening transplant organ shortage in USA; desperate times demand innovative solutions. J Nephropathol 4(4):105–109
Bastani B (2016) It’s time to reward the gift of life. J Nephropathol 5(3):88–89
Yacoubian AA, Dargham RA, Khauli RB (2018) A review of the possibility of adopting financially driven live donor kidney transplantation: review. Int Braz J Urol 44(6):1071–1080
Gaston RS et al (2006) Limiting financial disincentives in live organ donation: a rational solution to the kidney shortage. Am J Transplant 6(11):2548–2555
Bastani B, Fry-Revere S (2015) A practical solution that bypasses the altruism versus incentives debate. Int Urol Nephrol 47(9):1515–1517
Delmonico FL (2016) Point: living organ donation should elicit care for the donor and be a financially neutral act. Reported in January 24, 2016. http://www.insidesources.com/category/politics/
Tushla L et al (2015) Living-donor kidney transplantation: reducing financial barriers to live kidney donation-recommendations from a consensus conference. Clin J Am Soc Nephrol 10(9):1696–1702
Poor people can’t even afford to donate kidneys (2014). Reported in July 17, 2014. https://www.science20.com/print/140821
Gill J, Dong J, Gill J (2015) Population income and longitudinal trends in living kidney donation in the United States. J Am Soc Nephrol 26(1):201–207
Klarenbach S, Garg AX, Vlaicu S (2006) Living organ donors face financial barriers: a national reimbursement policy is needed. CMAJ 174(6):797–798
Rodrigue JR et al (2016) Direct and indirect costs following living kidney donation: findings from the KDOC study. Am J Transplant 16(3):869–876
Larson DB et al (2019) Financial burden associated with time to return to work after living kidney donation. Am J Transplant 19(1):204–207
Morrison J (2016) It’s time to treat organ donors with respect they deserve. The Washington post-in theory (Opinion). Reported in January 1, 2016. https://www.washingtonpost.com/news/in-theory/wp/2016/01/01/its-time-to-treat-organ-donors-with-the-respect-they-deserve/
Matas AJ, Schnitzler M, Daar AS (2004) Payment for living kidney donors (vendors) is not an abstract ethical discussion occurring in a vacuum. Am J Transplant 4(8):1380–1381
Fry-Revere S (2018) Solving the organ shortage by giving living organ donors what they deserve. J Hos Ethics 5(1):11–20
IRODaT (International Registry in Organ Donation and Transplantation) (2017) Final numbers 2016. Accessed in December 2017. WWW.irodat.org
Ghods AJ, Savaj S (2006) Iranian model of paid and regulated living-unrelated kidney donation. Clin J Am Soc Nephrol 1(6):1136–1145
Mahdavi-Mazdeh M (2012) The Iranian model of living renal transplantation. Kidney Int 82(6):627–634
Hamidian Jahromi A, Fry-Revere S, Bastani B (2015) A revised Iranian model of organ donation as an answer to the current organ shortage crisis. Iran J Kidney Dis 9(5):354–360
Fry-Revere S (2014) The kidney sellers: a journey of discovery in Iran. Carolina Academic Press, Durham North Carolina. ISBN-13: 978-1611635126
Bastani B (2018) The Iranian model as a potential solution for kidney shortage crisis. J Nephropathol 7(4):220–223
Ghahramani N (2016) Paid living donation and growth of deceased donor programs. Transplantation 100(6):1165–1169
Islamic Republic of Iran Parliament (2000) Deceased or brain dead patients organ transplantation Act. H/24804-T/9929, June 4, 2000
Simforoosh NBA, Tabibi A, Nadjafi-Semnani M (2018) Living unrelated kidney transplantation: Does it prevent deceased donor kidney transplantation growth? Transplantation 102(Supplement 7S-1)
Khoddami-Vishteh HR et al (2010) Causes and follow-up outcomes of brain dead patients in Shahid Beheshti University of Medical Sciences Hospitals. Pejouhandeh 15(4):171–178 (in Persian)
Einollahi B et al (2007) Deceased-donor kidney transplantation in Iran: trends, barriers and opportunities. Indian J Med Ethics 4(2):70–72
Mojtabaee M et al (2018) Update on causes of family refusal for organ donation and the related factors: reporting the changes over 6 Years. Transplant Proc 50(1):10–13
Massie AB et al (2017) Quantifying postdonation risk of ESRD in living kidney donors. J Am Soc Nephrol 28(9):2749–2755
Matas AJ et al (2018) Causes and timing of end-stage renal disease after living kidney donation. Am J Transplant 18(5):1140–1150
Matas AJ, Hays RE, Ibrahim HN (2017) A case-based analysis of whether living related donors listed for transplant share ESRD causes with their recipients. Clin J Am Soc Nephrol 12(4):663–668
Ravitsky V (2013) Incentives for postmortem organ donation: ethical and cultural considerations. J Med Ethics 39(6):380–381
Arnold R et al (2002) Financial incentives for cadaver organ donation: an ethical reappraisal. Transplantation 73(8):1361–1367
Delmonico FL et al (2002) Ethical incentives–not payment–for organ donation. N Engl J Med 346(25):2002–2005
Wu X, Fang Q (2013) Financial compensation for deceased organ donation in China. J Med Ethics 39(6):378–379
National Bureau of Statistics of China-China’s Economy Achieved a Stabilized and Accelerated Development in the Year of 2012. Accessed 9 Mar 2013. http://www.stats.gov.cn/was40/gjtjj_en_detail.jsp?searchword=Disposable+income&channelid=9528&record=3. January 18, 2013
Lam WA, McCullough LB (2000) Influence of religious and spiritual values on the willingness of Chinese-Americans to donate organs for transplantation. Clin Transplant 14(5):449–456
Naghavi M et al (2009) Adverse health outcomes of road traffic injuries in Iran after rapid motorization. Arch Iran Med 12(3):284–294
World Health Ranking. Accessed in August 31, 2018. http://www.worldlifeexpectancy.com/cause-of-death/road-traffic-accidents/by-country/
Broumand M, Parsapoor A, Asghari F (2012) Public opinion of organ donation: a survey in Iran. Clin Transplant 26(5):E500–E504
Lavee J et al (2010) A new law for allocation of donor organs in Israel. Lancet 375(9720):1131–1133
Lavee J et al (2013) Preliminary marked increase in the national organ donation rate in Israel following implementation of a new organ transplantation law. Am J Transplant 13(3):780–785
The Brain-Respiratory Death Law 5768-2008. Israeli Book of Laws. Accessed October 5, 2012. http://www.knesset.gov.il/Laws/Data/law/2144/2144.pdf
The Organ Transplantation Law 5768-2008. Israeli book of laws. English translation. Accessed October 5, 2012. http://www.declarationofistanbul.org/index.php?option=com_content&view=article&id=267:israel-transplant-law-organ-transplant-act-2008&catid=83:legislation&Itemid=130
Lavee J (2013) Ethical amendments to the Israeli organ transplant law. Am J Transplant 13(6):1614
Quigley M, Wright L, Ravitsky V (2012) Organ donation and priority points in Israel: an ethical analysis. Transplantation 93(10):970–973
H.R. 6448—Organ Donation Clarification Act of 2018. https://www.congress.gov/bill/115th-congress/house-bill/6448/text
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Bastani, B. The present and future of transplant organ shortage: some potential remedies. J Nephrol 33, 277–288 (2020). https://doi.org/10.1007/s40620-019-00634-x
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DOI: https://doi.org/10.1007/s40620-019-00634-x