Tuesday, November 22, 2011

Charts of the Day: Kidney Shortage Worsens Yearly

As a follow-up to this recent CD post on the market for kidneys, the charts above show up-to-date data on the kidney situation from the United Network for Organ Sharing (UNOS).  Here's the current situation:

1. There are currently 90,363 registered candidates on the ever-increasing waiting list to receive a kidney transplant, which is an all-time record high (see top chart). 

2. Based on actual transplant operations through August of this year, an estimated 16,855 patients will have a kidney transplant operation this year (see top chart).

3. Of the 90,363 patients currently on the waiting list, only about 18.6%, or fewer than one-in-five, will actually receive a kidney transplant this year (see bottom chart).  That's the lowest chance of receiving a kidney for those on the waiting list since UNOS records start in 1989, and way below the 50% chance in 1989, 1990 and 1991.  

4. Based on data from the last few years, there will be about 5,000 registered candidates on the list who will die this year while waiting for a kidney, and another 2,000 who will be removed from the list because they are considered to be too sick to survive a kidney transplant operation.  

Bottom Line: The situation for those with renal failure waiting desperately to receive a kidney continues to worsen every year under the current policy that prohibits donor compensation.  The only realistic, long-term and truly compassionate solution to address America's worsening kidney shortage is to legalize some form of donor compensation.  

38 Comments:

At 11/22/2011 7:42 PM, Blogger rjs said...

"The only realistic, long-term and truly compassionate solution to address America's worsening kidney shortage is to legalize some form of donor compensation."

i almost would agree with that; but should the same then be true for hearts or livers?

 
At 11/22/2011 8:46 PM, Blogger Benjamin said...

There is a unmet demand for some kinds of babies.

Should an enterprising young couple (or woman) be allowed to procreate for profit?

Of course, baby-selling already goes on, but maybe it is ready for the big time.

 
At 11/22/2011 9:09 PM, Blogger aorod said...

The only reasonable solution is to perfect organ cloning.

 
At 11/22/2011 11:56 PM, Blogger truth or consequences said...

If the situation is worsening as your graphs suggest it seems to me that there are three possible factors...

1- an aging population requires more kidneys

2- advances in medecine and their wider availability have made potential transplant recipients more numerous than before

3- the number of donors, even if it was growing (no stats on that unfortunately) is not keeping up with the need/demand

Nobody can do much about one and two so let's look at three...

In the past most kidney transplants happened because of a connection between the recipient and the donor (family, friend, co-worker)...

If the problem is worsening what does that say about either the recipients and/or the donors that the need cannot be met now. (???)

I think these are way more complicated issues than can just be dealt with by putting a price tag on a liver.

You say...assert even that: "The only realistic, long-term and truly compassionate solution to address America's worsening kidney shortage is to legalize some form of donor compensation."

I think you're taking the easy way out: "give 'em some money, problem solved" no guarantees of course that it will do the trick OR that it will not cause a whole lot of other unforseen problems...it's just that it "works" with widgets so why not....yeah right! I call it jumping into the pool before checking if there's water in there.

And BTW, that quote of yours would have been more credible if you had elected not to use the "shock term" "truly compassionate"....

People who use "shock terms" are just telegraphing, to me anyways, that their argument needs some crutches to stand on it's own.

But hey, all interesting stuff...keep it up...T&C

 
At 11/23/2011 12:19 AM, Blogger randian said...

but should the same then be true for hearts or livers

Why not? Money might pry open the door to cadaver organs not currently available because of objections on the part of family.

Should an enterprising young couple (or woman) be allowed to procreate for profit?

I don't see the problem. Giving away your baby via adoption is already legal, and you are not required to have "good" motivations for doing so. How can it be moral to give away your baby for free, but immoral for doing so for money? The base act is the same.

 
At 11/23/2011 3:51 AM, Blogger Ron H. said...

"3- the number of donors, even if it was growing (no stats on that unfortunately) is not keeping up with the need/demand

Nobody can do much about one and two so let's look at three...
"

I was looking forward to learning what you recommend, but I was disappointment. Was this just an exercise in "looking at #3"?

Actually, there are very good the stats for the number of kidney donors, if you understand that every transplant involves one, as indicated by the lower line on the chart.

"In the past most kidney transplants happened because of a connection between the recipient and the donor (family, friend, co-worker)..."

Umm...OK.

"If the problem is worsening what does that say about either the recipients and/or the donors that the need cannot be met now. (???)"

Well, what DOES it say? You explained part of it with your #1 and #2 above. People are living longer, and improvements in treatment allow those needing kidneys to need them for a longer time, hence the increasing number of candidates. What is your solution? Would you have them die rather than pay someone for a kidney?

"I think these are way more complicated issues than can just be dealt with by putting a price tag on a liver."

Complicated - how?

You mentioned earlier that: "I don't think it's desirable for society...".

You are certainly entitled to your opinion, but can you speak for others? What of the people who think it IS desirable for society? Would you impose your views on them through force?

 
At 11/23/2011 6:35 AM, Blogger geoih said...

Quote from Benjamin: "Should an enterprising young couple (or woman) be allowed to procreate for profit?"

Nice strawman.

 
At 11/23/2011 9:13 AM, Blogger VangelV said...

There is a unmet demand for some kinds of babies.

Should an enterprising young couple (or woman) be allowed to procreate for profit?


Why not?

 
At 11/23/2011 9:17 AM, Blogger VangelV said...

I think you're taking the easy way out: "give 'em some money, problem solved" no guarantees of course that it will do the trick OR that it will not cause a whole lot of other unforseen problems...it's just that it "works" with widgets so why not....yeah right! I call it jumping into the pool before checking if there's water in there.

I agree with one point. It is the easy way out. And clearly there are very obvious and predictable problems with the current system, which is clearly not working because it isn't a market system. The busybodies have had their chance and blown it big time. The distribution and selection processes are very corrupt because the monetary benefits go to the people who make the decisions, not those that provide the kidneys. It is time for that to change.

 
At 11/23/2011 9:51 AM, Blogger Mark J. Perry said...

The only country that I am aware of that does NOT have a kidney shortage is the only country that legally allows donor compensation: IRAN. Which is interesting because Iran is generally a country that is NOT favorable to free market ideas or solutions. But by allowing compensation to donors, it has essentially solved the kidney shortage.

 
At 11/23/2011 9:52 AM, Blogger morganovich said...

"In the past most kidney transplants happened because of a connection between the recipient and the donor (family, friend, co-worker)...

If the problem is worsening what does that say about either the recipients and/or the donors that the need cannot be met now. (???)"

this is a meaningless argument.

it says nothing.

kidney disease is up due to a large number of factors (obesity not least among them).

donor supply is falling way behind.

what it says is that there is far more demand than supply.

with price = 0, does that really surprise you?

what would the supply of iphones be if price was zero?

"no guarantees of course that it will do the trick OR that it will not cause a whole lot of other unforseen problems...it's just that it "works" with widgets so why not....yeah right! I call it jumping into the pool before checking if there's water in there."

and this is absurd. well, higher price creates more supply of pretty much every product and service in the world, but yeah, let's be careful to make sure this is one.

your argument is akin to claiming that every other object you have dropped has fallen due to gravity, but that that dos not assure us that the next one will.

you are just ducking the basic issue over and over:

what could be more your property that your own organs?

if they are your property, why can you not do with them as you please?

you can sell you hair for wigs or your blood to a blood bank, but somehow a kidney is different?

what underlying system of logic can you use to defend this?

none.

you are just making emotional appeals to absurd legal scenarios because the basic foundation of your belief set is inconsistent and illogical.

 
At 11/23/2011 10:17 AM, Blogger Buddy R Pacifico said...

"Should an enterprising young couple (or woman) be allowed to procreate for profit?"

Are we not there with sperm "donation" and egg "donation"?

A guy can earn $1000 - $2000 and a gal $6000, for their first day on the job. If they are good at what they produce, then successive raises will incurr for each new work unit.

 
At 11/23/2011 10:20 AM, Blogger truth or consequences said...

Well, Paul H and Morgy....sorry for not having all the answers.

A lot of very smart people with WAY more experience with this subject than us got together in 2008 and signed the "Istambul Decleration". Look it up.

It's easy to just say that "put a price on it" and the problem will go away...but there is a couple of decades of experience and data on the subject in countries that have a "regulated" market in transplant organs for medical tourism. That experience unfortunately shows less than desirable outcomes for donors AND recipients. Hence the Istambul Declaration.

Just because a bunch of old farts who have nothing better to do than sit at their computers and chant the mantra that "free markets fix everything" so let's apply that to kidneys.....is not the definitive, compelling argument I was looking for.

As MP says there is only ONE country that has an open free market in organs and that's Iran.

We know that a "regulated" market does not work as well as it was imagined it would.

I'd like to know how an open free market works out for all involved...before I "jump blindfolded into the pool"...because from what I'm reading that is what the pro side seems to be advocating for here.

 
At 11/23/2011 11:01 AM, Blogger VangelV said...

A lot of very smart people with WAY more experience with this subject than us got together in 2008 and signed the "Istambul Decleration". Look it up.

If their premises are wrong it does not matter how 'smart' the people are or how sound the logic. But if you look at the signatories you see bureaucrats representing governments and government institutions that meddle in markets, hardly an unbiased group. These are the same people who are responsible for most of the problems that their meddling has created. Now you can choose to keep accepting their views without much thought and keep getting the same type or results or you can actually think for yourself and use logic to come to another conclusion.

 
At 11/23/2011 11:14 AM, Blogger Benjamin said...

Buddy-

That's funny---I usually have to pay to give my sperm away.

 
At 11/23/2011 12:28 PM, Blogger morganovich said...

t or c-

"A lot of very smart people with WAY more experience with this subject than us got together in 2008 and signed the "Istambul Decleration". Look it up."

appeals to authority are very weak arguments.

their whole thesis is taking away rights for some form of social goal.

even if we accept their goal as laudable (and i do not) their violation of rights still ought not be permitted.

a similar case would be a body of experts deciding that women really are just as good at math as men and then banning free speech to the contrary.

would you feel like that was a good outcome in defense of your rights?

would not such an outcome be a very dangerous precedent?

property rights are no different.

you claim to want a definitive compelling argument, yet you cannot even supply the rudiments of one yourself, just appeals to authority and vague claims about free markets unsubstantiated by anything.

you are unable to answer even basic questions, yet feel entitled to an utterly unfounded opinion that you cannot defend while demanding definitive arguments from others?

is that a joke?

until you can respond to this, you have no business expressing your opinion as it is based on nothing:

what could be more your property that your own organs?

if they are your property, why can you not do with them as you please?

you can sell you hair for wigs or your blood to a blood bank, but somehow a kidney is different?

what underlying system of logic can you use to defend this?

that's the price of admission to this discussion, pure and simple.

if you believe in private ownership of your own body, there is pretty much no consistent argument against being able to do as you please with your organs.

i think you see this inconsistency clearly and have no answer, so you just keep hiding from it and trying to make specious appeals to authority and groundless accusations.

there is my definitive, compelling argument. it is logically consistent, and defines the issue clearly and precisely.

when you can find a way to oppose it without contradicting yourself, let me know.

 
At 11/23/2011 12:30 PM, Blogger morganovich said...

ps.

your childish rant about "free markets fix everyhting" is a pure straw man.

no one said they fix everyhting.

they said that they are better than what exists.

they need not be perfect to be superior.

 
At 11/23/2011 3:27 PM, Blogger truth or consequences said...

Ok so we have the status quo...and we have a proposed change. It's not up to me to defend the status quo, it's what we got. It's up to the other side to prove/convince the majority (general pop. and medical professionnals) that the change is better and that the "cure will not be worse than the curse".

from the ISN (International Society of Nephrology)...

"One approach to expanding the pool of kidney donors is to legalize payment of a fair market price of about $40 000 to donors. Establishing a federal agency to manage marketing and purchase of donor kidneys in collaboration with the United Network for Organ Sharing might be financially self-sustaining as reduction in costs of dialysis balances the expense of payment to donors."

Now I could probably warm up to that one as it addresses what I see as some real pitfalls of the wide open "cash for kidneys" proposals....but my guess is that the "markets in everything" crowd will be displaying it's usual all or nothing attitude and reject it.

What do you say?

 
At 11/23/2011 3:44 PM, Blogger rjs said...

what you all think about this?
http://www.bloomberg.com/news/2011-11-01/organ-gangs-force-poor-to-sell-kidneys-for-desperate-israelis.html

VangelV said...
There is a unmet demand for some kinds of babies.

Should an enterprising young couple (or woman) be allowed to procreate for profit?

Why not?


ok, let's take that one step further; should an enterprising couple be allowed to sell their children? if not, at what age do you cut off their marketability?

 
At 11/23/2011 3:49 PM, Blogger morganovich said...

i say it's better than the current system, but still fundamentally incompatible with property rights.

it's your kidney. you should be able to sell it how you want to whom you want.

price fixing by the feds never works.

why set some arbitrary price?

why create a monopsony where only a government agency can buy?

neither will result in the best market or the best availability and both trample your rights in an arbitrary fashion.

further, it just replaces capitalism with nepotism. if you know the right guy, you jump to the top of the list.

the notion that government rationing and price fixing gets you better resource allocation than market is absurd.

international agencies, even medical ones, are hopelessly corrupt.

swapping capitalism for nepotism is a huge loser.

 
At 11/23/2011 4:22 PM, Blogger truth or consequences said...

thanks Morgy...I must be psychic;)

 
At 11/24/2011 3:39 AM, Blogger Ron H. said...

rjs: "what you all think about this?
http://www.bloomberg.com/news/2011-11-01/organ-gangs-force-poor-to-sell-kidneys-for-desperate-israelis.html
"

A free market in kidneys would eliminate this problem.

"ok, let's take that one step further; should an enterprising couple be allowed to sell their children? if not, at what age do you cut off their marketability?"

That was discussed on a previous post. There are some interesting links.

Basically, parents don't own their children, but only have custodial rights, so they can't exactly sell the children, but only the custodial rights. Adoption is not uncommon now, so giving one's children away seems to be OK, what would the difference be if money changed hands?

 
At 11/24/2011 5:15 AM, Blogger sethstorm said...

This is more of a reason to tear down the moral/ethical blocks on research towards cloning human organs. At least there would be an easier argument as the product would be an additional organ as opposed to an organ from an existing person.

You want to have organ sales, start with organs that aren't in an existing body.

 
At 11/24/2011 9:34 AM, Blogger VangelV said...

from the ISN (International Society of Nephrology)...

"One approach to expanding the pool of kidney donors is to legalize payment of a fair market price of about $40 000 to donors. Establishing a federal agency to manage marketing and purchase of donor kidneys in collaboration with the United Network for Organ Sharing might be financially self-sustaining as reduction in costs of dialysis balances the expense of payment to donors."


What a bunch of idiots. Value is subjective. Some people, where the average annual income is $1,000 a year, may be very happy with $20,000. The ISN idiots are just arrogant fools who think that they know more than they actually do. That arrogance needs to be dismissed as what it is.

 
At 11/24/2011 9:35 AM, Blogger VangelV said...

ok, let's take that one step further; should an enterprising couple be allowed to sell their children? if not, at what age do you cut off their marketability?

Since children are not property they cannot be sold. Why can't you understand that point? The only thing that parents own is their right to look after those children. There is no reason why that right should only be given away.

 
At 11/24/2011 9:38 AM, Blogger VangelV said...

This is more of a reason to tear down the moral/ethical blocks on research towards cloning human organs. At least there would be an easier argument as the product would be an additional organ as opposed to an organ from an existing person.

The argument is actually very easy. The problem is that many people on the left and right have trouble with the idea of property rights and self ownership.

 
At 11/24/2011 2:34 PM, Blogger truth or consequences said...

Vange??? so now not only do you want to buy a kidney...but you want to buy it CHEAP?...LOL

"What a bunch of idiots. Value is subjective. Some people, where the average annual income is $1,000 a year, may be very happy with $20,000. The ISN idiots are just arrogant fools who think that they know more than they actually do. That arrogance needs to be dismissed as what it is."

Idiots, arrogant fools?? Did you check the credentials of the executive committee and members of this organization?? They represent the best doctors, administrators, companies that work in the field every damn day from around the whole frikkin world, man!! And they're IDIOTS according to you?

And who/what the heck are you?

"arrogance"??...now there's one subject you'd be an expert on...that's for sure.

 
At 11/24/2011 3:05 PM, Blogger Ron H. said...

"This is more of a reason to tear down the moral/ethical blocks on research towards cloning human organs."

There are no moral/ethical blocks on research on cloning human organs.

 
At 11/24/2011 3:24 PM, Blogger VangelV said...

Vange??? so now not only do you want to buy a kidney...but you want to buy it CHEAP?...LOL

I never said cheap. I said that nobody should set arbitrary prices because the owners of the kidneys are the people who have them in their bodies. We don't need some nanny organization of thieves tell them what they can and cannot do with their property.

Idiots, arrogant fools?? Did you check the credentials of the executive committee and members of this organization?? They represent the best doctors, administrators, companies that work in the field every damn day from around the whole frikkin world, man!!

No matter what the credentials they are just arrogant doctors and bureaucrats, not God. They are planners who love the idea of telling others what they must do and arrogant enough to believe that they have all the information to make the right decisions in all cases. But they are just clueless empty suits who like power.

And they're IDIOTS according to you?

Just because you are smart does not mean that you can't be an arrogant idiot. Most central planners fail not because they are stupid but because their arrogance fools them into thinking that they know more than they do. That makes them idiots.

And who/what the heck are you?

Someone who has been watching central planners make errors his whole life. Someone who knows that the problem was not the planners' IQ or ability to reason but their arrogance and their ignorance of the fact that they did not know as much as they thought. If you and people like you are right and I am wrong the USSR or Mao's China would have prospered because they used some of the smartest people ever to create and execute their plans.



I am. I see it every day in bureaucrats and politicians. And their cheerleaders.

 
At 11/24/2011 3:28 PM, Blogger Ron H. said...

TC: "Idiots, arrogant fools?? Did you check the credentials of the executive committee and members of this organization?? They represent the best doctors, administrators, companies that work in the field every damn day from around the whole frikkin world, man!! And they're IDIOTS according to you? "

Why do you believe that an organization of experts in kidney disease is qualified to suggest political policy in the form of a government agency to control a market in kidneys,? Does expertise in kidneys translate to expertise in other areas?

Worse, how is this group of kidney experts able to determine what a fair market value might be for something that currently has no free market value?

Don't the laws of supply and demand operate here as they do in every other market?

You are seriously confused by your ideology.

 
At 11/24/2011 6:11 PM, Blogger randian said...

Did you check the credentials of the executive committee and members of this organization??

Credentialism is fallacious.

 
At 11/25/2011 9:33 AM, Blogger truth or consequences said...

Ron H....

"Why do you believe that an organization of experts in kidney disease is qualified to suggest political policy in a market in kidneys,?"

Sorry, I thought that would have been obvious:

Because they spend all their working lives closely interacting with donors and recipients and witness first hand the motives, effects that the trade has on all people involved ("the good, the bad, and the ugly" if you will)

Because of the international nature of the association they would have had a chance to assess the successes and failures of a variety of different appoaches that differ from the status quo.

Now I have a question for you...

If my opinion, based on the practical experience of experts in the field (and we agree they are highly educated and probably smarter than the average guy) is "ideology" as you suggest...what is yours based on?

 
At 11/25/2011 12:16 PM, Blogger VangelV said...

Because they spend all their working lives closely interacting with donors and recipients and witness first hand the motives, effects that the trade has on all people involved ("the good, the bad, and the ugly" if you will)

Note that these same people have been caught up in pay for kidney scandals. Note that they all make their money because they get to run the current monopoly system. If you were to ask about the bet way to have an effective mail delivery system would you rely on the managers at the Post Office? Or might you suspect that bias may be a factor?

 
At 11/25/2011 1:41 PM, Blogger truth or consequences said...

If we believed that a country was hiding WMDs and decided that something had to be done about that...For the best course of action to follow would we ask the State Deparment and the Pentagon to formulate plans ....or would we just call Paul H and Vange and get their opinion?

And about the PO....if the decision was to scrap the existing system and come out with something completely new....yeah I'd have some ex-PO managers on board...like maybe 30-50% of that team...simply because they have the experience and could raise red flags when a "great idea on paper" would be an abject failure in reality. "Those that ignore history are doomed to repeat it."

 
At 11/25/2011 7:47 PM, Blogger OBloodyHell said...

>>> i almost would agree with that; but should the same then be true for hearts or livers?

It would certainly encourage people to put themselves on compensated organ donor lists, which would assure your heirs get some benefit from your death. THAT could even occur in an auction form, allowing one to be the highest bidder for the next compatible 'x' body part.

TorC:
One thing to consider is also that some new drugs increase the likelihood of renal failure, etc. -- for an example, which may affect the number of people who get renal failure avoiding a heart attack from high cholesterol or hypertension...

 
At 11/26/2011 1:00 PM, Blogger Ron H. said...

"Because they spend all their working lives closely interacting with donors and recipients and witness first hand the motives, effects that the trade has on all people involved ("the good, the bad, and the ugly" if you will)"

What experience or observation has allowed them to determine the price of a kidney at $40k, when there is no legal market in kidneys? That's just arrogance. The market can determine that price, not doctors.

"Because of the international nature of the association they would have had a chance to assess the successes and failures of a variety of different appoaches that differ from the status quo."

What different approaches would those be? There is no legal market anywhere except in Iran, where by sheer coincidence, I guess, there's no shortage of kidneys.

Now I have a question for you...

If my opinion, based on the practical experience of experts in the field (and we agree they are highly educated and probably smarter than the average guy) is "ideology" as you suggest...what is yours based on?

Your opinion appears to be based on the notion that there is something immoral about paying for a kidney. You haven't offered any good arguments for that position. A person can give away a kidney for free, but can't sell it. No logic there.

Mine is based on the well known and observable fact that a market will provide for something that is needed. It works with every other good and service, and it works in the kidney black market. Why not in a legal, free market?

 
At 11/26/2011 1:37 PM, Blogger Ron H. said...

"If we believed that a country was hiding WMDs and decided that something had to be done about that...For the best course of action to follow would we ask the State Deparment and the Pentagon to formulate plans ....or would we just call Paul H and Vange and get their opinion?"

Who is "we"?

Think back. How did you come to believe that a country was hiding WMD? What groups informed you and told you what must be done about it? Did you actually have any personal involvement or knowledge, or were you just sort of given bits and pieces over time by the news media?


"And about the PO....if the decision was to scrap the existing system and come out with something completely new....yeah I'd have some ex-PO managers on board...like maybe 30-50% of that team...simply because they have the experience and could raise red flags when a "great idea on paper" would be an abject failure in reality. "

You would rehire the same people who currently can't get the job done? Why would they raise red flags then, if they aren't doing so now?

"Those that ignore history are doomed to repeat it."

Exactly!

Why would you scrap the PO and start over from scratch when replacements already exist? The PO solution is to eliminate the legal monopoly the USPS has in delivery of 1st class mail. UPS and FedX are already outperforming the PO in every other capacity, but are forbidden by law to deliver 1st class.

The fact that the USPS can't run a profitable business even with a monopoly, tells you that it would soon go out of business.

 
At 11/27/2011 4:19 PM, Blogger VangelV said...

If we believed that a country was hiding WMDs and decided that something had to be done about that...For the best course of action to follow would we ask the State Deparment and the Pentagon to formulate plans ....or would we just call Paul H and Vange and get their opinion?

Who is we? The idiots who believed Curveball or the fake Niger documents? Why would any rational person believe them when the CIA analysts concluded otherwise and say that there is no new evidence to change the picture?

And about the PO....if the decision was to scrap the existing system and come out with something completely new....yeah I'd have some ex-PO managers on board...like maybe 30-50% of that team...simply because they have the experience and could raise red flags when a "great idea on paper" would be an abject failure in reality. "Those that ignore history are doomed to repeat it."

Why don't you ask the people that managed to drive the PO out of business instead? After all, they have proven to be much better at moving the mail.

 

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