The Rationale for Incentives for Living Donors: An International Perspective?

The organ shortage has become a crisis for transplant candidates with end-stage renal disease, and a significant number of them either die while waiting or become too sick to transplant. A consequence, worldwide, has been the development of unregulated markets for donation; these markets have been associated with poor outcomes for both donors and recipients. In contrast, a regulated system of incentives might increase donation rates while also providing a benefit to donors. Criteria for an acceptable system have been proposed: protection of the donor and recipient, regulation, transparency, and oversight. Many of the concerns about the implications and impact of such a system could be answered with a clinical trial in a country (or countries) that can meet the described standards. Yet the debate about the advisability of developing such a system continues, even as the waiting lists grow and candidates die while waiting.