How to End the Kidney Shortage.

• Author: McCormick, Frank

News stories abound of kind people--relatives, close friends, and even complete strangers--who donate a kidney to someone suffering from kidney failure. These stories usually explain that people whose kidneys have failed must either obtain a transplant, which enables them to live 10-20 years in reasonably good health, or suffer on dialysis for an average of four to five years as their health steadily deteriorates until they die.

Sometimes these stories explain that many kidney failure patients never receive the optimal treatment of a transplant because there is a drastic shortage of transplant kidneys. About 125,000 patients are diagnosed with kidney failure each year, but only about 22,000 receive a transplant. In a 2022 Value in Health article, we estimate that more than 40,000 additional kidney failure patients would be saved from premature death each year if they received kidney transplants.

Recently, there have been news stories about xenotransplantation: the transplanting of animal organs (usually from pigs) into humans. These came after a patient with terminal heart failure received a genetically modified pig heart and lived for two months. That raised the hopes of many that this breakthrough might be extended to kidneys. However, Food and Drug Administration approval for xenotransplant kidneys will not occur for some time (if ever); the data from the first Stage One trial--which is merely the first step toward any approval-won't be available for at least a decade. It is extremely unlikely that anyone currently suffering from kidney failure will benefit from xenotransplantation.

Few if any of these news stories lamenting the kidney shortage or touting high-tech breakthroughs mention that we already have a solution to the shortage: compensating kidney donors to induce more supply. Frustratingly, the U.S. government is obstructing this solution.

NOTA is the problem / Virtually all economists who have studied the issue believe the basic cause of the kidney shortage is a provision in the 1984 National Organ Transplant Act (NOTA): "It shall be unlawful for any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation if the transfer affects interstate commerce."

This sentence seems innocuous, but it imposes a price ceiling of near-zero on the market for kidneys. Both economic theory and abundant evidence have shown that whenever the government holds the price of a good below the...