Study: the kidney shortage kills more than 40,000 people a year

As a kidney donor, I talk a lot about the deadly scale of the kidney shortage in the US. A new paper helpfully puts a number on the problem: 43,000.

If there were enough kidneys for everyone in the US who needed one, we could save 43,000 lives every single year.

That’s the conclusion of researchers Frank McCormick, Philip Held, and Glenn Chertow, in an editorial published in the Journal of the American Society of Nephrologists.

Their math is rough, but simple. Every year about 126,000 people are diagnosed with end-stage renal disease (ESRD), the most severe form of kidney disease that typically necessitates a transplant. Not everyone diagnosed with ESRD would benefit from a transplant, mostly because some are already so sick and have weakened enough immune systems that their bodies couldn’t handle the transplantation of a foreign organ.

But McCormick, Held, and Chertow estimate, based on prior research, that about half of the diagnosed (or 63,000 people a year) would benefit from a transplant. That’s far more than the 31,000 who get added to the kidney waitlist each year; the backlog is so great that many people who’d benefit aren’t added. Of the 63,000 who’d benefit from a transplant, only 20,000 get one. Only 6,000 get a living donor kidney, which add another nine to 10 years of life on average, while the rest get deceased donor kidneys, which help considerably but last less long.

The 63,000 newly diagnosed people who would benefit from a transplant minus the 20,000 who will get one leaves us with the 43,000: the group of new people, each year, who will die prematurely on dialysis because they couldn’t get a new kidney.

43,000 people is … a lot of people. McCormick, Held, and Chertow note that it’s equivalent to 85 fully-boarded 747s crashing every year. It’s more people than die annually due to homicide, Parkinson’s, or HIV, and roughly similar to the suicide death toll. The kidney shortage kills more people than all gun deaths combined.

Healthy individuals have a clear option for helping ease this crisis: They can donate their kidney. They can give to a family member if they’re suffering, or to a stranger, like I did. If you’re part of a chain, you can help three, four, maybe as many as 30 different people get kidneys. It’s the best thing I’ve ever done in my life, and I encourage any readers thinking about it to fill out this form and learn more.

But as a society, what should we do to end the shortage? A lot of people I talk to about kidneys place hope in kidney transplants using 3D printing or stem cells, but while those technologies are promising, they are not clinically available yet, and are not likely to be in the near future.

“Until the happy day arrives when such [artificial] organs are readily available,” McCormick, Held, and Chertow write, “we should address here and now the terrible premature death toll caused by the kidney shortage with a technology that is already available and proven — compensating donors for their kidneys.”

Compensation is a controversial topic, and raises the specter of shady organ markets exploiting poor people. But there are a lot of things short of outright paying people for their kidneys that we can, and should, try.

One approach, endorsed in theory by mainstream kidney organizations like the National Kidney Foundation (NKF), is removing disincentives to donation by compensating donors for our lost wages, child care, and travel expenses incurred due to donation. The Trump administration could go a long way to funding lost wages with a simple regulatory change, and support from NKF — which, according to a spokesperson, “has not taken a position on this specific proposal” — and the rest of the kidney world could only help.

Then we could experiment with non-monetary incentives, as Rep. Matt Cartwright (D-PA) has proposed in his Organ Donor Clarification Act, which has bipartisan support in the House. Cartwright’s bill would enable pilot tests of incentives like, say, a lifetime of free health insurance, or GI Bill-style education benefits, or student loan forgiveness, or life insurance, or retirement savings contributions, instead of pure cash.

That approach reduces fears about exploitation that come with cash compensation while still providing incredibly valuable incentives that would increase donation and save lives. Cartwright’s bill would also clarify that it is legal for hospitals and perhaps Medicare too to reimburse donors for lost wages and other expenses incurred due to donation, going further than the Trump administration can with a single rule change.

In the meantime though, if you’re in good health and can afford the expenses, I really recommend considering donating. You’ll save a life, and then become part of a wonderful community of living donors trying to think up ways to save even more lives in the future.

Editor’s note: This piece has been updated with NKF’s position on a regulatory change allowing the National Living Donor Assistance Center (NLDAC) to reimburse lost wages and child care expenses for living donors.

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