Should we pay donors to increase the supply of organs for transplantation? Yes

doi:10.1136/bmj.a157

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Arthur J Matas, professor of surgery

¹Department of Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, Minnesota 55455

matas001{at}umn.edu

Paymentfor livingkidney donation is illegal in most countries. Arthur Matas believes that legalisation is needed to shorten waiting times, but Jeremy Chapman (doi: 10.1136/bmj.a179) argues that it will reduce the supply of all organs

Today’s biggest problem in kidney transplantation is the shortage of organs; a regulated system of compensation for living donation may be a solution. For patients with end stage renal disease, a kidney transplant provides significantly longer survival and better quality of life than dialysis.1 2 The longer candidates wait on dialysis, the worse the results of transplantation.3 Thus, early transplantation confers an important advantage.

Each year, more patients are placed on the waiting list for a deceased donor transplant than there are available organs. Consequently, each year the waiting list, and the resultant waiting time, get longer.4 In many parts of the United States, the average wait for a deceased donor transplant is five years; in some parts, it is approaching 10 years. Because of the long wait, the death rate for candidates …