A Primer on Kidney Transplantation: Anatomy of the Shortage

23 Pages Posted: 21 Jan 2014 Last revised: 14 Jan 2015

See all articles by Philip J. Cook

Philip J. Cook

Duke University - Sanford School of Public Policy; Duke University, Dept. of Economics; National Bureau of Economic Research (NBER)

Kimberly D. Krawiec

University of Virginia School of Law

Date Written: December 20, 2014


Kidneys are unique among the solid organs due to the combination of the low risk of living donation, the feasibility of sustaining life on dialysis for several years following kidney failure, and Medicare coverage of dialysis and transplantation for kidney patients. Despite these advantages, thousands of Americans die each year while waiting for a kidney transplant, and the waiting list grows each year. In this kidney transplantation primer, we provide a quantitative description of the kidney shortage and discuss future trends and possible solutions. We demonstrate that the current system provides only about half as many kidneys as are needed for transplantation and the gap cannot be eliminated through an increase in deceased donation alone, because most kidneys from suitable deceased donors are already procured. The prospects for increasing living donations under the current system are also dim. Donations from living kidney donors have declined from their 2003 peak and nearly all living kidney donations are directed by the donor, usually to family members, rendering the current account of living kidney donation as “altruistic” somewhat misleading. For all of these reasons, we believe the time is ripe to reconsider financial incentives for kidney donation. Needless to say, a system that provided financial rewards for living donors could produce unsavory consequences, and would have to be carefully designed and managed. But without such a system, the most likely version of the future is a continuation of unnecessarily high rates of death and disability from kidney failure.

Keywords: organ donation, kidney transplantation, kidney shortage

JEL Classification: I12, I18, K00, K32

Suggested Citation

Cook, Philip J. and Krawiec, Kimberly D., A Primer on Kidney Transplantation: Anatomy of the Shortage (December 20, 2014). Law and Contemporary Problems, Vol. 77, No. 3, 2014, USC CLASS Research Paper No. CLASS14-3, Available at SSRN: https://ssrn.com/abstract=2381296

Philip J. Cook

Duke University - Sanford School of Public Policy ( email )

201 Science Drive
Box 90312
Durham, NC 27708-0239
United States
919-613-7360 (Phone)
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Duke University, Dept. of Economics

213 Social Sciences Building
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National Bureau of Economic Research (NBER)

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Cambridge, MA 02138
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Kimberly D. Krawiec (Contact Author)

University of Virginia School of Law ( email )

580 Massie Road
Charlottesville, VA 22903
United States

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