An innovative voucher program has begun at the UCLA Medical Center to increase the number of live kidney donations. The program allows for an individual to donate his or her kidney in exchange for a voucher that allows the donor’s specified voucher recipient to receive a kidney in the future. See HERE for the details.
Presently the number of people needing a kidney donation far exceeds the number of available kidneys. Historically, kidneys were obtained upon the death of an individual via the United Network for Organ Sharing (UNOS) and were (and still are) dispensed via a transparent process matching donors and recipients based upon disease severity and tissue-type matching. More recently, it has become possible for a living person to donate one of their two kidneys to another individual that the donor specifies (usually a close family member). The process is managed by several organizations, such as the National Kidney Registry. The process is regulated such that donor kidneys may not be bought or sold. There are real health risks to the donor in a live kidney donation but the actual risk of death is low. Despite the addition of live kidney donations to the pool from UNOS, the number of people awaiting a kidney donation far outpaces the number of available kidneys – approximately 13 people die every day awaiting a kidney transplant.
Trusty Wikipedia defines a voucher as “a bond of the redeemable transaction type which is worth a certain monetary value and which may be spent only for specific reasons or on specific goods”. Is this voucher system going to lead to a “cash for kidneys” situation? Presently, there appear to be some good safeguards in place. The UCLA voucher is not transferable to anyone other than the five people listed on the voucher, and only the first person within the list needing a kidney can redeem that voucher. Recipients are also identified by specific tissue typing and blood typing, making it virtually impossible to transfer the voucher to a random person. As long as these restrictions remain in place, these vouchers should have no market value for anyone not listed on the voucher.
But the voucher program does abstract the act of donating a kidney, storing the value of the act in paper format, allowing its redemption (in this case, the receiving of a kidney) at some future time. Effectively, the voucher program monetizes the kidney donation. Kidneys perish and vouchers do not. This is effectively one of the benefits of using money over bartering as a basis for expanding trade. UCLA hopes the voucher program results in such an expansion of the supply of kidneys and that expansion of supply is a good thing.
However, this monetization of the kidney donation program demands we remain ever more ethically vigilant to avoid heading down the slippery slope of “cash for kidneys”.