Shortage of Kidneys for Transplantation
Introduction
As a health care provider, everyday I see patients presenting to the Emergency Department due to renal failure. For kidney failure patients, we at least have the technology to keep them alive using hemodialysis. For liver failure patients, they are often left without real recourse and their mortality is almost certain. While a more permanent solution in the form of organ transplant is technological feasible, few organs are available for needed patients. The inequality between supply and demand is both expensive and fatal. In this paper, I will focus on the problem with insufficient kidney available for transplant, analyze its social and economic effects in the United States and evaluate the problem and a possible solution using economic sociology principles.
Social and Economic Costs
Currently, there are over 100,000 end-stage renal disease (ESRD) patients on the waiting list for a kidney transplant in the United States. (National Kidney Foundation, 2014) Patients have to wait anywhere between 5 to 10 years for a deceased organ. While they wait for available organs, most patients endure a four-hour session in a dialysis center three times per week. In 2009, the annual cost of taking care of an ESRD patient is around $70,000. The total cost was estimated to be over $40 billion. (USA Today, 2009) Because of Medicare rules written in the 1970’s, hemodialysis is a covered service, and no politician who desires to be re-elected will ever suggest eliminating hemodialysis coverage despite the cost. Aside from the financial cost, ESRD results in significant morbidity and mortality. Individuals with no chronic kidney disease are more likely than those with chronic kidney disease (CKD) stage 3 to 5 to be alive 1 year after a heart attack. (National Kidney and Urologic Diseases Information Clearinghouse, 2012) The 1-year mortality for heart attack patients without chronic kidney disease is 36%, compared to 51% for patients with CKD stage 3 to 5. The five-year survival rate for a transplant patient is 85.5%, compared to 35.8% for a patient who remained on dialysis. Studies have shown the living donor kidneys are not only better kidneys for the recipients; donors also live very healthy lives with only one kidney.
Sociological Analysis During the 19th and 20th centuries, sociological studies focused on conflict theories. Numerous sociologists developed important philosophical principles that helped us understand conflicts and limited resources in our society. The field of conflict theory allows us to understand how scarce resources are allocated. Karl Marx and Friedrich Engels’s work in the mid 1800’s led us to understand resource conflicts in terms of class struggles. (The Communist Manifesto, 1848) The proletariat and bourgeoisie compete for control over scant resources. In their texts, Marx and Engel focused on the idea of alienation in the form of giving one’s labor. In a parallel fashion, there is probably no greater form of alienation than donating a kidney. The current distribution of kidneys in the United States is regulated by the United Network for Organ Sharing, UNOS. UNOS serves as an important liaison arranging for kidneys to be harvested from deceased donors and provide social support to living donors. 20th century sociology C. Wright Mills would view such system and organization as a part of the power elite, holding onto centralized power and authority within the society. (Power Elite, 1956)
Solution
Though highly frowned upon and not accept by most countries, one way to increase the availability of transplantable kidneys is to pay for them. Despite laws prohibiting the sales of human organs, it is currently done in black market where there is little transparency and protection for both the donor and recipient. Modern economic sociologists, such as Gary Becker and Julio Elias, have argued for the government to pay for kidneys in order to alleviate the severe shortage. In their study, Becker and Elias discuss the one country where there is no shortage of donor organs, Iran. In the Iranian system, organs are not bought and sold at the bazaar. Patients who cannot be assigned a kidney from a deceased donor and who cannot find a related living donor may apply to the nonprofit, volunteer-run Dialysis and Transplant Patients Association (Datpa). Donors receive donors between $2,300 and $4,500 from the recipient, $1,200 and one year of limited health-insurance coverage from the government. To ensure objectivity, Datpa identifies potential donors from a pool of applicants. Those donors are medically evaluated by independent transplant physicians in just the same way as are uncompensated donors. The Iranian system began in 1988 and by 1999, kidney shortage was eliminated. (Tabarrok, 2010) Becker and Elias estimated that in the United States, a payment of $15,000 would eliminate the shortage of transplantable kidneys. (Journal of Economic Perspectives, 2007)
Conclusion
The shortage of transplantable kidney in the United States is a fatal problem. The breathe and nature of the problem can be understood using sociological theories proposed by Marx, Engels and Mills. Ironically, it appears that empiric data suggest that this problem with scarce resource can be solved using the capitalistic, free market forces that were criticized by Marx, Engels and Mills.