![]() Surveys have shown that the public: (1) support incentives and (2) would be more likely to donate if incentives were offered ( 20, 21). Yet, numerous scholars and consensus conferences have concluded that there are no ethical principles by which incentives should be rejected under all circumstances ( 15– 19). At first, many opposed incentives as a matter of principle, claiming that an incentive for donation was wrong in itself. Over the ensuing years, the pros and cons of incentive programs have been debated. When the concept of incentives was first proposed, almost 3 decades ago, there was immediate condemnation ( 14). Thus, these unregulated markets have been associated with adverse consequences for both donors and recipients.Ī regulated system of incentives for donation has the potential to increase both living and deceased donation while eliminating the harms of unregulated markets. Often, the medical and surgical details have not been sent with them, so that their home transplant center has tremendous difficulty with continuation of care. At the same time, because of limited donor screening, some recipients have developed serious infections transmitted by the donor organ others have received little postoperative care or immunosuppressive treatment and have returned to their native country with active rejection and no knowledge of which immunosuppressive medications they were given ( 9– 13). Living donors who participate in these unregulated markets are often poorly informed about the procedure, deprived of appropriate screening and of quality postoperative and continuing medical care, and not compensated as agreed upon ( 6– 9). Such underground, unregulated markets have been associated with exploitation of the poor and vulnerable. Yet, because of: (1) the shortage of kidneys, (2) the morbidity and mortality associated with long-term (or no) dialysis, (3) increasing desperation of many candidates and (4) the potential for profit, illegal and unregulated organ markets have developed throughout the world. Within some countries, only biologic relatives are permitted to be living donors. In most countries donation is limited to “altruistic” donors (in the case of deceased donation, donor families) and by law, donors are not allowed to receive anything of material value in exchange for giving a kidney. Because of the ongoing shortage, many suitable transplant candidates suffer and ultimately die while waiting for a transplant. This growing shortage persists in spite of efforts to prevent ESRD and the recent expansion of both deceased donation (through the use of such strategies as expanded donor criteria and donation after cardiac death) and living donation (through increased unrelated and nondirected donation, paired exchanges, ABO incompatible transplants, desensitization and transplant chains). Because of the increasing demand for a transplant and a relatively static supply of organs, there is a widening gap between the number of patients wanting a kidney and the number of available organs. deceased) donors are associated with better short- and long-term outcomes ( 4) and facilitate early or preemptive transplantation, thus avoiding the adverse consequences associated with dialysis ( 5).īecause of the benefits of transplantation, patients with ESRD increasingly opt for a transplant. ![]() ![]() Patients can receive a kidney transplant from either a living (biologically related or unrelated) or deceased donor. The reasons are clear-for patients with end-stage kidney disease (ESRD), a kidney transplant offers significant advantages compared to dialysis: increased longevity ( 1), a better quality of life ( 2) and cost-effectiveness (including cost saving for the health care system Ref. Every country with an active kidney transplant system is working to increase organ donation. ![]()
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