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The need for organ transplants in the U.S. does not match the current supply: 120,729 people were on the waiting list for an organ on November 1, 2013.1 Kidneys account for the vast majority of the organ shortage: 98,613 of the people on the waiting list were waiting for a kidney transplant. In 2012, 36,457 people joined the waiting list for kidneys, while only 15,939 people were removed from the wait list as a result of receiving one; 7,188 people died or became too sick to receive a kidney transplant.2 Additionally, some researchers have argued that the official waiting list significantly underestimates the true need for kidney transplants due to inequalities in access.
Matas and Schnitzler 2003 estimated that receiving a kidney transplant from a living donor saves 3.5 quality-adjusted life years (QALYs) and about $100,000 relative to remaining on dialysis, which implies that clearing the kidney waiting list could (naively) save billions of dollars and hundreds of thousands of QALYs.
There are a number of different avenues that may increase the availability of organs for transplant:
Deceased Donors: Deceased donors are the main source of organs for transplant in the U.S., and the only source available for organs other than kidneys and liver.
Living Donors: Transplants from living donors currently make up about a third of all kidney transplants, a proportion that has been declining since 2004.
A philanthropist could plausibly pursue any of the strategies discussed above. We do not have a strong sense of which activities might be most effective or cost-effective, but our initial inclination is to focus on less conventional areas (i.e. incentives for donors, donation after uncontrolled cardiac death) because they appear to receive less attention and to have greater potential than the other approaches discussed.
In practice, we expect that a philanthropist supporting work on either of those issues would likely focus on advocacy and research. In the case of incentives for living donors, the primary approach would likely be to support advocacy efforts aimed at reversing the U.S. ban on exchanging “valuable consideration” for organ donation. On the front of expanding the pool of potential deceased donors to include those who die of cardiac arrest outside hospitals, a philanthropist might support further research to determine the costs and benefits of the approach, or advocacy efforts aimed at encouraging other actors in the transplant system to devote more resources to such approaches.