Rohin Dhar, at the Priceonomics Blog has put together a brilliant, straight-forward essay describing the problem, showing how current ideas for increasing the organ supply (make donating organs the default after death, paired kidney donation, improved donor-recipient matching) are not working and cannot hope to solve the problem and then goes on to describe a hypothetical organ purchasing system run by medicare. I'm convinced.
When discussing this on twitter, the always interesting Christos Argyropoulos talked a bit about the problem with Greece's implementation of default organ donation:
@kidney_boy The Iranian system was covered last year in KI if I am not mistaken. Opt out can also backfire as it has in Greece
— ChristosArgyropoulos (@ChristosArgyrop) May 29, 2013
@kidney_boy Opt out legislated in 2011;hugely unpopular, a couple of high profile resignations from the Ntl Transplant body-> # of Txps down
— ChristosArgyropoulos (@ChristosArgyrop) May 29, 2013
@kidney_boy Public pushback makes ICUs reluctant to refer donors,even though almost everyone is. Opt out systems are embraced not imposed
— ChristosArgyropoulos (@ChristosArgyrop) May 29, 2013
An open access review of Iran's transplant system can be found here (A non-systemic review from McGuil University? I grow feint.) Here is the Kidney International paper Dr. Argyropoulos was referring to.
Look at how the number of transplantations is growing in Iran:
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| Mitra Mahdavi-Mazdeh. Kidney International, 2012 |
While it is flat in the US:
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| USRDS |
The current system of paired exchanges and campaigns for kidney donors has noble intentions, but it’s not working. People are needlessly dying as a result.
