July 15, 2019

Possible Effects of Reimbursing Kidney Donors

Donald Trump recently passed an executive order which, among other things, will allow live kidney donors to get reimbursed for expenses like childcare costs and lost wages they incur during the donation procedure.

Hopefully, this will enable many more people to donate kidneys and is great news for the supply of kidneys in the US. However, I couldn’t help feeling immediately dismayed at the thought of donors having to go through a cumbersome bureaucratic reimbursement process.

I doubt I’m alone in having many negative experiences with reimbursements, from lengthy delays to getting denied based on technicalities. Because of these negative experiences, I’m extremely wary of using any service that requires me to make an upfront payment and get reimbursed later — and I will only do it if I’m sure I can cope if I don’t end up getting the money back. In the case of kidney donation, I imagine the costs incurred could be pretty significant, and I’d be very, very, nervous about going ahead based on the promise of a reimbursement, without knowledge of how reliable and efficient the process is.

But you might argue: Surely even an unreliable option of reimbursement is better than the current system where nothing (except travel) is covered?!

I hope so. But I have some concerns.

If I pay for something without any expectation of compensation, I don’t feel an injustice when I don’t receive a reimbursement. However if I pay for something with the expectation of a reimbursement, and then it never materializes (or the process is very painful), I feel resentful and angry.

Currently, the people who donate kidneys (presumably) see the costs they incur as part of their generous, altruistic action. I’m concerned that once a reimbursement option is on the table, if it’s not processed efficiently, they may end up feeling negative and resentful about something they would have otherwise given gladly (research suggests that when people are offered compensation for an activity they normally do for free, it changes their attitude and can taint the thing).

I hope that the negative effects of this are outweighed by the addition of new kidney donors who wouldn’t have participated if compensation wasn’t offered, but this also has an issue: if people start donating kidneys based on the promise of the reimbursement but the process is poor, they may experience financial hardship. As well as being a terrible experience for them, this could reflect badly on the whole system and make others wary of getting involved.

On balance, it still seems likely that offering reimbursements will increase the kidney supply (as Vox points out, donation rates in Israel quadrupled after a similar law was passed). And most of my concerns dissipate if the reimbursement system is implemented effectively and has the confidence of potential donors. I hope this works out and my misgivings are misplaced!