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Iran pays kidney donors. Should the U.S. follow?

In the U.S., Medicare spending on dialysis accounts for nearly 1 percent of the entire federal budget, and the cost is growing. On the other hand, kidney transplants are actually less expensive and offer the possibility of getting back to work and off disability, but there are not enough for every patient in need. Economics correspondent Paul Solman looks at one idea for spurring donations.

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  • Judy Woodruff:

    Now, the demand for a kidney transplant and a controversial idea used elsewhere to increase the odds of getting one.

    The facts can be grim. More than 100,000 people in the U.S. are awaiting a kidney transplant, and the median wait time is more than three-and-a-half years.

    Economics correspondent Paul Solman looks at the considerable odds Americans are facing and one very unusual market for obtaining a kidney.

    It's part of his weekly series, Making Sense.

  • Jairo Acevedo:

    I was born with something called polycystic kidney disease. And around the age of 23, I began to swell up more, retain water.

  • Paul Solman:

    At age 32, Jairo Acevedo ended up in the emergency room.

  • Jairo Acevedo:

    They said, your kidneys have totally shut down.

  • Paul Solman:

    So, for over seven years now, Acevedo's been undergoing kidney dialysis at New York's Westchester Medical Center, learning to set the procedure up himself, in part to relieve the boredom of the four-hour sessions three times a week. And the price?

  • Jairo Acevedo:

    Each treatment, it's about $700 to $800.

  • Paul Solman:

    So that's 100,000 a year, a little more.

  • Jairo Acevedo:

    It's pretty costly.

  • Paul Solman:

    In total, nearly a million dollars to date. And then there's the pain.

  • Jairo Acevedo:

    There are days when I wake up and my lower back, my kidney area just hurts too much, it's on fire.

  • Paul Solman:

    Not to mention the mental toll.

  • Jairo Acevedo:

    Some doctors just call it pee in the brain.

  • Paul Solman:

    Pee in the brain?

  • Jairo Acevedo:

    Yes, pee in the brain. Your mind starts to slow down, and even paying attention or concentrating becomes an issue.

  • Paul Solman:

    What's happening now is your blood is being recycled through the machine to get rid of…

  • Jairo Acevedo:

    A lot of the waste and the toxins and the liquid.

  • Paul Solman:

    Unable to work — he used to be an auditor at an HMO — Acevedo survives on disability benefits from Social Security and medical benefits from Medicare, which picks up the total dialysis tab for Acevedo and every other such patient in America.

    With some half-a-million of us on kidney machines, spending on dialysis alone accounts for nearly — get this — 1 percent of the entire federal budget, more than the outlay for all foreign aid. And the cost of dialysis is growing.

  • Dr. Thomas Diflo:

    The population is getting older, lot more diabetes, hypertension, and these all have significant impact on kidney disease.

  • Paul Solman:

    Dr. Thomas Diflo is the chief of kidney transplant surgery here. The cost of that?

  • Dr. Thomas Diflo:

    The transplants all in cost probably $120,000.

  • Paul Solman:

    At first glance, a bloody fortune, also paid by the government. But when you compare it to $100,000-a-year dialysis…

  • Dr. Thomas Diflo:

    So if you do a transplant on somebody and the kidney lasts for more than a year, year-and-a-half, then the system actually saves a great deal of money. And if you look at how people do after a transplant just, from a health point of view, they do much, much better.

  • Paul Solman:

    Which means lower medical costs and the possibility of getting back to work, and off disability and Medicare entirely.

    Stay on dialysis, though, and the medical problems and their costs compound.

  • Jairo Acevedo:

    This machine does take a toll on your heart.

  • Paul Solman:

    Last year, Acevedo had bypass surgery. Before that, he'd had 18 stents inserted to keep his arteries open.

    In short, a kidney transplant would be a colossal cost-benefit win-win. But, with no living donor, someone with a matching blood and tissue type willing to give him one of their two kidneys, Acevedo's sole option is a waiting list for a deceased donor kidney.

    You have a number?

  • Jairo Acevedo:

    The last time I checked it, it was about in the 30,000s, I believe.

  • Paul Solman:

    Thirty thousand?

  • Jairo Acevedo:

    Yes, that was like two years ago. And after that, I decided just to wait out and not look at the number again.

  • Paul Solman:

    So, is there nothing to be done?

  • Mohammad Akbarpour:

    We are losing nearly 10,000 people per year because they don't have a family member, they don't have a friend who can donate to them.

  • Paul Solman:

    Well, consider Iran, which for 30 years has had the world's only legal market for kidneys. It grew out of necessity, says economist Mohammad Akbarpour, after the Iran-Iraq War.

  • Mohammad Akbarpour:

    Because of sanctions, assets were frozen. The country didn't have even dialysis.

  • Paul Solman:

    So, the government made a radical announcement.

  • Mohammad Akbarpour:

    If you donate your kidneys to your fellow citizens, the government is going to compensate you.

  • Paul Solman:

    The equivalent of some 4,500 U.S. dollars, more than half a year's average household income in Iran.

    Today, recipients of live kidneys pay most of that cost, at a literal market in downtown Tehran. The government pays for the actual operation.

    And for those who can't afford to buy from a living seller, whose kidneys have the best chance of success, cadaver kidneys are free, and relatively plentiful.

    Akbarpour and others say the market has slashed the waiting time for a kidney down to around a year, and completely eliminated the need to ask relatives or friends to donate one of theirs.

    Dialysis patient Zahra Hajikarimi was confident she'd be transplanted soon.

  • Zahra Hajikarimi (through translator):

    I can't imagine living without the possibility of a kidney donation, of having to suffer with this disease until the very last moment of your life.

  • Paul Solman:

    So, this is the solution, right? A free market for kidneys. But — and you knew this was coming — even in Iran, cash for kidneys is suspect.

    For one thing, most sellers are poor. Who else would run the risk of a major operation to remove a vital organ, even if you can live with just one kidney?

  • Man (through translator):

    The reason I had to sell my kidney was that my life would have completely fallen apart if I didn't do that.

  • Paul Solman:

    This Iranian wouldn't agree to show his face on camera.

  • Man (through translator):

    I would have lost my wife, my child, my life.

  • Mohammad Akbarpour:

    If I sell my kidney to feed my starving family, it's not actually a voluntary transaction.

  • Paul Solman:

    Moreover, says transplant doctor Diflo-

  • Dr. Thomas Diflo:

    People would have significant incentive to hide things.

  • Jairo Acevedo:

    How would you know if you're getting a good kidney?

  • Melanie Melillo:

    I'm not sure how you could regulate it as well to make sure that the donor is being taken care of medically.

  • Paul Solman:

    And there's at least one more problem with cash for kidneys, says Melanie Melillo, who was moved to become an altruistic donor as she has watched her husband suffer with end-stage kidney disease.

    If there were a market for kidneys, would you feel the same way?

  • Melanie Melillo:

    I don't know.

  • Paul Solman:

    Chances are, she wouldn't, says economist Akbarpour.

    Look at the history of paid blood donations in the U.S. and around the world.

  • Mohammad Akbarpour:

    Once they started paying money for blood donation, actually, the donation went down. I mean, I was giving my donation for, I mean, moral reasons. Now you're paying me. It's not moral anymore.

  • Paul Solman:

    Right.

    But he asks, with 100,000 Americans waiting for a kidney, why not give at least some small incentives to encourage donation?

  • Mohammad Akbarpour:

    Now, in this country, if you donate a kidney, you cannot even get reimbursed for your travel.

  • Paul Solman:

    Or lost wages.

    Even Dr. Diflo, who opposes legalization, says we ought to improve the economics somehow.

  • Dr. Thomas Diflo:

    So, things like universal health insurance for donors, paid at the government's expense, I think, is a very reasonable thing to do.

  • Paul Solman:

    With no other way of increasing the number of kidneys for transplant, the prognosis is grim for patients like Jairo Acevedo.

  • Jairo Acevedo:

    They say that for every year that you spend in this machine, you lose five years of your life expectancy. So, if you were to live to 80 years old, if that is the number, your time clock, I have lost about 35 years of that.

  • Paul Solman:

    How old are you now?

  • Jairo Acevedo:

    I am 39. Hopefully, I will be turning 40 in December.

    (LAUGHTER)

  • Paul Solman:

    Well, we're rooting for you.

  • Jairo Acevedo:

    Thank you. So am I.

    (LAUGHTER)

  • Paul Solman:

    For the "PBS NewsHour," this is economics correspondent Paul Solman reporting from Westchester, New York.

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