Patient Willingness to Pay for a Kidney for Transplantation
Abstract and Introduction
While kidney transplantation is the most cost-effective treatment available for end-stage renal disease (ESRD) and affords patients with the best quality of life, the current supply of kidneys does not meet the demand. A potential solution to increasing the supply is to compensate living donors for a kidney. The purpose of this study was to describe ESRD patient willingness to pay for a kidney. Using a self-administered survey, 107 patients in 31 U.S. states completed the survey. The quantitative method and descriptive survey design employed descriptive, correlational, nonparametric and multivariate statistical tests to evaluate the data. Of participants, 78.5% were willing to pay for a kidney; there were significant correlations between gender, health status, household income, preferred source of a kidney and willingness to pay. Men, patients with poor and fair health status and those with household incomes ≥$50 000 were more willing to pay. Step-wise regression analysis found price and doctor's influence accounting for 52% of variance in willingness to pay. As price increased and doctor's opinion mattered, willingness to pay increased. This study supports development of additional studies with larger sample sizes and patients on kidney transplant waiting lists.
End-stage renal disease (ESRD) is a life-threatening illness that is physically debilitating for patients and creates economic challenges for patients and society. Estimates predict that by 2030, the number of patients suffering from ESRD in the United States will climb to 2.24 million. In 2007, 527 283 patients suffered from ESRD and 87 812 patients died of ESRD. Although not all patients with ESRD are transplant candidates, a significant proportion are candidates. Currently there are over 83 300 patients on the waiting list for a kidney transplant in the United States and researchers estimate that an additional 70 000 are candidates. In the last two decades, the number of patients with ESRD opting for a transplant has significantly increased however; there has not been a commensurate increase in the number of organs available for transplantation. Researchers reported that candidates over 60 years old have a greater chance of dying while waiting than they do of receiving a kidney. While kidney transplantation is the most cost-effective treatment method available for ESRD and affords patients with the best quality of life, the supply of kidneys from deceased and living donors does not meet the demand for kidneys. At the end of 2007, 71 862 patients were on the waiting list, 16 119 patients had received a transplant, and 4452 patients had died while waiting for a transplant.
To address the paucity of kidneys for transplantation, two models of compensation for donation have been proposed. The first is a free market where the recipient directly pays for the kidney. The second is a regulated system where the government (or insurance company) compensates the donor and the kidney is allocated to the next person on the waiting list (similar to the allocation of deceased donor kidneys). The disadvantage of the free market is that only the wealthy may be able to participate; in a regulated system, all candidates with ESRD could participate. Although this study did not directly address the two models, the study's findings are informative. The purpose of this research was to describe patient willingness to pay (WTP) for a kidney for transplantation from a healthy living donor. Of note, men, participants with fair and poor health status, and those with incomes ≥$50 000 were more willing to pay for a kidney suggesting that a free market would lead to social inequities.