The Broken Economics of Organ Transplants

I just saw this video on YouTube from Wendover Productions:

I didn’t know about the EPTS score. That was never mentioned to me at either transplant centers. I was led to believe that the wait list mainly depended on blood type and geography. The wait list in Southern California for B-type blood is 9-11 years and approximately 4 years in Phoenix, Arizona. If the organ recipient selection is based on this EPTS score, then I’m screwed. I found a calculator online and my number is 64%. I guess that means about 2/3 of the patients on the wait list will live longer than me post-transplant. The website also has a PDF that helps explain the EPTS score.

Interpreting the EPTS Score

The EPTS score, which ranges from 0% to 100%, represents the percentage of kidney candidates in the reference population
with a higher expected post-transplant survival. Lower EPTS scores are associated with higher expected post-transplant
longevity, and vice-versa (Figure 1).

Candidates with EPTS scores less than or equal to 20% will be prioritized by the kidney allocation system to receive
kidney offers from donors with the highest estimated quality (KDPI ≲20%). Candidates with EPTS scores exceeding 20%
will be eligible to receive these offers. They will be prioritized after candidates in the EPTS top 20%.

https://optn.transplant.hrsa.gov/media/1511/guide_to_calculating_interpreting_epts.pdf

I think what it says is that I won’t get the best kidneys available. Those will be offered to patients with EPTS scores <20%. After that, I can’t tell if it’s wait time based or still ranked by EPTS scores. If I put no for diabetes, the number drops to 27%. I guess that’s a huge determining factor on post-transplant survival. Also, I think the patient’s age and years on dialysis affects the score negatively so in long wait time areas, your score gets worse every year, while younger and newer patients get priority. Maybe this is why some people have had three or four kidney transplants by age 20, while older patients have to wait 10+ years for a deceased kidney and one of lower quality.

I don’t know what the right answer is. The video did mention Iran’s experiment with using a market based approach eliminated the wait list. However, it did not mention whether poor people were priced out of the market. How do you determine the ethics of saving a small random number of transplant patients versus saving more lives but biased toward more well-off patients? I guess our society has decided that more people should die so we can have wealth equality.

==========

Ironically, dialysis and kidney transplants are covered by Medicare in the US. That means almost everyone’s treatment and surgery costs are paid by taxpayers anyway. There’s got to be a way to calculate the cost savings between a live donor transplant versus dialysis until death. Based on my dialysis statements, we can use $5,000/month or $60k/year for dialysis on Medicare rates. If a typical patient stays on dialysis for 10 years, that’s $600k. This website quotes a kidney transplant will cost Medicare $100k so we can double that for live donor transplants since there are two surgeries. That’s $400k of savings.

So it appears that Medicare can offer donors $100k for a kidney and still save $300k if the patient would have lived >10 years on dialysis. They can still have their “ethical” wait list but vastly increase organ supply, improve the quality of donated organs (live vs. deceased donor), and save taxpayers money. Maybe the complaint will be that only poor people will be incentivized to donate or some people are not healthy enough to donate, and that will be somehow unfair. Meanwhile, you are saving thousands of additional lives each year and reducing the number of suffering dialysis patients.

Then there’s the China model where government officials harvest organs from political prisoners and sell them on the black market.