It’s illegal to pay people for organs, but some advocates want a $50,000 tax credit for kidneys

Gregory Hess was running out of time. His kidneys had stopped working. He’d die without an organ transplant.

For two years, Hess had scrambled to find a kidney donor. Friends and family offered to donate, but each potential donor got ruled out for medical or logistical reasons.

Hess, an emergency medicine doctor from Wayne, began flying around the country to register with multiple transplant centers, which improved his chances of getting a kidney on a waitlist with roughly 90,000 Americans.

People in need of kidney transplants can buy better odds, but not a kidney. Federal law bans organ sales in the United States.

Hess’ life was saved last May after a stranger learned about his plight through a local church and donated her kidney. Now, Hess has signed onto a growing coalition of kidney recipients and donors pushing the federal government to provide a financial incentive to living kidney donors.

They think a $50,000 tax credit over five years — $10,000 a year — would encourage more living donors to give a kidney to a stranger. (Donors would get paid regardless of their income under the 10-year pilot program envisioned in the End Kidney Deaths Act.)

Hess sees the proposal as a way to address racial and socioeconomic disparities in kidney disease, which disproportionately affects people living in poverty and Black Americans. Many don’t have the financial means or social network to find a donor on their own.

“A wealthy person is more likely to be able to put up a big billboard on the Schuylkill or some other major highway to say, ‘I need a kidney,’” Hess said.

But many bioethicists are vehemently opposed to the idea, calling it “horrific,” “immoral,” and “exploitative.”

“It’s basically paying people for organs. They just turned the idea into a tax refund to try and quiet down all the people who hate that idea,” said Arthur Caplan, a bioethics expert and professor at New York University. “It’s just a more polite way to create a market in body parts.”

It’s illegal to sell and buy organs in the United States under the 1984 National Organ Transplant Act (NOTA). The tax incentive proposal, launched this year by the Coalition to Modify NOTA, seeks to upend 40 years of the status quo in kidney donations.

Critics fear that it could undermine efforts to end illicit organ markets in some foreign countries, where people in poverty may be coerced into selling a kidney or driven to make a decision they’ll regret. They also argue that a financial incentive would make the experience of donating a kidney during your life less meaningful and ultimately decrease the number of so-called altruistic donors — those who give a kidney to a stranger.

Advocates say the tax incentive would increase the number of living donors and help to prevent many of the roughly 5,000 deaths annually among Americans on the kidney waiting list.

Elaine Perlman, 55, a former Manhattan educator, founded the coalition last year, along with three other altruistic donors.

“Why have we allowed this to go on for so long, just letting people die?” Perlman said. “To me, that’s the scandal.”

» READ MORE: Thinking of donating a kidney? Here’s what to expect.

In America, it’s legal to pay people for sperm, plasma, and for the use of a woman’s eggs or womb. Why not kidneys?

Bioethicists say kidneys are different for several reasons:

First, kidneys are a finite resource.

Second, the surgery carries some risk, though minimal.

Third, it would send the wrong message to countries that already struggle with unsanctioned transplant tourism — wealthy patients who travel to acquire a kidney.

More than 30 years ago, the World Health Organization urged nations not to allow payments for organs. Iran is the only country in the world that has legalized a state-run system of paying kidney donors, and that system has fueled a problematic secondary market with wealthy people making side deals to secure the youngest, healthiest donors.

If the U.S. starts paying kidney donors, efforts to curb the thriving black market for organs in other foreign countries will lose standing, critics say.

“There will be a ripple effect — a very bad ripple effect if the United States legalizes it,” said Alexander Capron, professor emeritus at University of Southern California and former director of ethics, trade, human rights, and health law at the World Health Organization in Geneva.

Capron and other bioethicists also point out that the tax credit would be burdensome for people who don’t normally file full income tax returns. Also, donors might have to wait months to receive the tax benefit.

And the cost of a kidney transplant is covered for all Americans under the government’s Medicare program. So low-income kidney patients are not at a disadvantage, bioethicists say.

Instead, the health-care community should double down on programs that help prevent kidney disease, bioethicists argue. They’d rather increase the minimum wage as a way to help people afford healthier lifestyles, which would include access to nutrition and medical care.

They think federal funding to fully cover donors’ out-of-pocket costs is the best way to encourage more living donors to step forward. Currently, donors can apply for government reimbursement of expenses such as travel, lodging, and lost wages, but income limitations apply.

Congress needs to make kidney donation “financially neutral” for donors, Capron said.

“If we want to increase organ donation, the first thing we need to do is remove all financial disincentives,” Capron said.

Each year, only 300 people nationwide donate a kidney to a stranger. Roughly 5,700 others donate kidneys to people they know, such as a relative or friend.

In the last two decades, the pool of living donors has stagnated, while the number of people in need of a kidney has doubled to 89,400 Americans.

Supporters say paying kidney donors would solve the supply-and-demand crisis.

Perlman, the coalition cofounder and altruistic donor, said “kidney donation is work.” It’s time-consuming, stressful, and painful.

It also costs donors thousands of dollars in out-of-pocket expenses, including child care, pet sitting, lost wages, and travel. Donors go through a months-long medical workup to qualify and six weeks of surgery recovery.

“If you’re not going to pay people for work, of course you’re going to have a shortage,” Perlman said. “It’s econ 101.”

Supporters also argue that the act would save billions in federal tax dollars currently spent on dialysis treatment, which removes waste from the blood when kidneys fail.

Medicare covers the cost of dialysis and kidney transplants for all Americans, regardless of age. Dialysis costs taxpayers far more than kidney transplants — about $50 billion a year, or $100,000 per dialysis patient.

The proposal is a pilot program that would provide facts and data to inform the debate, said Hess, the Wayne kidney recipient who is also an adjunct professor at Thomas Jefferson University’s College of Population Health.

Hess pointed to estimates that the tax credit would save 60,000 lives and $25 billion in tax dollars over 10 years.

“This would save lives and money, which is something we hardly see in health economics,” he said. “Usually you have to spend more money to get a better health outcome.”

The idea of offering a financial incentive, including college tuition vouchers or a government payment into a retirement account, to kidney donors is not new.

Similar proposals have failed to get traction in Congress. Supporters think their odds are better today because recent surveys show increased support among Americans for compensation of kidney donors if it would save more lives.

In January, coalition members mounted a letter-writing blitz to Congress.

In letters to his representatives, Langhorne resident Mel Cherry used his story of being on the kidney waitlist for five years before undergoing a kidney transplant in 2013 at Thomas Jefferson University Hospital to try to persuade lawmakers to pass the act.

Cherry, who has been an accountant for 60 years and who serves on the coalition’s board and on the board of directors at Jefferson Health-Northeast hospitals, sees the proposal as a way for people to help each other.

He said he’s not bothered by the idea of compensating kidney donors who may be struggling financially, perhaps in need of money “for a sick child.”

“They are trying to get along monetarily,” Cherry said, “and somebody who needs a kidney has a full life and contributes to the economy and contributes to society.”

Sara Sciacchitano was working remotely as an executive assistant from her Chester County home when she opened an email from a church that asked for prayers for Hess, saying a father of two was dying for lack of a kidney donor.

“It really resonated with me that in a world like this, where we don’t really think about acts of kindness often enough,” Sciacchitano said. “It just hit me. I may not be able to change the world at all. But how can I make that one first casting stone that could potentially lead to more good in the future?”

Sciacchitano, a 36-year-old mother of two, and Hess both had surgery at the same transplant center in Philadelphia on May 10, 2023.

They didn’t meet at the time.

A month later, Sciacchitano’s husband took her to a checkup appointment. In the lobby waiting room, he overheard a receptionist call Hess’ name. He immediately texted his wife.

“Are you freakin’ kidding me?” she recalled texting back.

Moments later, she approached Hess in the lobby.

“We were speechless for a good minute,” she said. Then, they hugged.

“I felt at home. I felt peace,” she said.