Former VP Dick Cheney recently announced that having suffered five heart attacks, he is interested in a heart transplant. I offer my best wishes for success—and for multiple reasons.

In addition to prolonging his life, should his operation occur it will focus attention on reforming our thinking regarding organ transplants. This issue is economically and ethically dense, complex, and contentious. When a major national figure, Steve Jobs for example, has a successful transplant, we have an opportunity to move up the learning curve toward policy reform.

The following column is by Sally Satel, MD of the American Enterprise Institute and the Yale School of Medicine. Sally, a friend and a speaker at FREE’s conference series for federal judges, is a beneficiary of a kidney transplant. Health Care Reform is one of the topics we’ll address at FREE’s conference for judges August 28-September 2 and we’ve invited Sally to again join us. (I’d be delighted if VP Cheney were sufficiently healthy to attend.)

When teaching in universities, I often cautioned students to be careful when using the word “need.” This term means absolute necessity, and this implies a vertical demand curve, one insensitive to costs. While these are really quite rare, I would not have faulted Sally for using it as below.

“As ingenious, painstaking and justifiably attention-getting as domino swaps are, they shouldn’t blot out the dismal news that rates of kidney donation, from both living and deceased donors, fall woefully short of the need.”

Please read her brief essay and you’ll better understand our “need” of reform. And if you are a federal judge, consider joining us in Montana this summer.

-John Baden

From The Washington Post (March 7, 2010)

More Kidney Donors are Needed to Meet a Rising Demand

By Sally Satel and Mark J. Perry

“Adonation that resonated a dozen times over,” said the Dec. 16 front page of The Post, joining media around the world to trumpet the good medical news: Thirteen patients are now alive and healthy with new kidneys from a successful 26-operation kidney exchange. The six-day marathon of operations, believed to be the world’s largest ever, was performed at Georgetown Medical Center and Washington Hospital Center.

Such organ exchanges are a godsend for sick people with loved ones who are willing to give them a kidney but are not biologically compatible with them. In an exchange, unmatched couples switch partners to form compatible pairs. Perhaps the most heartwarming aspect of the Washington “domino” swap, as such chains are called, were the three people who volunteered to be partners in a pair, giving a kidney even without having a family member or other loved one benefit.

But now for the bad medical news. There are more than 83,000 Americans with renal failure on the national waiting list for kidneys, a grim new high. Almost 13 die each day.

As ingenious, painstaking and justifiably attention-getting as domino swaps are, they shouldn’t blot out the dismal news that rates of kidney donation, from both living and deceased donors, fall woefully short of the need.

According to the United Network for Organ Sharing (UNOS), the nonprofit entity overseen by the Department of Health and Human Services, which maintains the national waiting list, the number of transplant operations has been basically flat since 2004. Even with the recent increase in kidney swaps, there will probably be fewer operations this year than in 2006.

As the number of renal transplant operations remains mired between 16,000 and 17,000 a year, the number of candidates on the waiting list mounts. Within the last four years, for example, the list grew by more than one-third, from about 65,000 patients at the end of 2005.

This means that only one kidney transplant operation was performed last year for every five needy patients, making the chance in 2009 of getting an organ only about one in five — an all-time low. As recently as the early 1990s, patients on the waiting list had a greater than 50 percent chance of receiving a kidney in a given year, but the situation has worsened every year since 1991.

Thus, even if surgeons were able to schedule an additional 13-kidney swap operation every day of the year, more than 60,000 patients would still languish on dialysis, facing premature death. The only realistic long-term solution to the kidney shortage in the United States is to allow some form of donor compensation. This would require Congress to amend the National Organ Transplant Act of 1984 so that people who give organs could receive a benefit, perhaps a tax credit, tuition voucher, lifetime health coverage or a contribution to a retirement plan. Such compensation would be regulated by the government, with kidneys allocated to ill patients according to the national formula being used across the country.

One of the magnificent altruistic souls who gave a kidney in the 13-way swap, a 45-year-old Maryland woman, explained her rationale. “I just wanted to help someone out who needed my help, to give them a better life,” she told the Associated Press.

Perhaps a handful of people who read about her spectacular generosity will now volunteer to do the same thing. Bless them all. Now imagine how many more people might come forward if it were not illegal for them to accept some reward for saving the life of another.

And keep in mind that more transplants not only save lives, they also save money. For every patient taken off dialysis after receiving a kidney, $72,000 in Medicare expenditures are saved every year, compared with the roughly $12,000 annual cost of anti-rejection medications. Congress should take note of this fact as it pursues health-care savings.

We should surely celebrate the world’s largest-ever kidney exchange and hope that more of them occur. Yet we shouldn’t lose sight of the reality that the most promising long-run solution to the kidney shortage is a system of donor compensation.