Armitage Richard C
Academic Unit of Population and Lifespan Sciences, School of Medicine, University of Nottingham, Clinical Sciences Building, Nottingham City Hospital Campus, Hucknall Road, Nottingham, NG5 1PB, UK.
J Bioeth Inq. 2025 Jun 3. doi: 10.1007/s11673-024-10420-5.
Rodger and Venter have proposed a monopsony system in which the National Health Service (NHS) in England, as the single buyer, allows living kidney donors to opt-in to receive £35,000 tax-free financial compensation while preserving the right to donate without such compensation. This approach aims to alleviate the severe and growing shortage of kidneys available for transplant in England and is projected to generate substantial economic savings for the NHS. This paper sets out to strengthen their proposal by: (1) presenting updated figures on the increasing kidney transplant wait list in England to highlight the urgency for intervention; (2) detailing the rigor of the existing donor evaluation process to mitigate concerns about exploitation and coercion in compensated living donation; (3) outlining the various kinds of living kidney donation and the U.K. Living Kidney Sharing Scheme, to demonstrate that the proposal's projected economic benefits are likely to be underestimations; (4) suggesting five modifications to the proposal that do not significantly alter its underlying structure; and (5) providing additional arguments against the major objections to such proposals-that financial compensation is exploitative, coercive, and likely to "crowd out" altruistic donors-and showing how the five suggested modifications could strengthen the proposal by bolstering it against those objections. The paper strengthens existing arguments for a pilot project of financial compensation for living kidney donors in England.
罗杰和文特尔提出了一种买方垄断系统，在该系统中，英国国家医疗服务体系（NHS）作为唯一的购买方，允许活体肾捐赠者选择接受3.5万英镑的免税经济补偿，同时保留无偿捐赠的权利。这种方法旨在缓解英国可用于移植的肾脏严重且不断加剧的短缺状况，并预计为NHS节省大量经济开支。本文旨在通过以下方式强化他们的提议：（1）提供关于英国肾脏移植等待名单不断增加的最新数据，以突出干预的紧迫性；（2）详细说明现有捐赠者评估过程的严格性，以减轻对有偿活体捐赠中剥削和胁迫行为的担忧；（3）概述各种活体肾捐赠及英国活体肾共享计划，以证明该提议预计的经济效益可能被低估；（4）针对该提议提出五项修改建议，这些建议不会显著改变其基本结构；（5）针对对此类提议的主要反对意见——经济补偿具有剥削性、强制性且可能“排挤”利他性捐赠者——提供更多论据，并说明这五项建议的修改如何通过增强提议对这些反对意见的抵抗力来强化该提议。本文强化了英国为活体肾捐赠者提供经济补偿试点项目的现有论据。
