Risk, regulation, and financial incentives for living kidney donation

In his comprehensive review of the hazards of existing,largely unregulated markets in human kidneys, Koplin(2014) argues that advocates of regulated markets mayunderestimate the potential physical, psychosocial andfinancial harms risked by vendors. He acknowledges, however,that market proponents will likely be undeterred incalling for “trials” or “pilot studies” of financial incentivesin developed countries on the grounds that the experienceof international black markets is of limited predictive valuein anticipating the outcomes of regulated markets. We contendthat there is good evidence to support the concernthat living vendors would be at higher risk of adversehealth outcomes compared to altruistic donors in the contextof a regulated market. This has important implicationsnot only for the informed consent of prospective vendors,but also for the potential regulations that would berequired to mitigate these risks. We argue here that pilotstudies would be at the very least premature until suchtime as market proponents have sufficiently engaged withpotential harms to prospective kidney vendors.