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Madhav Goyal, MD, MPH; Ravindra L. Mehta, MBBS, MD; Lawrence J. Schneiderman, MD; Ashwini R. Sehgal, MD

JAMA. 2002;288:1589-1593.

Context  Many countries have a shortage of kidneys available for transplantation. Paying people to donate kidneys is often proposed or justified as a way to benefit recipients by increasing the supply of organs and to benefit donors by improving their economic status. However, whether individuals who sell their kidneys actually benefit from the sale is controversial.

Objective  To determine the economic and health effects of selling a kidney.

Design, Setting, and Participants  Cross-sectional survey conducted in February 2001 among 305 individuals who had sold a kidney in Chennai, India, an average of 6 years before the survey.

Main Outcome Measures  Reasons for selling kidney, amount received from sale, how money was spent, change in economic status, change in health status, advice for others contemplating selling a kidney.

Results  Ninety-six percent of participants sold their kidneys to pay off debts. The average amount received was $1070. Most of the money received was spent on debts, food, and clothing. Average family income declined by one third after nephrectomy (P<.001), and the number of participants living below the poverty line increased. Three fourths of participants were still in debt at the time of the survey. About 86% of participants reported a deterioration in their health status after nephrectomy. Seventy-nine percent would not recommend that others sell a kidney.

Conclusions  Among paid donors in India, selling a kidney does not lead to a long-term economic benefit and may be associated with a decline in health. Physicians and policy makers should reexamine the value of using financial incentives to increase the supply of organs for transplantation.

Author Affiliations: Department of Internal Medicine, Geisinger Health System, State College, Pa (Dr Goyal); Department of Nephrology, University of California, San Diego (Dr Mehta); Departments of Family and Preventive Medicine and Medicine, University of California, San Diego, School of Medicine (Dr Schneiderman); Division of Nephrology and Center for Health Care Research and Policy, MetroHealth Medical Center, and Departments of Medicine, Biomedical Ethics, and Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, Ohio (Dr Sehgal).

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