Year: 2010
Type: letter
Abstract: To the Editor: We read with great interest the article by Herold (1Herold DK Patient willingness to pay for a kidney for transplantation..Am J Transplant. 2010; 10: 1394-1400Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar), who reported on findings from a survey of end-stage renal disease (ESRD) patients regarding willingness to pay for a kidney for transplantation. Herold found that the majority of her sample (n = 84/107; 78.5%)werewilling to pay,with gender, health status and household income described as key factors associated with this decision. Although this is one of the fewpapers that have presented patient perspectives on this issue, there were significant methodological and analytic flaws that seriously limit the paper's heuristic value. The use of Internet-based questionnaires is acceptable for attitudinal research; however, some items raised more questions than they addressed. For example, it is unclear why the first question asked permission to use data for research when informed consent was previously obtained. ‘Years with ESRD’ was assessed with a multiple-choice question with nonmutually exclusive choices, making an average meaningless; data on chronic kidney disease stage or length of time on dialysis would have been more illuminating. With respect to Herold's methods, it isn't obvious how ‘calls to dialysis centers’ resulted in accrual of ESRD patients in the study. The sample itself raises concerns. As the author acknowledges, only a small (n = 107) group of individuals completed the questionnaire. Perhaps due to the small sample size, a clear geographic distribution of the respondents is not provided. While the sample is similar to the US ESRD population on gender, it is overrepresented with 20—44 year-olds (46% vs. 21%, respectively). The implication of this disparity is not fully discussed with respect to its impact on the findings or future follow-up studies that may consider using an internet-based recruitment strategy. Herold's data analyses are also problematic. First, it is unclear exactly how to interpret correlation coefficients for gender and preferred source of kidney, as both variables are nominal variables that should have no implied ranking. Notably, both variables are described as significant predictors of willingness to pay.More problematic is the low ratio of number of subjects to predictors (n = 11). It is quite unlikely that the observed regression weights or model R2 would be reproduced in a larger sample (2Tabachnick BG Fidell LS Using multivariate statistics 3rd Ed. HarperCollins, New York1996Google Scholar). Great caution is needed in the interpretation of the finding that most patients would be willing to pay for a kidney for transplantation. It is a hypothetical scenario in which payment by the recipient would be the only avenue available for obtaining a transplant. The unsurprising finding that poor patients would be less willing to pay underscores the value of the current system that grants all ESRD patients access to kidney transplantation. Most troublesome is the conflation of two distinct ethical issues: patients' willingness to pay for a kidney and the acceptability of paying individuals to donate a kidney. While the Herold paper may be useful in sparking discussion on patient attitudes related to payment for organs, there are significant problems with the science itself that should limit the generalizability of the study findings. Discussions of a regulated kidney market based on these data are premature. Funding source: Supported in part by grant KL2RR0254740 from the National Center for Research Resources, National Institutes of Health. Disclosure: The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.
Authors: Z. Butt, E. Gordon, D. Penrod, L.A. Sherman
Institution: Northwestern University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,300
Awards: G3208985518, G8596419801
OpenAlex ID: W1991359513