# An Even Fairer Exchange: Further Reasons Why Living Kidney Donors in England Should Be Financially Compensated

## TL;DR

This paper argues for financially compensating living kidney donors in England to address transplant shortages and save costs.

## Contribution

The paper strengthens a prior proposal by providing updated data, addressing ethical concerns, and suggesting modifications to improve the compensation model.

## Key findings

- The kidney transplant wait list in England is growing, highlighting the need for intervention.
- The donor evaluation process is rigorous, reducing risks of exploitation or coercion.
- Modifications to the compensation proposal could address ethical objections and improve its effectiveness.

## Abstract

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.