A (perhaps) novel solution to kidney donation

Like Dante's Peak and Volcano, and Armageddon and Deep Impact, this month we have an interesting pair of long-form magazine articles on kidney donations from the New Yorker and the Atlantic (both very much worth reading- New Yorker's here and Atlantic's here).

The New Yorker article focuses on people who decide, for varying reasons, to donate a kidney to a complete stranger- complete altruism seems to be the uniting theme. The Atlantic article ranges along varying methods of spurring donations, such as exchanges where a husband who's not compatible with his sick wife (pair A) and a mother not compatible with her sick daughter (pair B) swap kidneys- healthy A to sick B, healthy B to sick A. It also looks at more convoluted chain donations where one altruistic donor can kick off a cascade of matching donations- with each donor giving to an unknown recipient.

Both discuss the idea of paying donors- either in immediate cash payments, or perhaps (to be less likely to exploit the desperate) paying in the form of health insurance, or 401k contributions, or college funds. For many people, the idea of paying for kidneys is ghoulish, or raises problems of class inequality, which I can definitely understand- even though it seems that the person selling his or her kidney is unlikely to face any serious health consequences, as the other kidney will grow to assume all the functions of the pair, and kidney disease typically strikes both.

Right now, people waiting for kidneys are on the United Network for Organ Sharing (UNOS) list, where there's a 4-year wait time- many of those on the list will die while waiting, and the rest will spend a lot of time undergoing painful dialysis. What if donating a kidney didn't have to be an altruistic act, but could essentially function like insurance. It would work like this- a healthy person could, at any time, arrange to donate a kidney that would go to whichever matchable person is at the top of the list in the donor's state (the lists go state-by-state). In exchange, the donor would then have the right, if he or she ever needed a kidney, to slot into the list at the top. This right would be assignable, so if person A donated a kidney, but never needed one, she could assign her "cut to the front" right to her husband, aunt, etc (but the right could not be sold or exchanged for anything of value).

Furthermore, if a healthy friend or relative of a person who needed a kidney was willing to donate, but was not a match, he or she could donate to the person at the top of the list, and then immediately assign their "cut to the front" to their sick relation.

I don't think that this would be any less equitable than the current system- and would probably improve things. Some number of people would donate for the "insurance" purpose, and then never have to use it because they or their friends/relatives never needed a kidney- thus adding additional organs into the system that would not be there otherwise. For people that did then use the "cut to the front" for themselves or friends/relatives, it would give the most benefit to sick people who have a large circle of altruistic friends, but that's the case currently, where anyone who has a matchable friend or relative who's willing to donate gets to cut the line.

I know I have some doctors and other smart folks who read this blog- so please feel free to point out to me what the problems are with this idea are- it wouldn't surprise me if this had been thought of (and discarded) before...