WHAT follows is a quite radical idea following Carrie Bickmore’s Logie-award plea for more money for brain cancer research. Cancer research consumes a huge amount of money but we are going to have to raise it if we are to get better results. One way is to see if spending in other health areas can be reduced, to free up money for research.
Kidney disease is one of the biggest consumers of the Australian health dollar. Kidney disease contributes to about 15 per cent of hospitalisations.
Dialysis costs about $60,000 a year per person. About 22,000 people are on dialysis at any given time, and rising. That is $1.3 billion a year. Then you have to add all the costs of people being partly or wholly out of the workforce.
The trouble is that the average wait for a transplant is more than three years because the supply of kidneys for transplant is too small.
There are not enough organ donors. In Australia, we have an opt-in system on your driver’s licence. There has been talk of an opt-out system, but it hasn’t happened.
Kidneys, however, present a special opportunity. Unlike many organs, you can do live donations with kidneys because you have got two of them, and you can make do with one if need be.
Usually, live donations are made by a close relative. Tissue matching is often better. Also, live transplants are slightly more successful. Overall, kidney transplants are hugely successful. If only we had more of them and more live ones. At present, less than 20 per cent are live ones.
That could change. The transplant rate could rise rapidly if state legislatures removed the prohibition on payment for kidney and other tissue donations.
I know that that initially sounds abhorrent. But think about it for a bit.
How is it that the surgeons, anesthetists, nurses and hospitals all get paid for their contribution but the poor donor, who really makes the whole thing happen, gets nothing?
Also, the state law prohibiting payment for tissue donation ceases as soon as the tissue has been subjected to some kind of manufacturing process. Then it is considered freely available for commercial applications as a human-tissue product.
An article in the Australian Medical Journal mentions: bone screws and bone putty; collagen products; acellular dermis (which is derived from human tissue, but no longer contains human cells); a range of blood products; and non-medical uses of human tissue or human tissue products, such as in the manufacture of human collagen for cosmetic use.
So once a big company gets into the action, suddenly the legal and ethical considerations disappear and they are allowed to make a buck. Meanwhile, someone who is happy to sell a kidney is prohibited.
And the level of penalty is irrelevant because any prohibition stops hospitals from using any paid-for kidney
Yes, people might say the less well off will be exploited, but informed consent can overcome that.
Also, the less well off would be most likely to gain from allowing kidney sales – not only in the form of money to the donors, but also because the less well-off are more frequently affected by the long wait for organ donations, so more of them would be helped.
Aboriginal and Torres Strait Islander people are almost four times as likely to die with chronic kidney disease as a cause of death than non-Indigenous Australians.
Given the economic burden of dialysis it might be in the interests of the health-insurance industry to urge an end to the prohibition of payment for live kidney donations. Indeed, they might want to consider payments to the estates of dead people whose organs are used in transplants, given the economic benefit they derive from the donation.
The idea of someone donating a kidney for cash is surely less abhorrent than one person a week on the transplant list dying and thousands of people suffering the pain, inconvenience and discomfort of dialysis – which is by no means a satisfactory substitute for having a functioning kidney.
Of course, donations of blood are different. There is no chronic shortage of voluntarily given blood (though there are often local and temporary ones). Further, the thought of payment might induce lying and compromise screening, thus risking the whole blood supply.
But that is not the case with kidneys. The benefits in reducing pain, death and economic loss by cutting waiting times for kidney transplants to near zero should make state legislatures rethink their ban on payment for tissue transplants.
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MY DEADLINE was before the UK elections results were in, but by the time you read this, the whole sorry undemocratic shemozzle will have become apparent. Some parties will have many more seats than their vote share warrants and some many less. And either a ghastly jockeying for power or an immediate but richly undeserved drive to Buckingham Palace will ensue.
The lesson is that you should change your electoral system as circumstances warrant.
New Zealand did this. It now has a mixed system of some seats obtained according to national vote and some through electorates. At the time, people (especially from major parties) squealed it would cause instability and deadlock. The record shows to the contrary. New Zealand’s reform effort has been better than Australia’s recently, though there have been other factors.
Australia needs to address the rise of minor parties in its electoral system.
The micro-party aberration in the Senate needs fixing without being unfair to minor (as distinct from micro) parties.
Perhaps in return, minor parties could be given a better chance in the House of Representatives with a mixed system along New Zealand lines. The Constitution does not permit national seats, but it does permit state-wide seats.
If, say, a quarter or a third of the Reps seats were state-wide seats, it would also prevent all the attention at election time just on marginal electorates.
If minor parties got a few more seats in the Reps it might turn Australia’s obsessively adversarial and increasingly deadlocked system into one where compromise and consensus are seen as virtues not vices.
It might even restore a bit of business confidence as it has done in New Zealand.
CRISPIN HULL
This article was first published in The Canberra Times and other Fairfax Media on 9 May 2014.