Report on Living Organ Donation as a Strategy for Achieving Sustainable Development Goals

Introduction: The Organ Shortage as a Barrier to Sustainable Health Outcomes

In the United States, the significant gap between the demand for and supply of transplantable organs represents a critical public health challenge. This scarcity directly undermines progress towards Sustainable Development Goal 3 (Good Health and Well-being), as an average of 13 individuals die daily while on the organ transplant waiting list. Of the more than 105,000 Americans awaiting transplants, over 86 percent require a kidney. While posthumous donation is valuable, its potential is limited by strict medical criteria, with only three in 1,000 deaths permitting organ recovery. Consequently, promoting living organ donation emerges as a vital and effective policy priority to save lives, improve health outcomes, and advance key sustainable development targets.

Living Donation: Advancing SDG 3 through Improved Medical Outcomes

Living organ donation, where a healthy volunteer donates an organ or a portion of an organ, offers superior clinical results compared to cadaveric transplants, directly contributing to the targets of SDG 3, which include reducing premature mortality from non-communicable diseases.

Comparative Survival Rates

• Kidney Transplants: The five-year survival rate for a living-donor kidney transplant is 85.6 percent, significantly higher than the 74.4 percent rate for a cadaveric transplant.
• Liver Transplants: Similarly, living-donor liver recipients have a 77.3 percent five-year survival rate, compared to 71.8 percent for those receiving a posthumous liver.

Enhanced Longevity and Reduced Complications

Organs from living donors not only function better but also last longer. A living-donor kidney typically functions for 15 to 20 years, nearly double the 7-to-10-year lifespan of a deceased-donor kidney. This longevity reduces the need for patients to re-enter the transplant waitlist, alleviating pressure on the healthcare system and improving long-term quality of life. Furthermore, with thorough pre-donation health screenings, risks to donors are minimized, and studies indicate that kidney donors tend to live longer than non-donors.

Policy Frameworks for a Sustainable Donation System

Addressing the organ shortage requires robust policy interventions that align with the principles of SDG 16 (Peace, Justice and Strong Institutions) by creating effective and accountable systems. Several states and the federal government have initiated policies to encourage living donation.

Existing State and Federal Support Mechanisms

Many states have implemented policies to remove barriers for living donors. The American Kidney Fund evaluates states based on criteria that promote SDG 8 (Decent Work and Economic Growth) by protecting donors’ economic stability. Key policy areas include:

• Protections against insurance discrimination.
• Job-protected leave for public and private sector employees.
• Tax incentives for employers providing paid leave.
• Reimbursement or tax deductions for donor expenses.
• Paid leave provided through state family and medical leave programs.

At the federal level, employees are granted up to 30 days of paid leave for organ donation, and grants are available to reimburse donor-related costs.

The End Kidney Deaths Act (EKDA): A Legislative Solution

The bipartisan End Kidney Deaths Act (EKDA) proposes a transformative approach by offering a significant financial incentive. The act would provide a $50,000 refundable tax credit ($10,000 annually for five years) to nondirected living kidney donors. By amending the National Organ Transplant Act of 1984, this bill aims to:

1. Incentivize Altruism: Motivate new donors who lack a personal connection to a recipient, thereby expanding the donor pool.
2. Promote Equity: Nondirected donations are allocated based on medical need, which helps to advance SDG 10 (Reduced Inequalities) by ensuring organs are distributed fairly.
3. Strengthen Institutions: The bill represents a crucial legislative reform to build a more effective and responsive system for organ procurement, a core tenet of SDG 16.

Economic Analysis: Fiscal Responsibility and Sustainable Healthcare

The EKDA is projected to generate substantial economic benefits, reinforcing its alignment with sustainable development principles. By increasing the number of transplants, the act would reduce federal expenditures on costly dialysis treatments.

Projected Savings and Cost-Effectiveness

The financial case for the EKDA is compelling. In 2022, Medicare spent between $82,554 and $110,000 annually per dialysis patient. In contrast, a post-transplant patient costs the program approximately $45,000 annually. This leads to potential savings of $37,000 to $53,000 per year for each new transplant facilitated by the act. Over a decade, the EKDA is estimated to save U.S. taxpayers between $10 billion and $37 billion. These savings demonstrate a fiscally responsible policy that promotes long-term economic sustainability within the healthcare sector, contributing to the objectives of SDG 8.

International Precedent and Donor Motivation

The potential impact of financial incentives is supported by international evidence. Israel implemented a benefits package for nondirected donors that successfully quadrupled its living donation rates. While predicting the exact response in the U.S. is difficult, research suggests that a compensation package like the one in the EKDA would significantly increase donation rates and yield substantial budgetary savings.

Conclusion: A Multi-Goal Strategy for Sustainable Development

The chronic shortage of organs is a policy failure with fatal consequences. Addressing this crisis through the promotion of living donation is a powerful strategy for achieving multiple Sustainable Development Goals. Legislative actions like the End Kidney Deaths Act offer a pathway to:

• Advance SDG 3 by saving lives, reducing mortality from kidney failure, and improving health outcomes.
• Support SDG 8 by creating a more cost-effective healthcare system and reducing the economic burden of chronic disease.
• Further SDG 10 by ensuring organs are allocated equitably based on need.
• Strengthen SDG 16 and SDG 17 (Partnerships for the Goals) through bipartisan legislation that builds effective, accountable, and inclusive institutions.

By implementing financial incentives and robust support systems for living donors, federal lawmakers can resolve a persistent public health crisis, save taxpayer funds, and build a healthier, more sustainable, and equitable society.

1. Which SDGs are addressed or connected to the issues highlighted in the article?

The article on organ donation, particularly living kidney donation, addresses several Sustainable Development Goals (SDGs) by focusing on health outcomes, economic factors, and policy-making.

• SDG 3: Good Health and Well-being

  This is the most prominent SDG in the article. The entire discussion revolves around improving health outcomes and saving lives through organ transplantation. The article details the high mortality rate of those on the waiting list (“13 people die every day”), the health benefits of living donation over cadaveric donation (“five-year survival rate after a living kidney transplant is about 85.6 percent” compared to 74.4 percent), and the need to address kidney failure, a major non-communicable disease.

• SDG 8: Decent Work and Economic Growth

  The article connects organ donation to labor policies. It mentions that a key criterion for supportive state policies is “Job-protected leave for living donation from private employers” and “Job-protected leave from public employers.” Furthermore, it discusses lost wages as a significant cost for donors and notes that federal employees are granted “up to 30 days of paid leave” for donation. These points directly relate to protecting workers’ rights and ensuring they are not economically penalized for donating.

• SDG 10: Reduced Inequalities

  The article touches upon reducing financial inequalities that act as barriers to organ donation. Policies like the “Living Organ Donor Tax Credit Act” and the “End Kidney Deaths Act” (EKDA) aim to reimburse expenses or provide financial incentives ($50,000 tax credit). This makes it more feasible for individuals of all economic statuses to become living donors without suffering financial hardship, thereby promoting economic inclusion in this life-saving act.

• SDG 16: Peace, Justice and Strong Institutions

  The article highlights the role of effective governance and strong institutions in solving the organ shortage crisis, which it calls a “policy failure.” It discusses specific legislation introduced in Congress, such as the “End Kidney Deaths Act” and the “Living Donor Protection Act.” It also refers to the actions of governmental bodies like the Department of Health and Human Services and non-governmental organizations like the American Kidney Fund, which rates state policies. This demonstrates the importance of developing effective and accountable institutions to create and implement life-saving policies.

2. What specific targets under those SDGs can be identified based on the article’s content?

Based on the article’s focus, several specific SDG targets can be identified:

• SDG 3: Good Health and Well-being

  • Target 3.4: By 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment. The article directly addresses this by proposing solutions to increase kidney transplants, a critical treatment for end-stage renal disease. The goal is to reduce the number of deaths among the “more than 105,000 Americans waiting for organs,” thus lowering premature mortality from this non-communicable disease.
  • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services. The article discusses the high cost of dialysis (“$82,554 to $98,434” annually for Medicare) versus the lower long-term cost of a transplant. By making transplants more accessible, the policies discussed aim to provide a more cost-effective and higher-quality health service. The financial incentives for donors also reduce their financial risk, contributing to the overall goal.

• SDG 8: Decent Work and Economic Growth

  • Target 8.8: Protect labour rights and promote safe and secure working environments for all workers. The article’s mention of policies for “Job-protected leave” and paid leave for donors directly aligns with this target. These measures ensure that individuals can donate an organ without risking their employment or income, thereby protecting their labor rights.

• SDG 10: Reduced Inequalities

  • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… economic or other status. The proposed financial incentives, such as the $50,000 tax credit in the EKDA, are designed to remove the economic barriers that may prevent lower-income individuals from becoming living donors. This promotes economic inclusion by ensuring that the ability to donate is not limited to those who can afford the associated costs and lost wages.

• SDG 16: Peace, Justice and Strong Institutions

  • Target 16.6: Develop effective, accountable and transparent institutions at all levels. The article’s analysis of federal and state legislation (e.g., EKDA, Living Donor Protection Act) and the rating of state policies by the American Kidney Fund are examples of efforts to create more effective and accountable institutional frameworks to address the public health crisis of organ shortages.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

Yes, the article provides several quantitative and qualitative indicators that can be used to measure progress.

• For SDG 3 (Good Health and Well-being)

  • Mortality rate for patients on the transplant waitlist: The article states “13 people die every day awaiting an organ transplant.” A reduction in this number would be a direct indicator of progress.
  • Size of the transplant waiting list: The article mentions “more than 105,000 Americans waiting for organs.” A decrease in this list would indicate success.
  • Survival rates post-transplant: The article provides 5-year survival rates for living (85.6% for kidney) versus cadaveric (74.4% for kidney) transplants. An increase in the overall survival rate, driven by more living donations, would be a key indicator.
  • Number and proportion of living donations: The article notes that “less than a quarter of kidney transplants came from a living donor in 2024.” An increase in this percentage would measure progress.
  • Federal health expenditures: The article compares the annual cost of dialysis per patient to the cost of a transplant patient. A shift in federal spending from dialysis to post-transplant care, resulting in overall savings (“$10 billion and $37 billion over 10 years”), would be a powerful economic indicator of improved health outcomes.

• For SDG 8 (Decent Work and Economic Growth)

  • Number of states with job-protected leave policies: The article states that “22 states have enacted at least three” of the seven recommended policies, including job protection. An increase in this number would indicate progress.
  • Availability of paid leave for donors: The article mentions federal employees get “up to 30 days of paid leave.” Tracking the adoption of similar policies in the private sector or at the state level would be an indicator.

• For SDG 10 (Reduced Inequalities)

  • Number of nondirected living donors: The article cites “545 kidneys and 109 livers” from nondirected donors in 2024. A significant increase in this number following the implementation of financial incentives would suggest that economic barriers are being successfully removed.

• For SDG 16 (Peace, Justice and Strong Institutions)

  • Passage of relevant federal legislation: The status of bills like the “End Kidney Deaths Act” and the “Living Donor Protection Act” serves as a direct indicator of institutional action.
  • State policy adoption rate: The American Kidney Fund’s rating system provides a clear metric. Progress can be measured by the number of states adopting more of the recommended supportive policies.

4. Table of SDGs, Targets, and Indicators

Source: niskanencenter.org