Taboo Trades
Taboo Trades
Bonus Episode: Ending the Kidney Shortage with Frank McCormick
Frank McCormick is an economist and the author of numerous articles focused on the shortage of kidneys for transplantation. He is retired from the Bank of America where he was Vice-president and Director of U.S. Economic and Financial Research. Today, we’re discussing his recent article, Projecting the Economic Impact of Compensating Living Kidney Donors in the United States: Cost-Benefit Analysis Demonstrates Substantial Patient and Societal Gains, co-authored with Philip J. Held, Glenn Chertow, Thomas G. Peters, and John P. Roberts. It is published in the journal, Value in Health and is available here: https://www.sciencedirect.com/science/article/pii/S109830152201957X/
And this is the repugnance that you have addressed. And Al Roth, who says you are his favorite lawyer, is also addressing. And the price of that repugnance, however, in this case, is just enormous. It's astonishing.
SPEAKER_02:Hey, hey, everybody. Welcome to the Taboo Trades podcast, a show about stuff we aren't supposed to sell, but do anyway. I'm your host, Kim Kravick. My guest today is Frank McCormick, an economist and the author of numerous articles focused on the shortage of kidneys for transplantation. He is retired from the Bank of America, where he was Vice President and Director of U.S. Economic and Financial Research. Today we're discussing his recent article, Projecting the Economic Impact of Compensating Living Kidney Donors in the United States. It's co-authored with Philip J. Held, Glenn Chertow, Thomas Peters and John P. Roberts. It's published in the journal Value and Help and is available at the link I've attached to the show notes. Before we jump into the article, I wanted to talk about you a little bit just to give our listeners a little bit of background and me, quite frankly. I'm interested in how you made the transition from Bank of America to one of the world's leading researchers on kidney transplantation?
SPEAKER_00:Well, I was teaching at Berkeley and at UC Davis in the business school after I retired from the Bank of America. And one of the courses I taught was microeconomics. The standard exercise in that is to show that when the government imposes a price control That's below the market clearing price. Then the quantity demand exceeds the quantity supply. You have a shortage. Okay. Now, usually we would use examples like from the 1970s when they had the price controls on gasoline and things like that. Philip Held has been working in this area all his career. And he told me that there is price controls on kidneys that were causing people to die. And so this got my attention. And so I started using the example in the class and it got the student's attention also. You know, don't write, see price controls that cause people to die. And the more I looked into it, the more I realized there was an enormous number of people dying. We estimate 40,000 people a year dying because of the kidney shortage. And so that got us interested in the thing. And so writing articles with Philip about it. And that's been going on for some time.
SPEAKER_02:This new article that we're talking about today is in Value and Health. Is that right? And has it been already been published or has just been published?
SPEAKER_00:It's been published online as of June 9th.
SPEAKER_02:Okay. All right. And I will put a link to that in the show notes for the episode. And the title of it is projecting the economic impact of compensating living kidney donors in the United States. And that's what we're going to talk about today. I'm going to just before we start, you have a lot of components to the paper, and you do an analysis of a government program for living donor kidneys. And you have a couple of findings, which I'm going to go ahead and get your findings out there. And then if you are willing, I I wanted to get you to talk a little bit about each separate finding because each of them has a whole lot of components that sort of how you arrived there. And I know that you'll be shocked to learn, Frank, that lawyers are not known for their quantitative skills. So we're going to be asking you to do the simplified version of some of your analysis here. You find that Half of all patients diagnosed with kidney failure each year could avoid dialysis. That's about 62,000 people a year. You can correct or any of this, but we're going to expand on all of it. The government would have to compensate each donor about$77,000. The value to a transplant for each patient would be about$1.5 million. And the savings per recipient from no dialysis would be about$1.2 million. So tell me, before we start looking at each of these, tell me what's your big takeaway? What do you want people to really remember about your analysis here and your findings? What's the takeaway for them?
SPEAKER_00:Well, the big one is that an awful lot of people are dying. We estimate that it's equivalent to 87, 47 crashing each year. That's an enormous number. And right now, it's despair for these people. There's no program really that will address this. And so we concluded that it was relatively simple to address this if we had the government compensate the donors living kidney donors about roughly$80,000 a year. So we could save 40,000 people a year from a premature death if the government would compensate the living donors. Now, the problem with that, of course, is a law, National Organ Transplant Act, which forbids any kind of compensation of donors. And so we would have to change that law in order to completely address the serious problem.
SPEAKER_01:But
SPEAKER_00:it's worth doing because the suffering is so great under the current law. As a matter of fact, we added up, we have data going back to 1988. And if we look at the number of premature deaths that occurred because of the kidney shortage since that time, it adds up to about a million people. Now think that a million people die unnecessarily because of a government law is just appalling in our judgment. And we hope it's appalling to other people too.
SPEAKER_02:Maybe before we talk about the specific findings, I know you've presented this paper a couple of places as well as a prior paper that was looking at similar issues. And you've presented at least some of those papers, I think, to groups of medical professionals. What's the reaction most of the time when you present these findings?
SPEAKER_00:Well, it's half and half. Half of the people seem to be sympathetic to what we're saying, and half seem to be opposed. But the ones who are opposed are vehemently opposed. It's simply immoral behavior. to pay donors for donating organs. And this is the repugnance that you have addressed. And Al Roth, who says you are his favorite lawyer, is also addressing. And the price of that repugnance, however, in this case, is just enormous.
UNKNOWN:It's astonishing.
SPEAKER_02:Let's talk a little bit about the number of patients that would be saved. Can you, as I read your paper, you actually, I think, believe that people have been under, I mean, everybody knows that a lot of people are dying because of a lack of a transplant that could otherwise be saved. But the number is actually greater than many people believe. And that's part of what you do in this paper. Can you tell us a little bit about As I understand it, your argument is that simply using the waitlist, as a lot of people do, significantly undercounts, right? Because a lot of people never get put on the waitlist, either because they're too sick, they are discouraged, they know that they would be a long wait for them and probably would not survive to the transplant date. In other words, just looking at the number of people that are on the waitlist is probably an underestimate of how many people could be helped by having greater access to a transplantation.
SPEAKER_00:That's right. We approach it from the opposite point of view. But every year, about 124,000 people are diagnosed with kidney failure. And we asked how many of them could be helped, could have their lives saved by having a kidney transplant. And the number we came up with was about half of them. And that's based on some hard evidence but mainly on the anecdotal information from nephrologists, who would be the medical profession that would be most knowledgeable about it. And they tend to think that more than half of the people diagnosed would benefit from a transplant. So that's where we begin, that 62,000 people out there could benefit right now Only about 22,000 are getting transplants. So that's where the 40,000 number comes from, the people who could benefit but are now dying prematurely.
SPEAKER_02:Got it. I see. So you took out the 20,000 roughly that are currently being transplanted from the 62,000, and that's where the 40-ish number comes from. Right. Okay. And you also estimate... one and a half transplants per person in arriving at this. Can you tell us why that is? Is it because some people will need multiple transplants? Is it down the road? Is it graft failure? Why is it that most people will need, or some people, let me clarify, would need more than one?
SPEAKER_00:Well, they don't last forever is the short answer. In general, they last for 10 to 20 years. And the people are in reasonably good health. It's not as perfect. They have to take all kinds of drugs and things like that to prevent the organ from being rejected. But it's vastly better than if they were on dialysis. If you're on dialysis, your life expectancy is four to five years and your health steadily deteriorates because the kidney, the dialysis does not do as good a job as a good kidney would do. And so your health steadily deteriorates until you die prematurely. It's not a very pleasant existence. The one thing that can be said for it, it keeps you alive until perhaps you can get a kidney transplant. But that only occurs for roughly 20% of the people who have kidney failure. So it's not a very pleasant thing. And it's something that could be cured by having the government compensate kidney donors. If they did that, then they could save 40,000 people a year. I mean, it's astonishing. Now, some people say, well, you know,$80,000 is expensive. It's very cheap, even if you double that price. And there's great uncertainty about exactly what that price would be. Even if it was twice as high, the benefit to the recipient is so large It doesn't be worth any kind of cost to the government.
SPEAKER_02:And I should point out for our readers that you have, along with the paper, and I will put links to both of these, you have a lot of supplemental materials where you detail quite carefully how you arrived at each of these numbers. There's probably, I forget how many pages of appendix there was, but something like 45, much, much more than the paper itself. So we're just, so I'm trying to hit some of the main points here and people who want more information about how you arrived at the specific numbers can of course go look at the paper and more importantly, look at the supplements where you, the As you say, the$77,000 number, the amount that you guys conclude the government would have to compensate each donor. And as you acknowledge in the paper, that's the number that has quite a bit of uncertainty around it. I completely agree with you that the benefits are so large that it doesn't really matter whether it's twice as much or three times as much. This is not a deficit in the paper by any means. But I'm just interested in how, because I'm sure that everybody who's listening here is going to say, how on earth could Could they come up with what it would take to pay somebody to give up their kidney? What did you use to come up with that?
SPEAKER_00:Well, we use supply and demand analysis. And I have been warned by all kinds of people that if you draw a supply and demand curve in a paper, especially one that we want medical people to look at, that that would turn them off. So it's usually supply and demand curve. And actually, we have data. That's pretty good for the first part of the, if you go up to about$38,000 in payment for a donor. We have a lot of data from various places that suggest how much that would increase the number of donors.
SPEAKER_02:Does it come from Iran? Does it come from the black? What does it come from?
SPEAKER_00:Well, there's about five places. One of them is from the United States. There was a, what's called a trolley survey done a number of years ago. Okay. That is one of them. There's other, it's not from Iran, but from Israel has a very extensive program. And also Saudi Arabia has a very extensive program. I can't remember. Oh, yes. We have the National Living Donor Assistance Center in this
SPEAKER_01:country,
SPEAKER_00:and they did an analysis of that data. They're all in the same ballpark, incidentally. Considering they're vastly different in their origins, they produced similar results. Up to about$38,000 in compensation, we have a pretty good way of estimating that. Beyond that, it's very uncertain. We know that some people like Gary Becker, who was the Nobel Prize winning economist at the University of Chicago, argues that as soon as you get above what's called a reservation price in economics, that the supply would be very In other words, we'd have a whole lot of people donating kidneys. And so we had one bound, and then we had an upper bound, and we took the middle part of that. And so there's great uncertainty there. But as you emphasized, it doesn't matter because it's so small relative to the tremendous payoff that it's of secondary importance. As a matter of fact, in the article, we did what was called a sensitivity analysis. Yeah, yeah.
SPEAKER_02:Because the benefits are just so great for what is comparatively at least a small amount of money, regardless of whether this is exactly on point or not. The savings or the benefits that you highlight in the article, the value to a transplant for each patient would be about 1.5 million. How do you estimate that?
SPEAKER_00:Well, that includes, well, we looked at how much their lives would be extended
SPEAKER_01:and
SPEAKER_00:what would be the value of that. And we used the relatively low value,$150,000 per year. And when we multiplied the number of years, it would be saved for the person by that number. And then we threw in an innovation, which is the And who's the caregiver?
SPEAKER_02:Is this family members or who's the caregiver?
SPEAKER_00:It's usually the spouse, if they're married, that's where the big burden falls.
SPEAKER_02:Got it. I was making sure you weren't referring to sort of medical professionals or insurers or anything like that.
SPEAKER_00:Anyway, it's quite substantial, and no other analyses have included that in there. And we have an appendix devoted strictly to that.
SPEAKER_02:Right. And presumably, the years spent with the post-transplant are... better years than you're spent on dialysis. Do you take that into account at all, or are you just assuming that that's all equal, making your estimate even more conservative?
SPEAKER_00:No, we take that into account. The quality of life is the technical term, and it is much, much better for people who have received a transplant than it is for folks who are on dialysis. Being on
SPEAKER_01:dialysis is
SPEAKER_00:just not very pleasant. And people who have had transplants don't complain about their quality of life. They consider it quite satisfactory, even though it's not ideal. They still have to take a lot of drugs and things like that. It is vastly better than being on dialysis.
SPEAKER_02:And then finally, you have the savings per recipient from the lack of dialysis, which is$1.2 million. I assume that number was pretty straightforward to come up with. You're just looking at the cost of dialysis.
SPEAKER_00:That's right. Not quite as straightforward as you might think. Oh, really? A product of Philip Hill, who you know.
SPEAKER_02:Yeah.
SPEAKER_00:He has done a much more careful analysis than anyone else has done. And so his number is different than other folks who usually just take the number that I guess Medicare turns out. It's a different thing. So he has done a very careful analysis of what all of these costs are. He is the expert on the particular numbers. And so that's where that comes from.
SPEAKER_02:And as you point out in the article, all of this represents significant taxpayer savings or would if we had your program, right? Because taxpayers fund about almost 80% of the expenses of dialysis and transplantation.
SPEAKER_00:That's right. It's the only disease which we actually have a socialized medicine for. that once you are diagnosed with kidney failure, Medicare steps in, even if you're not 65, and it pays for it. And so that is, anyway, a big difference.
SPEAKER_02:People ask me this all the time, and I don't know the answer, and I keep saying that I'm going to find out, and maybe you know. Do you know the origins of the end-stage renal disease entitlement story? Why do we have this special regime for end-stage renal disease and nothing else?
SPEAKER_00:I think it has to do with in the early days of dialysis, there was very limited capacity. And so you have what were called God committees that were set
SPEAKER_01:up
SPEAKER_00:to decide who would get dialysis or who would not. And this appalled a lot of people. And so they decided that the government should step in and pay for this. And it's quite reasonable. At the time, they thought that the peak number of people on dialysis would be like 25,000 people. Of course, it's way above 500,000 now. So that's what happened. But it goes back to the time when it was a much, much smaller thing. And people were just appalled that these God committees were deciding who would live and who would die. So anyway.
SPEAKER_02:Interesting. My students in particular ask me that almost every year. And every year I'm like, I'm going to look and I keep forgetting. So I'm glad you could enlighten us on that. Of course, now it eats up an ever bigger part of the budget year after year. Not only are more people using the benefit, but the cost of the benefit has gone up substantially since that time.
SPEAKER_00:That's right. So there's tremendous potential to be made for saving money for the government. And the simple fact is that transplantation is much cheaper than dialysis. Dialysis is just very expensive. So in addition to saving 40,000 people's lives a year, it would save about$7 billion a year for the government.
SPEAKER_02:Yeah, a win-win situation. What would you, I mean, I know that what you would like to see, I assume, is to have the National Organ Transplant Act repealed and a government program to compensate donors. Let's assume we're not going to see that anytime soon. What are some interim steps that might plausibly be taken, what might they look like? And do you think that we have a chance of any of them?
SPEAKER_00:Yes,
SPEAKER_02:yes.
SPEAKER_00:New York State just passed a law unanimously through both houses of the legislature, and it is awaiting the signature of the governor. And we will see how that works out. But that is very generous in its reimbursement of people who have donated a kidney. And if we could replicate that on a national level, which is altogether possible if this law gets signed into effect, we would take care of part of the problem. We might be able to save 10,000 of those 40,000 people a year who are dying unnecessarily with the level of reimbursement that is in the New York law. So that's a very hopeful sign that we could make significant progress in dealing with the problem.
SPEAKER_02:Do you know offhand what the New York state law reimburses? Is it lost wages? What exactly? How are they keying reimbursement?
SPEAKER_00:Lost wages is the big one. They are giving, reimbursing four weeks of pay for people who donate. And indeed, in special cases, like where the person does manual labor and things like that, they will extend that up to eight weeks. So that is just very generous. And it takes a long way toward reducing the disincentive. Right now, we estimate that the person who donates a kidney incurs an economic burden of about$38,000, okay? So that's an enormous discouragement to a lot of people, especially poor people. And consequently, you have a disproportionate number of high-income people or higher income who donate the organs. And you could take care of that, remove those disincentives, then a lot more poor people would be able to donate And so it would help them quite a bit. Right now, you often hear saying, oh, you can't pay for organs that it would hurt poor people. Exactly the opposite is the case. Poor people will be vastly better off because of the government paying for organs. Even if the poor people are disproportionately represented among those who are donating, they are also disproportionately represented among the recipients of the organ, the people who need a kidney transplant.
SPEAKER_02:Right. Going back to your$38,000 number, I know that you know Martha Gershon. She and her co-author John were both guests on this podcast earlier. And, you know, in addition to the money that she was out of pocket, and of course she was an altruistic donor, so a little bit different if you're donating to a family member as most donors are. But in addition to the money that she had to pay, just the amount of time that she had to spend with, you know, there's just a lot more to organ donation than just donating your organ. It's a demanding procedure financially. medically, and in her case, and I have no reason to think it's not representative, organizationally.
SPEAKER_00:Yes. We wrote an article on the disincentives that people face, and we laid out seven of them, and we tried to estimate very accurately what each of these were, what kind of a burden it was. We did not have in there any bureaucratic interferences Which is what she got into.
SPEAKER_02:Exactly.
SPEAKER_00:And if we update the article on disincentives, we're going to have an ace disincentive in there, which is these petty bureaucratic
SPEAKER_02:obstacles. Right. Well, so going back to the New York statute, that is quite generous. Four weeks for everybody and possibly up to eight weeks. And you may know, I thought Israel was four weeks. Is that right? Right. You probably know, you've probably looked at it more recently than I have, but it was also much more generous than.
SPEAKER_00:Much more generous. Yeah. Rather innovative. I think they have money for psychologists or whatever. You can go see them. They also have, you can spend a week vacation at a resort and things of that nature. So it's rather creative in addition to the economic impact. which has been considerable. So they have a system well worth emulating. And if we thought we could go for solving the whole problem, we would very much consider that sort of thing. At the moment, we're just interested in the New York version because we know that can get passed. That avoided the opposition, which I said was fierce. from some people who are opposed to this. But for instance, the National Kidney Foundation, which is a crucial stakeholder here, supported the New York law. And so it passed muster with them. So we could get them to go along with the federal law like that. That would be very important.
SPEAKER_02:Do you know whether the New York statute has a cap on one of the things that people have raised that I have heard people raise before when it comes to the reimbursement of lost wages is that they worry about the investment banker who gets reimbursed? thousands of dollars a week versus the manual laborer who gets reimbursed a much lower amount. Does New York get actual wages? Is there a cap on wages? Do they deal with that at all?
SPEAKER_00:Yes, there is a cap. I think it's$125,000 a year a salary is the equivalent. But they deal with that. But even if you gave the money to a rich guy, the benefit is that still going to accrue mainly the poor people in getting the transplanted organ. So wherever it comes from is really irrelevant compared to the huge payoff for the recipients who are mainly lower income.
SPEAKER_01:As a matter of
SPEAKER_00:fact, they're way disproportionately Black people. I'm not sure all the medical reasons for that, but they're like three times the level of kidney failure of white folks. So no matter how you cut it, the current law is hard on poor people, it's hard on black people, other minorities, and ending this would be a great benefit to those.
SPEAKER_02:So going back to the reaction that you've gotten, as you said, I mean, I'm surprised that it's half of the people. I mean, I guess I'm not having been at some of these same functions myself. So I guess I'm not surprised that about half of people sort of are just puzzled why we would fail to implement a program that both improves health outcomes and saves tons of money. And that half of the people, as you say, are not just opposed, but adamantly opposed.
SPEAKER_00:I should correct that. This is just raising hands after a talk and things like that. Nothing scientific about it. But we get the idea that roughly half the people are sympathetic to our views, especially among the younger docs. And about half are opposed. And there's a tiny proportion, it's not half, that is adamantly opposed. And they consider us to be murderers and things of that nature. Just off the charts here. That's
SPEAKER_02:interesting that younger doctors in particular have a perhaps different view and is important because, I mean, obviously, I think that we're unlikely to have any legislative changes in these areas that the medical profession, that the transplant profession is adamantly opposed to. Although, as you point out, sometimes a very loud minority can be very persuasive. Tell me a little bit about their objections. I'm familiar with them as well, but it would be helpful to have you run through some of them.
SPEAKER_00:I am, of course, the worst person in the world to adequately present their position. But one of the things they say is that this would commodify the human body. And this is puzzling since it's already very well commodified. If you need a kidney transplant and the kidney is delivered to you in the operating room, it is not provided free. It has a stiff price tag on it, which involves all the people who were involved in producing that kidney. And they are rightfully compensated at market rates. The only person who is not compensated is the donor. And if the donor were compensated, it wouldn't increase the cost of it very much. So it's already a commodity. And so it just doesn't make much sense to us that they would object to the donor getting a fair price for the
SPEAKER_02:kidney. I don't know if you've met my colleague, Julia Mahoney, at the University of Virginia. She was actually one of the early people in law to write about the possibility of compensating kidney donors. And she, I forget the exact way she phrased the analogy, but it was something along the lines of, as you just said, the donor is the only person not being paid. You're paying a lot of money for this procedure that implicitly includes a kidney. And, you know, people will respond, yeah, but that's not paying for a that restaurants are selling a dining experience instead of food. It was something along those lines that has sort of stuck with me over the years. She said it better than in my retelling. So for the people who object, especially on commodification grounds, what is it your sense that there is no amount of benefit that could bring them around? Are they, in other words, is the concept of commodifying the body As you know, I agree with you. I believe that ship has sailed, in my opinion. But for those who don't agree with us, how sacred is that value to them? Would they trade it off against anything? I mean, against nothing? Or is there some benefit that would make it worthwhile for them? Or are you not able to get a sense from them?
SPEAKER_00:Well, for the minority, it's like it's written on stone somewhere that you are not allowed to compensate donors. And this is quite strange because You may be familiar with the Istanbul Declaration.
SPEAKER_02:Yes, very.
SPEAKER_00:In 1908, a lot of very highly compensated doctors got together and decided that donors should not be compensated. They did not decide that transplant surgeons or nephrologists shouldn't be compensated, but it was the poor donor. And that's where they're coming from. That is sacred text for them. And a lot of them were just unwilling to consider almost any kind of compensation.
SPEAKER_02:That's interesting. I've often wondered, certainly as you mentioned, some of them no doubt feel this very genuinely, right? It's an actual belief for them. I can't help but think that Some are probably, they're worried more about, I always just got the sense that for some doctors, at least, they're just very risk averse. That their main concern is public acceptance of transplantation and that anything that might reflect negatively on the practice of transplantation is to be avoided. That already, there's enough people already who are concerned that the doctors aren't really going to try to save them because they're just going to take their organ. And if they thought they were worth actual money, then that fear might be, you know, so that it has something to do more with a concern about maintaining the purity of this gift, right, this gift of life, than about an actual concern about the morality of commodification. Although I agree with you that clearly for some people, It's an independent issue. Did you ever get a sense of that? Perhaps.
SPEAKER_00:It's interesting that self-interest is a very poor guide in this particular debate. And that's unusual for an economist to say that. But if we had the compensating donor, we would have a lot more transplant occurring. And you would think that would be something that transplant surgeons would favor. And half of them do, half of them don't. So, poor guy. And it's just, anyway, the transplant people, it's a very tiny minority that is vehemently opposed, but they've been quite effective. They actually try to get our articles not published. Really?
UNKNOWN:Yeah.
SPEAKER_00:Yes, they're willing to go through back channels in order to try to not have our articles accepted. Frequently, we get a very positive reception to the initial submission, a revise and resubmit. And we proceed to do that. And suddenly, the journal gets cold feet on the whole thing. And we begin to suspect that something is going on in the back room that we don't know anything about. And occasionally it comes into the front room where we know the person who is objecting to it and they're trying to kill the article.
UNKNOWN:So anyway.
SPEAKER_02:Amazing. Rather than debating these issues, you know, sort of in the open, amazing that, I mean, not amazing, right? This happens in fields, I guess, but it's still disappointing to think that rather than having an open debate, people would try to stifle that debate, especially in academic journals.
SPEAKER_00:Yes. We had this recent symposium sponsored by the University of Chicago. And one of the professional societies, one of the members put on a bulletin board recommending this particular symposium. And other members of the society objected that this was too controversial. And they got the leaders of the society to have the posting removed. So it's very strange that a professional society would come out against discussion of the issue on the grounds that it's too controversial.
SPEAKER_02:Yeah. And this is the Chicago Symposium that you're referring to. And so I know some of the speakers there, including yourself, Martha, who we already mentioned. I know Al Roth was a speaker there. So there's one person who won a Nobel Prize in part for his work facilitating kidney donation, right? You know, the matching algorithms. At least one, and my recollection is several people who had been altruistic donors themselves. Was Josh Morris in there? I don't remember if he was. Right. And so... This is a group of people who, even if you disagree with them, have unquestionably been trying to help others and have actually done so in very specific ways.
SPEAKER_00:And Janet Radcliffe Richards was our keynote speaker, and she is a noted philosopher who has been long involved in this area. And she gave an excellent presentation. So... I'm not sure who the controversial speaker was. It might have been me. The least resume of all the major speakers.
SPEAKER_02:I guess it's a variation. If you don't know who the controversial speaker is, it must be you. I
SPEAKER_00:guess so. The history of thought is loaded with all kinds of people who were controversial speakers. in the beginning, going back to Galileo and Darwin and all like that. So that for anyone to object to something simply because it's controversial is hard to believe for me.
SPEAKER_02:Yeah, it really
SPEAKER_00:is. The big message is that the problem is much greater than it's generally acknowledged. For instance, the government agency, the Health Resources Service Administration, estimates that the shortage of all organs is killing about 19 people a day. And what they're doing is just looking at people on the waiting list who have died, not those who have been removed for the waiting list because they are in poor health, or the people who never get to the waiting list as youth. So that is a real low ball estimate. We think about 110 people a day die because of the kidney shortage. So that's the first big thing. That's a
SPEAKER_02:huge differential. Yes.
SPEAKER_00:And we don't know why other people are minimizing the problem. But the problem is much greater than is generally acknowledged. So that's the first point. And the second point is that we can solve the problem. We can save all those lives by a relatively small investment by the government, which would, because of the savings in the long run, would save them money. So from a rational point of view, it's hard to, at least from our point of view, argue it. against those two facts.
SPEAKER_02:Right. Yeah. I think it's important to emphasize this for listeners, right? Because sometimes people say, why kidneys? Why transplantation? Why so much focus on this? People die from lots of things and we're already spending a lot of money on this. And now we're also focusing a lot of attention on it. But it seems to me that this is This one is within our grasp. We don't have a cure for cancer yet. We might at some point, but we know what to do here. We just need more transplants and people have two kidneys. They only need one to live. We can keep people alive on dialysis while we find a donor and we could save a lot more money than what we're currently spending on end-stage renal disease care through dialysis. more transplantation. And so, I mean, to me, that's the answer of why we're all focused on this problem. It's one that is solvable with the tools we have. That's
SPEAKER_00:why we have been working on this for eight years here. And it's just, there's a lot of people whose lives could be saved every year. And if we go back to 1988, the total is over a million. I mean, it's less the, it's a problem worth addressing.
SPEAKER_02:Well, thank you so much for doing this. This was a lot of fun.
SPEAKER_00:Well, it was very nice meeting you,
SPEAKER_02:Kim. I know, I know. I've been on phone calls with you before, but this is the first time I think I've actually, you know, this is the closest we've come to an actual meeting.
SPEAKER_00:Maybe someday when COVID is behind us, we'll all get together in person.
SPEAKER_02:Yes, that would be, I'm missing those in-person meetings. No, I agree. Well, this has been fun. Thank you so much for doing this. It
SPEAKER_00:was fun chatting with you.
SPEAKER_02:Yeah, you too. Take care.
SPEAKER_00:Bye-bye.
SPEAKER_02:Bye-bye.
