30 Issues | If You Needed a Kidney Transplant in Spain...
Spain has enviable stats when it comes to organ donation. The latest numbers from 2014 show 4,360 transplants were carried out that year, securing its spot as the country with the highest donation rate in the world.
This is, in some small part, because Spain has an opt-out system. That means that everyone is an organ donor unless they’ve explicitly stated otherwise.
So if you were a Spaniard in need of a riñón (that’s a kidney), here’s what would happen.
You’re covered by Spain’s single-payer health system, so the costs for transplantation are completely taken care of by national health insurance as long as you go to a public health facility. If you decide to go to a privately-run clinic, you’ll need to pay some out-of-pocket fees; but not many people decide to do that for transplant surgeries in Spain because the system is so efficient.
So let’s say you go to a public facility. You’re put on the organ donation list by the National Transplant Organization, which is part of Spain’s Health Ministry. It’s an organized group with “transplant coordinators” in a number of hospitals who have special training as intensive care specialists, and they also manage donor and recipient lists.
And the average wait time for a kidney in Spain? Less than 8 months.
Compare that to America, where depending on where you are, your blood type, and a number of other factors, the average wait time for a kidney varies from 3 to 10 years.
Ara, a l'NPR, al show de @BrianLehrer, parlen de l'eficiència del sistema sanitari espanyol en la donació i transplantament d'òrgans.
— Rut Vilar (@rut_vilar) April 28, 2016
@BrianLehrer nyc resident here. Lived in madrid for a few years and have only great things to say about the spanish healthcare system
— PhDSquared (@AlphaSquared) April 28, 2016
@BrianLehrer i got very ill there and was treated quickly and medication was very cheap. Also damaged my knee. Never paid a cent for doctors
— PhDSquared (@AlphaSquared) April 28, 2016
For comparison, here's what it's like to get a kidney transplant in a few other countries...
America
America has an opt-in donor list, which means you have to elect yourself as an organ donor. This is typically done with a DMV registration.
As with most services in the American system, costs vary widely depending on your insurance. If you're on dialysis before getting a transplant, that could cost around $80,000 per year.
Transplantation involves laboratory tests, organ procurement, surgical costs, and immunosuppressive drugs after the surgery. In 2011, the average cost of a kidney transplant was about $262,000 - but remember, insurance companies can negotiate this price down and end up covering a good chunk of this bill.
Medicare and Medicaid both offer substantial aid in transplant-related costs.
Israel
Jewish law forbids desecration of the dead, which some interpret as a definitive ruling-out of organ donation. As a result, many people end up dying on waiting lists.
But now there's an added incentive to opt into the organ donation program. Organ donors are given priority if they ever need an organ transplant, making Israel the first country to consider non-medical factors in organ allocation. Since implementing this policy in 2012, the country has seen an uptick in donors.
Still, the black market and organ-trafficking rings connecting donors from other countries (like Costa Rica and Kosovo) are flourishing, at costs ranging from $100,000 to $200,000.
Iran
Selling your organs in Iran is perfectly legally and has created an economy among its poorest citizens who see it as an opportunity to make extra rials. It's the only country that allows cash payment for donors.
Donors are compensated by both the government and the organ recipient. The official list price for a kidney is about 7 million rials ($230.93 USD), of which 1 million ($32.99 USD) is paid by the government.
The upside to this system (which some denounce, ethically) is that people who need kidneys get them quickly, and the donors who give kidneys are screened and monitored before and after the operation. Also: no wait times. Supply is effectively meeting demand for kidneys in Iran.
We'll continue to examine other healthcare scenarios all week, as part of our "30 Issues in 30 Weeks" elections series. And if you like knowing tidbits like these, sign up for our newsletter! It'll be a once-a-week digest of what we learned while preparing our series segments, Brian's insights, and fun facts that didn't make it to the air.
