The United States has an endemic shortage of kidneys available for transplantation, and this shortage is costly in both money and lives needlessly lost. There are currently a half-million Americans receiving dialysis, and the federal government bears nearly all of this cost. Medicare spends over $50 billion a year providing dialysis and other treatments for people with end-stage renal disease.

Over 100,000 people are on the waiting list to receive a kidney, but many of them will perish before receiving a transplant. Thousands more would benefit from a new kidney, but they never make it on the transplant list simply because there is no chance they would receive one in time to save their lives. Over 40,000 people die of end-stage renal disease each year, about the same as die from car accidents or gun violence. Many of those deaths would be prevented with an adequate supply of kidneys.

Kidney disease also disproportionately affects African Americans, who are five times more likely to have end-stage renal disease than people of European descent.

There are several efforts afoot to change government policy on organ transplantation. I asked some of the people involved in these efforts to write about their work on the issue. Josh Morrison and Sammy Beyda of the advocacy group Waitlist Zero write about kidney donation in Israel, which saw donations increase dramatically when it began paying all costs and forgone wages of kidney donors. American Enterprise Institute scholar Sally Satel has proposed that kidney donors receive a generous federal tax credit, and she and AEI colleague Alan Viard discuss the mechanics of providing one as well as the degree to which it might boost supply. Former White House domestic policy adviser Abe Sutton writes about the poor performance of many organ procurement organizations (OPOs) and the organ procurement and transplantation network (OPTN), which are tasked with retrieving and allocating transplant organs in different parts of the country. Sutton recommends steps to improve their performance and boost supply by using competition to modernize their technology and governance. Finally, Johns Hopkins University economist Mario Macis writes about his research on public objections to the government directly compensating kidney donors and how their opposition softens if compensation substantially increases donations and lives saved.

Unlike our expensive and ineffective efforts to reduce deaths from auto accidents and drug abuse, these proposals, if enacted, would save the government tens of billions of dollars a year by removing people from dialysis. The fact that a sensible reform of this failed system would also save thousands of lives is why our authors — and many others — are passionate about these efforts.