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The world’s first voucher system for people who donate kidneys has boosted donations by giving US donors transplant coupons they can give to loved ones in need.

The concept was invented by a former judge in California, who became the first donor to the scheme in 2014. Howard Broadman wanted to give a kidney to his 4-year-old grandson Quinn Gerlach, whose chronic kidney disease means he is likely to need a transplant within the next decade or two.

When somebody needs a new organ, they go on a transplant list, but organs are in short supply. There are currently more than 93,000 people in the US waiting for a kidney, and 12 of these die waiting every day. One way to get around this is to have a friend or relative choose to donate a kidney directly to you.

“I know Quinn will eventually need a transplant, but by the time he’s ready, I’ll be too old to give him one of my kidneys,” says Broadman. He says he first considered being altruistic, and simply donating a kidney to someone else. “But then I started thinking ‘this is bullshit – I should get something for this’.”

Broadman approached the University of California, Los Angeles, and asked them to give him a voucher for donating a kidney to someone now that will make his grandson more likely to get a transplant when he needs one in the future. UCLA surgeon Jeffrey Veale agreed, and set up a voucher scheme.

Veale and his team’s analysis of the scheme, published this month, suggests it really does encourage more people to donate kidneys. Veale says wider adoption of the scheme could lead to thousands more donations.

Chain of donations

A previous study found that over a third of people who require a transplant are unable to accept a kidney from a friend or relative willing to donate because of biological incompatibility.

Doctors tackle this problem by matching up incompatible donors with other patients facing the same problem, creating long donation “chains”. Rather than giving directly to their incompatible loved ones, the relatives and friends give kidneys to each other instead, enabling everyone to find a match.

Each voucher in Veale’s scheme helps to get one of these chains started, sometimes enabling dozens more transplants. Broadman started a chain when he donated his kidney to Kathy DeGrandis, a retired airport manager. DeGrandis’s sister previously hadn’t donated because she was incompatible, but she then donated her kidney to a stranger, and that  person’s family then donated to someone else.

Each donor was given a voucher that can be used by a loved one. The voucher doesn’t guarantee a kidney transplant, but it gives a person high priority for being included in a donation chain when an appropriate match becomes available.

Working with the UCLA team, the US National Kidney Registry has so far issued 21 kidney vouchers across 30 hospitals, each one stimulating donation chains that have led to a total of 68 new transplants.

“If only a fraction of the 40 million chronic kidney disease patients in the US had a donor like Judge Broadman, then tens of thousands of high-quality organs would enter the system,” says Veale. “For the first time in history we could actually start reducing the waiting list.”

But Joy Riley of the Tennessee Center for Bioethics and Culture says she is sceptical of a system that relies on “trusting in a piece of paper with no guarantees”. Though the scheme has been approved by the medical board of the National Kidney Registry and is now offered in 30 hospitals, Riley says she would like to see a “national conversation” before the scheme is rolled out further.