Could the Rich and Famous Game the Kidney Transplant List? That's Complicated. 

If current reports on his health are to be believed, Lamar Odom may be in need of a new kidney. But unlike the 100,000+ Americans currently waiting for a kidney transplant, Odom is rich, famous, and backed by one of today’s most powerful entertainment dynasties. When it comes to organ donation, are the rich and famous stuck in the same frightening holding pattern as the rest of the people in need, or is there a way for them to jump the line?

As of around midday today, there are roughly 122, 554 Americans currently waiting for an organ transplant. Most of those people are waiting for a kidney, with a new person added to the kidney transplant list every 14 minutes. The waiting list for deceased donor kidneys encompases everyone in need of a transplant — young, old, black, white, rich, poor. And now—maybe—Lamar Odom.

First, a (very) brief anatomy lesson: most people are born with two kidneys. In a pinch, you can generally adapt to living with only one — the remaining kidney will grow and take on part of the function of the one you lost. Among other things, this means that living people can serve as donors, giving away one of the set and continuing on to lead comparatively healthy lives. People in renal failure and in need of a transplant can receive a new kidney in one of two ways: deceased or living donor.

The process by which it’s determined who does and does not get a kidney is complicated. Depending on the patient’s blood type and other medical signifiers, some people may wait years for a match. When a patient’s health declines to the point of needing a transplant, they are evaluated in one of the more than 200 transplant centers in the US. Staff assess their medical condition, whether transplant will be an effective treatment, psychosocial issues — essentially, if the person gets a transplant, will they do well with it? Receiving an organ isn’t just plug and go, it involves extensive follow up care and treatment centers must be confident that patients will return for visits after the transplant. Organs are hard to come by and no one wants one to go to waste. This is logical, but also one of the major flaws in the system — people without permanent addresses or strong support systems may be less likely to be approved for transplant. Ability to pay for the surgery itself is generally irrelevant— kidney transplants are almost universally financed through either private insurance or medicare — but social factors that influence a patient’s ability to manage before and after the surgery may influence a hospital’s decision to approve them as a transplant recipient. To further complicate matters, these decisions are entirely up to each individual hospital; there is no shared set of guidelines, and so it may be possible for a patient rejected at one center to be approved at another.

If patients are accepted, their name is forwarded along to the United Network for Organ Sharing (UNOS), a private nonprofit under federal contract that maintains the national matching system for deceased transplants (also known as “the waiting list”). Roughly 60% of kidney transplants in the United States are from deceased donors. The waiting list is organized by date of registration, but that doesn’t automatically mean that people higher on the list will receive the first kidney available. UNOS describes the list as dynamic and continuously changing. “New people are constantly coming on to the list and dropping off — not every patient matches to every donor. It is not as though you are given a definitive number of priority for a transplant. When an organ is available from one of the 58 nationwide organ procurement organizations, information on the donor is matched with medical characteristics from patients on the list. Then the computer system gives us a ranked list of matching patients. If we contact the patient’s transplant hospital and the answer is no for whatever reason, we continue down the sequence until the organ gets placed.”

Essentially, patients are not called up in order of 1, 2, 3, and 4. It ends up being more like patients 5, 99, 2045, and 9384, as the algorithm pulls out the people from the list who will actually match the available organ. Some patients may be prioritized on the list based on certain medical characteristics, but these are not things that an individual can control. The matching system is based on science and your place is not governed by whether you live in a mansion or public housing. Which is exactly as it should be.

Organs are offered to local hospitals, then by region, and then nationwide. So while it doesn’t technically matter if you’re rich or poor, here’s where being rich can help a person get a kidney. Some areas of the country have significantly shorter lists than others. UNOS’s “policies allow for multiple listing. An individual, if they want to increase potential chance of a local offer, can choose to register and list in different hospitals in different local areas with the idea that they have multiple opportunities to get matched.” Individuals of means can put themselves on several lists, aware that they can travel easily to the location when their number is up, increasing the odds of finding a match. Rich people can also move to areas with greater odds of receiving transplants. There is no limit to the number of places you can put your name down, as long as you have your paperwork and clinical data up to date at each location. This is controversial for obvious reasons—it may be legal, but it seems spectacularly unfair.

A different selection process applies to patients who receive kidneys from living donors. The gold standard is for a family member to donate—siblings, for example, have a 25% chance of being a perfect match. But direct genetic relationship isn’t a prerequisite for a successful kidney transplant; at the California Pacific Medical Center, one of the leading transplant hospitals in the country, more than half living donor transplants are not blood related. “Donors can be spouses, friends, community members, people you’ve met online. Some people come in with ten donors. When social media word gets around, there can be 100s of people. It’s not surprising that someone who is famous would have more people interested.” There are also cases where people are just unimaginably altruistic. Last year more than 500 people donated kidneys to complete strangers, sight unseen. This may even kick off a transplant chain—the altruistic kidney goes to a patient in need and that patient’s willing but incompatible loved one then donates their kidney to another stranger; the chain could, theoretically, continue indefinitely.

Living donation in many ways comes down to whether you are lucky enough to have a loved one who is both a willing and medically compatible donor. Selling organs in the US is illegal under federal law, which, for better or worse, means that not a lot people are willing to part with their kidneys for a stranger. Donors can be compensated with things like lodging, meals, missed wages, but not with property or something bought or sold for value. Wealthy people (like, say, a Kardashian affiliate) can’t just pay someone $500,000 out of pocket and walk away with a kidney. But they can do things like donate to a chosen charity. In the case of athletes and celebrities, if family and friends are not a match, they may have fans who just want the opportunity to save one of their heroes. And get the bragging rights of having their organ keeping a famous person alive—less than a week after news leaked of Lamar Odom’s condition, superfans were contacting him, eager to offer up an organ to save one of their heroes.

There are some ways that the rich and famous can game the system and increase their odds of receiving organ transplants. The best way to even that playing field is to increase the available pool of organs. Every day, 22 people die waiting for a transplant and thousands more struggle with severe disease, waiting for someone to change their lives. There are simply not enough donors to accommodate all of the people who need kidneys, livers, hearts, bone marrow, and pancreases. Consider registering as an organ donor here and discuss the choice to become a donor with your loved ones. Don’t do it just for Lamar Odom. Do it for your neighbor.

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