Where Most Needed

In a Forbes magazine column, Virginia Postrel gives us one side of a long running debate about the advisability of compensating for transplant organs.  To us, the importance of this debate is that it is being carried out almost entirely within and among nonprofit organizations.

The current policy dates from the National Organ Transplant Act of 1984, which also created a nationwide Organ Procurement and Transplantation Network, which since its inception has been managed by the United Network for Organ Sharing (EIN 54-1327878 Form 990), based in Richmond, Virginia.  UNOS maintains the database that is used to match available organs with recipients.  The fees for this service ($447 in 2004) and a government contract provide about 85% of the organization's income of $25 million.  Executive director Walter Graham receives compensation of $284,654.  One concern is that the organization has a staff of 226 and lists two other officers and five staff earning well over $100,000, but none of them are in a fiscal accountability function (for example, a chief financial officer). 

On the other side of the debate is the American Enterprise Institute (EIN 53-0218495 Form 990), on 17th Street between L and M in Washington, DC.  AEI published in 2002 the book "The US Organ Procurement System: A Prescription for Reform," by A. H. Barnett and David L. Kaserman.  This laid out the argument in favor of changing the policy against compensating for transplant organs.  The AEI, in contrast to UNOS, receives more than 90% of its $20 million revenue from donations.  Its president, Christopher DeMuth, receives a salary of $583,750.  The staff of 141 includes another "key employee" earning $305,000 and five others earning in the $100,000-$200,000 range.  One key employee is CFO Margaret Gochal earning $113,000.  However, the total non-key staff salaries in management and administration is $239,633.  It is doubtful whether this limited staff can provide adequate fiscal accountability for a staff of many scholars responsible for many grants. 

In her blog, Virginia Postrel complains that the National Kidney Foundation (EIN 13-1673104 Form 990*) is attempting to stifle debate about the topic.  AEI is planning a conference in June to promote paid transplants ("Buy or Die"), but NKF CEO John Davis wrote to Chris DeMuth saying that such a conference would serve no useful purpose, since the Institute of Medicine (a US agency, part of the National Institutes of Health) had just issued a report in April, following 15 years of debate on the topic, that paid transplants are not desirable from a policy standpoint.  Here's the executive summary and the link to purchase the whole report in PDF format is here.

*National Kidney Foundation has a federated structure with independent local chapters.  The Form 990 is that of the New York headquarters.  A Guidestar search on NKF turns up 56 local organizations.  But NKF does produce a consolidated financial report that gives a more comprehensive picture of its activities as a whole.  On a consolidated basis it reports income of about $34 million, about 25% of which is contributions and 60% is fee income.   The headquarters employs but one key staff, CEO Davis, earning $349,286.  There is one non-key staff earning $220,000 and there are four others listed in the $100,000 to $200,000 range.  However, the organization reports non-key administrative salaries of $960,774, which seems more reasonable to support a total headquarters staff of 119 plus coordination with a number of local chapters. 

It is noteworthy that this debate about very fundamental values is going on between a handful of nonprofit organizations of relatively modest size, without any evident media or public attention. 

And for what it is worth, the AEI report in favor of paid transplants is available for free download, but the Institute of Medicine report affirming the current policy costs $37.50 even for the PDF download ($55.80 hardcover & $49.50 paperback).  Maybe that is a measure of the relative value of the two positions. 

For another perspective, here's another famous study about economic values appplied to human health concerns, more often talked about than actually read.