All things considered, Michael Bowles is one of the lucky ones.

Last year, the 38-year-old Waterville native was diagnosed with end-stage renal failure, his best hope for long-term survival coming from a donation system unable to meet the demand for healthy kidneys.

Then, through Facebook, he connected with Davine Grantz, a Saco woman who was willing and – as tests confirmed – able to give Bowles one of her kidneys. After surgery Aug. 9 at Maine Medical Center, both are doing well.

But too often, that’s not the case. In 2014, nearly 30,000 Americans received life-extending organ transplants, mostly kidneys. But around 8,000 people died awaiting donations – 22 a day – and more were removed from the list after becoming too sick for a transplant.

The unnecessary death and suffering are the result of a donation system that does not attract enough donors. To fill the growing gap, the medical community has to change the way it views donor compensation.

Organ donation is a medical marvel. For people with kidney failure, the only alternative is dialysis, which Bowles was undergoing four hours a day, three days a week. It is costly and time-limited – hardly a long-term solution.

But kidney organ recipients have a five-year survival rate of 92 percent for kidneys from living donors and higher than 83 percent from deceased donors.

There are, however, around 120,000 people waiting to receive organ donations in the U.S., up from about 20,000 in the early 1990s and nearly 80,000 in 2000. In that time, the number of people who have donated an organ has only doubled, to about 14,000.

For too many people waiting for a healthy kidney or liver, the math just doesn’t work. There are simply not enough organs in the pipeline.

Fixing that requires an effort to bolster not only the number of Americans who allow their organs to be donated upon their death, but also the ranks of those who are willing, like Grantz, to donate while they are alive.

That’s a sensitive area for many surgeons and medical ethicists, who are concerned that allowing any compensation would enable exploitation. Now, kidneys from deceased donors are distributed through a logarithm; living donors are free to make their own arrangements with a recipient, but they can only be given money to offset expenses incurred.

In most cases, those costs are significant, and represent a barrier to donation. Donors face up to eight weeks of missed work, travel and endless medical appointments, not to mention any long-term health concerns from limited kidney or liver function.

Better, more complete forms of reimbursement are necessary to allow more people to give. In addition to programs through hospitals and health-care providers, states or the federal government could offer incentives, as suggested by the American Society of Transplantation and the American Society of Transplant Surgeons. These could include tax credits, retirement contributions or early access to Medicare or some other form of long-term health insurance.

A waiting period could weed out impulsive donors, and organs could be distributed through existing logarithms, further cutting down on opportunities for exploitation.

There’s no need for an immediate complete overhaul – these ideas could be tested through regional pilot projects.

These suggestions may make some in the medical community feel squeamish. But the real problem is with a system that ends in early death for too many Americans.

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