Attitudes Toward Strategies to Increase Organ Donation

Abstract

Summary Background and objective The acceptability of financial incentives for organ donation is contentious. This study sought to determine (1) the acceptability of expense reimbursement or financial incentives by the general public, health professionals involved with organ donation and transplantation, and those with or affected by kidney disease and (2) for the public, whether financial incentives would alter their willingness to consider donation. Design, setting, participants, & measurements Web-based survey administered to members of the Canadian public, health professionals, and people with or affected by kidney disease asking questions regarding acceptability of strategies to increase living and deceased kidney donation and willingness to donate a kidney under various financial incentives. Results Responses were collected from 2004 members of the Canadian public October 11–18, 2011; responses from health professionals (n=339) and people with or affected by kidney disease (n=268) were collected during a 4-week period commencing October 11, 2011. Acceptability of one or more financial incentives to increase deceased and living donation was noted in >70% and 40% of all groups, respectively. Support for monetary payment for living donors was 45%, 14%, and 27% for the public, health professionals, and people with or affected by kidney disease, respectively. Overall, reimbursement of funeral expenses for deceased donors and a tax break for living donors were the most acceptable. Conclusion The general public views regulated financial incentives for living and deceased donation to be acceptable. Future research needs to examine the impact of financial incentives on rates of deceased and living donors.

Living Donor Kidney Transplantation

“…Legislative authorization to expand the NLDAC to include reimbursement of lost wages (with an appropriate cap) and other direct expenses as well as the removal of financial means testing is an immediate priority to reduce the effects of class and racial disparities. Transplant patients, living donors, the general public, community nephrologists, and transplant providers all strongly support reimbursement of donation-related expenses to achieve financial neutrality for living donors (36,(71)(72)(73), and at least 17 countries have launched pilot or national programs that include reimbursement for living donor lost wages (74).…”

The Cost-Effectiveness of Using Payment to Increase Living Donor Kidneys for Transplantation

“…Living donors would still be able to donate to a relative/friend or anonymously to the waiting list, and all living donors would receive payment. In the absence of data from high-quality studies examining the impact of financial incentives on living kidney donation rates, our estimates were based on a recent survey (10), which found that, of those who would not consider donating at baseline, 54% would consider donating to a relative for payment of $10,000 from a third party government payer on donation. Because this survey only measured intent to consider donation, we used a conservative estimate of an increase of 5% in transplants-representing five additional paid living donors in a 100 total transplant/yr program-if $10,000 were offered through a paid living donor strategy to all living donors in the base case analysis and considered a broad range of estimates in sensitivity analyses.…”

“…Multiple strategies to increase living donation have been proposed, including limiting financial disincentives for living donors (6)(7)(8)(9). Recently, we conducted a survey examining the acceptability of financial incentives to increase the number of kidneys for transplantation (10). Most respondents reported that financial incentives were an acceptable strategy to increase the number of living donor kidneys for transplantation, and nearly one half found monetary payment an acceptable form of financial incentive.…”

Does Financial Compensation for Living Kidney Donation Change Willingness to Donate?

“…Empirical studies in North America have examined the attitudes of potential donors (17), and others (18) on the effect of financial compensation on willingness to donate, a (crowding out) disincentive to donate, and/or whether a quantifiable limit can be generalized, after which an offer becomes an undue inducement. Halpern et al (19) used conjoint analysis in which participants assessed their own willingness to donate when conditions such as risk levels were experimentally changed in hypothetical scenarios.…”