Current Canadian Initiatives to Reimburse Live Organ Donors for their Non-Medical Expenses

Abstract

Living organ donors frequently incur non-medical expenses for travel, accommodation, prescription drugs, loss of income, and child care in conjunction with organ donation. Despite international precedent and widespread public support, Canada currently lacks a unified strategy to reimburse donors for these expenses. In 2005, we communicated with 78 individuals within the field of Canadian transplantation to identify which initiatives for reimbursement of living donors existed in each province. Saskatchewan was the only province in which public employees were granted paid leave for organ donation. Six provincial governments partially reimbursed travel and accommodation. At the federal level, other expenses could be partially reimbursed through an income tax credit, while the Employment Insurance program and the Canada Pension Plan provided funding for donors who become unemployed or develop longterm disability as a result of donation. Charities helped a limited number of patients in financial need through grants and no-interest loans, but funding was generally limited by contributions received. While reimbursing living donors for their non-medical expenses is considered just, existing programs only partially reimburse expenses and are not available in all provinces. Developing future reimbursement policies will remove a disincentive faced by some potential donors, and may increase rates of transplantation in Canada.MeSH terms: Living donors; kidney transplantation; health policy; economics; costs and cost analysis RÉSUMÉLes donneurs vivants engagent souvent des dépenses extramédicales (frais de déplacement et d'hébergement, achat de médicaments sur ordonnance, perte de revenus, frais de garde d'enfants) en liaison avec leurs dons d'organes. Or, malgré les précédents internationaux et l'appui généralisé du public, le Canada n'a pas de stratégie unifiée pour leur rembourser ces dépenses. En 2005, nous avons communiqué avec 78 intervenants du secteur de la transplantation au Canada afin de repérer, dans chaque province, les initiatives de remboursement des dépenses des donneurs vivants. La Saskatchewan est la seule province qui octroie un congé payé aux fonctionnaires faisant un don d'organe. Six administrations provinciales remboursent en partie leurs frais de déplacement et d'hébergement. Dans l'administration fédérale, d'autres frais peuvent être partiellement remboursés par un crédit d'impôt sur le revenu, et le programme d'assurance-emploi et le Régime de pensions du Canada prévoient des fonds pour les donneurs qui ont perdu leur emploi ou qui présentent des limitations fonctionnelles de longue durée en raison d'un don d'organe. Des oeuvres de bienfaisance aident un petit nombre de patients en difficulté financière en leur octroyant des subventions et des prêts sans intérêt, mais le montant du financement est en général limité par les contributions reçues. On considère qu'il est juste de rembourser les dépenses extramédicales des donneurs vivants, mais les programmes existants n'en remboursent qu'une partie, et t...

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“…There are many who cannot donate if their family expenses are not covered while they undergo evaluation, surgery and recovery [30]. Currently in the US, there is no general program to assist donors with transportation, lodging and loss of wages except for the National Living Donor Assistance Center [31,32]. Although very helpful, donors must meet eligibility criteria, including an income threshold of 300% of the Department of Health and Human Services Poverty Guidelines.…”

Reimbursing Live Organ Donors for Incurred Non-Medical Expenses: A Global Perspective on Policies and Programs

“…Information obtained from country representatives, however, may be subject to bias and is directly limited by the individual’s experience in living organ donation. In some countries, multiple complex opportunities for reimbursement exist, including programs beyond the sphere of transplantation (18). We provided generalizations of these opportunities to allow for broader comparisons across countries.…”

“…To ease the financial burden of organ donation, experts advocate reimbursement of legitimate expenses, stating that it is just and ethically responsible, and should be considered a cost associated with treating living organ recipients (12)(13)(14)(15)(16)(17)(18). In 2008, the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, the European Parliament, and the Asian Taskforce on Organ Trafficking each issued formal statements urging member states to define conditions in which reimbursement can be granted (12,13,16).…”

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“…68,69 In some countries, the health plan also tends to provide long-term protection for donors and their families in case of eventuality that may be related to donation and thus can be viewed as removing disincentives potentially experienced by a do-nor. 70 Such models potentially are scalable in developing countries also, with culturally appropriate modifications using local interpretations of individual autonomy, rights, and utilitarianism. It would be important to report mid-to long-term outcomes on donor satisfaction surveys and other health, economic, and social indicators.…”