Economic Consequences Incurred by Living Kidney Donors: A Canadian Multi-Center Prospective Study

Klarenbach, Scott; Gill, Jagbir; Knoll, Greg; Caulfield, Timothy; Boudville, Neil; Prasad, G. V. Ramesh; Karpinski, Martin; Storsley, Leroy; Treleaven, Darin; Arnold, Jennifer M.; Cuerden, Meaghan; Jacobs, Philip; Garg, Amit X.

doi:10.1111/ajt.12662

Cited by 95 publications

(101 citation statements)

References 17 publications

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“…The disparities workgroup supports the recommendations of Tushla et al (44) from the Consensus Conference to achieve financial neutrality for living donors. These recommendations include legislative protection from job loss and insurance discrimination as a result of living donation as well as the creation of a toolkit to better educate transplant centers and potential living donors about the financial effect of donation and potential resources to mitigate cost.…”

Section: Recommendation 1: Remove Financial Disincentives To Lkdmentioning

confidence: 67%

“…The LDKT and LKD financial concerns of patients and potential donors are not unfounded (41)(42)(43). The workgroup noted the likelihood that the financial effect of LKD is a significant driver of disparities in LDKT, both for those in lower socioeconomic classes and for many members of minority groups.…”

Section: Incomementioning

confidence: 99%

“…The workgroup noted the likelihood that the financial effect of LKD is a significant driver of disparities in LDKT, both for those in lower socioeconomic classes and for many members of minority groups. Although this topic was explored in more depth in another workgroup (44), the finances of access to care and burdens of LKD were central to our workgroup's discussion. Unfortunately, living donor costs have not been systematically captured by the transplant community, although some have estimated total costs to range from $0 to $20,000, with an average of approximately $5000 (41)(42)(43)45).…”

Section: Incomementioning

confidence: 99%

“…Although this topic was explored in more depth in another workgroup (44), the finances of access to care and burdens of LKD were central to our workgroup's discussion. Unfortunately, living donor costs have not been systematically captured by the transplant community, although some have estimated total costs to range from $0 to $20,000, with an average of approximately $5000 (41)(42)(43)45). Concern about these costs deters both transplant candidates from talking to others about possible donation and potential living donors from pursuing donation (46).…”

Section: Incomementioning

confidence: 99%

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Living Donor Kidney Transplantation

Rodrigue

Kazley

Mandelbrot

et al. 2015

Clinical Journal of the American Society of Nephrology

108

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Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.

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Section: Recommendation 1: Remove Financial Disincentives To Lkdmentioning

confidence: 67%

Section: Incomementioning

confidence: 99%

Section: Incomementioning

confidence: 99%

Section: Incomementioning

confidence: 99%

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Living Donor Kidney Transplantation

Rodrigue

Kazley

Mandelbrot

et al. 2015

Clinical Journal of the American Society of Nephrology

108

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“…These may include direct out-of-pocket expenses (i.e., travel, lodging, meals, parking, dependent care, and some uncovered medical expenses) and indirect costs (i.e., lost wages, use of employer-sponsored paid time off, and effect of insurability or premium rates) (Table 1) (4). Total estimated costs for LKDs range from $0-$20,000, with an average of approximately $5000 (4,16,17). In a 2014 Canadian study, Klarenbach et al reported that 96% of LKDs had experienced negative financial consequences from donation, with 47% reporting lost wages (16).…”

Section: Background On Systemic Barriers To Living Kidney Donationmentioning

confidence: 99%

Living-Donor Kidney Transplantation

Tushla

Rudow

Milton

et al. 2015

Clinical Journal of the American Society of Nephrology

108

113

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Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.

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The Effect of State Policies on Organ Donation and Transplantation in the United States

et al. 2015

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IMPORTANCE Shortages in transplantable solid organs remain a critical public health challenge in the United States. During the past 2 decades, all states have implemented policies to increase organ supply, although their effectiveness is unknown.OBJECTIVE To determine the effects on organ donation and transplantation rates of state policies to provide incentives for volunteer donation. DESIGN, SETTING, AND PARTICIPANTSUsing a quasi-experimental design and difference-in-differences regression analyses, we estimated the effect of policies in all 50 states and the District of Columbia on organ donors per capita and the number of transplantations from January 1, 1988, to December 31, 2010. Analyses were also stratified by type of donor (living vs deceased). Data were derived from the United Network for Organ Sharing. All data collection occurred between July 7 and September 27, 2013.EXPOSURES Policies of interest were the presence of first-person consent laws, donor registries, dedicated revenue streams for donor recruitment activities, population education programs, paid leave for donation, and tax incentives. Information on states' passage of various policies was obtained from primary legislative and legal sources. MAIN OUTCOMES AND MEASURESThe number of organ donors and transplantations per state, per year, during the study period.RESULTS From 1988 to 2010, the number of states passing at least 1 donation-related policy increased from 7 (14%) to 50 (100%). First-person consent laws, donor registries, public education, paid leave, and tax incentives had no robust, significant association with either donation rates or number of transplants. The establishment of revenue policies, in which individuals contribute to a protected state fund for donation promotion activities, was associated with a 5.3% increase in the absolute number of transplants (95% CI, 0.57%-10.1%; P = .03). These associations were driven by a 4.9% increase in organ donations (95% CI, 0.97%-8.7%; P = .01) and an 8.0% increase in transplants (95% CI, 3.1%-12.9%; P = .001) from deceased donors as opposed to changes among living donors or transplants from living donors. CONCLUSIONS AND RELEVANCENearly all state-level policies to encourage organ donation have had no observable effect on the rate of organ donation and transplantation in the United States. The one exception was the establishment of revenue policies to promote organ donation, which may have led to small increases in organ donations and transplantations from deceased donors. New policy designs are needed to increase donation rates and curtail the widening gap between organ supply and demand.

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Economic Consequences Incurred by Living Kidney Donors: A Canadian Multi-Center Prospective Study

Cited by 95 publications

References 17 publications

Living Donor Kidney Transplantation

Living Donor Kidney Transplantation

Living-Donor Kidney Transplantation

The Effect of State Policies on Organ Donation and Transplantation in the United States

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