Factors associated with perceived donation-related financial burden among living kidney donors

Ruck, Jessica M.; Holscher, Courtenay M.; Purnell, Tanjala S.; Massie, Allan B.; Henderson, Macey L.; Segev, Dorry L.

doi:10.1111/ajt.14548

Cited by 12 publications

(8 citation statements)

References 20 publications

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“…15 Our finding that sex-related differences in living donation persisted after adjustment for differences in ESRD between women and men suggests the importance of other factors including differences in the financial implications of donation, attitudes toward donation, or societal expectations of donation between women and men contribute to the sex-related difference in living donation. 5,15 Our findings also draw further attention to financial barriers to living donation (see recommendations from the American Society of Transplantation Living Donor Community of Practice consensus conference 16 and other recent publications 17,18 for a comprehensive overview of this issue). The finding that income had a greater effect on donation from men should be interpreted with the knowledge that living donors and recipients are usually from the same socioeconomic background and, in many cases, the same household.…”

Section: Discussionsupporting

confidence: 53%

The Change in Living Kidney Donation in Women and Men in the United States (2005–2015): A Population-Based Analysis

Gill

Joffres

Rose

et al. 2018

JASN

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The factors underlying the decline in living kidney donation in the United States since 2005 must be understood to inform strategies to ensure access to this option for future patients. Population-based estimates provide a better assessment of donation activity than do trends in the number of living donor transplants. Using data from the Scientific Registry of Transplant Recipients and the United States Census, we determined longitudinal changes in living kidney donation between 2005 and 2015, focusing on the effect of sex and income. We used multilevel Poisson models to adjust for differences in age, race, the incidence of ESRD, and geographic factors (including population density, urbanization, and daily commuting). During the study period, the unadjusted rate of donation was 30.1 and 19.3 per million population in women and men, respectively, and the adjusted incidence of donation was 44% higher in women (incidence rate ratio [IRR], 1.44; 95% confidence interval [95% CI], 1.39 to 1.49). The incidence of donation was stable in women (IRR, 0.95; 95% CI, 0.84 to 1.07) but declined in men (IRR, 0.75; 95% CI, 0.68 to 0.83). Income was associated with longitudinal changes in donation in both sexes, yet donation was stable in the highest two population income quartiles in women but only in the highest income quartile in men. In both sexes, living related donations declined, irrespective of income. In conclusion, living donation declined in men but remained stable in women between 2005 and 2015, and income appeared to have a greater effect on living donation in men.

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Section: Discussionsupporting

confidence: 53%

The Change in Living Kidney Donation in Women and Men in the United States (2005–2015): A Population-Based Analysis

Gill

Joffres

Rose

et al. 2018

JASN

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“…A recent report found that donors who perceived donation-related financial burden were less likely to have an income above the median in their residential area. 30 In a separate study, candidates told family members and friends that they were willing to donate but that they were concerned about the potential lost income. 31 Prior cost estimates vary, with median out-of-pocket costs ranging between $179 and $821 (not accounting for productivity losses).…”

Section: Discussionmentioning

confidence: 99%

Financial Costs Incurred by Living Kidney Donors: A Prospective Cohort Study

Przech

Garg

Arnold

et al. 2018

JASN

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Background Approximately 40% of the kidneys for transplant worldwide come from living donors. Despite advantages of living donor transplants, rates have stagnated in recent years. One possible barrier may be costs related to the transplant process that potential willing donors may incur for travel, parking, accommodation, and lost productivity.Methods To better understand and quantify the financial costs incurred by living kidney donors, we conducted a prospective cohort study, recruiting 912 living kidney donors from 12 transplant centers across Canada between 2009 and 2014; 821 of them completed all or a portion of the costing survey. We report microcosted total, out-of-pocket, and lost productivity costs (in 2016 Canadian dollars) for living kidney donors from donor evaluation start to 3 months after donation. We examined costs according to (1) the donor's relationship with their recipient, including spousal (donation to a partner), emotionally related nonspousal (friend, step-parent, in law), or genetically related; and (2) donation type (directed, paired kidney, or nondirected). ResultsLiving kidney donors incurred a median (75th percentile) of $1254 ($2589) in out-of-pocket costs and $0 ($1908) in lost productivity costs. On average, total costs were $2226 higher in spousal compared with emotionally related nonspousal donors (P=0.02) and $1664 higher in directed donors compared with nondirected donors (P,0.001). Total costs (out-of-pocket and lost productivity) exceeded $5500 for 205 (25%) donors.Conclusions Our results can be used to inform strategies to minimize the financial burden of living donation, which may help improve the donation experience and increase the number of living donor kidney transplants.

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“…There were disparities in donor-recipient concordance as well; while 95% of non-Hispanic White children were likely to receive a kidney from a non-Hispanic White donor, only 56% of Asian recipients had Asian donors. Socioeconomic factors that allow individuals to step forward as kidney donors are a major contributor ( 37 ). Literature also supports that deceased donor transplant rates are lower among Black children compared to Whites ( 38 ).…”

Section: The Impact Of Systemic Bias and Racism On Ckd And Transplant...mentioning

confidence: 99%

Seeking justice, equity, diversity and inclusion in pediatric nephrology

et al. 2022

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Inequity, racism, and health care disparities negatively impact the well-being of children with kidney disease. This review defines social determinants of health and describes how they impact pediatric nephrology care; outlines the specific impact of systemic biases and racism on chronic kidney disease care and transplant outcomes; characterizes and critiques the diversity of the current pediatric nephrology workforce; and aims to provide strategies to acknowledge and dismantle bias, address barriers to care, improve diversity in recruitment, and strengthen the pediatric nephrology community. By recognizing historical and current realities and limitations, we can move forward with strategies to address racism and bias in our field and clinical practices, thereby cultivating inclusive training and practice environments.

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Factors associated with perceived donation-related financial burden among living kidney donors

Cited by 12 publications

References 20 publications

The Change in Living Kidney Donation in Women and Men in the United States (2005–2015): A Population-Based Analysis

The Change in Living Kidney Donation in Women and Men in the United States (2005–2015): A Population-Based Analysis

Financial Costs Incurred by Living Kidney Donors: A Prospective Cohort Study

Seeking justice, equity, diversity and inclusion in pediatric nephrology

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