Financial Burden Borne by Laparoscopic Living Kidney Donors

Wiseman, Jennifer F.; Jacobs, Cheryl; Larson, Dawn B.; Berglund, Danielle; Garvey, Catherine A.; Ibrahim, Hassan N.; Matas, Arthur J.

doi:10.1097/tp.0000000000001568

Cited by 19 publications

(20 citation statements)

References 12 publications

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“…34 In that study, 83% of the donors were employed, compared with 86% of the NDD responders in the current study. Donors were asked to rank financial burden on a 10-point Likert scale (0 = no burden; 10 = extreme) and to describe the financial resources they used to cover costs associated with donation.…”

Section: Discussionmentioning

confidence: 60%

Long-term psychosocial outcomes after nondirected donation: A single-center experience

Jacobs

Berglund

Wiseman

et al. 2019

American Journal of Transplantation

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Short‐term studies have demonstrated that nondirected donors (NDDs) have psychosocial outcomes that are similar to donors who donate directly, but long‐term studies have not been done. NDDs at our center were surveyed regarding motivation; support during donation; stress related to donation; regret; financial resources used for donation; preferences about communication with the recipient; and cost reimbursement. Of 100 NDDs who donated at our center in the last 20 years, 95 remain in contact with us, and 77 responded to our survey (mean ± standard deviation [SD] 6.7 ± 4 years postdonation). The most common motivation for donation was the desire to help another (99%). Many NDDs received support from family, friends, and employers. NDDs voiced stress about the possibility of recipient kidney rejection, physical consequences to themselves, and financial burden. Only one donor expressed regret. Almost half wanted some recipient information at donation; 61% preferred routine recipient status updates; 56% believed meeting the recipient should occur at any mutually agreeable time; and 55% endorsed reimbursement for expenses. Stressors for NDDs are analogous to those of directed donors; NDDs prefer having some information about the recipient and prefer to be given a choice regarding the timing for communication with the recipient. NDDs supported donation being financially neutral.

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Section: Discussionmentioning

confidence: 60%

Long-term psychosocial outcomes after nondirected donation: A single-center experience

Jacobs

Berglund

Wiseman

et al. 2019

American Journal of Transplantation

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“…Prolonged hospital stay and presence of donor-related complications have also been associated with perceived financial burden (17), however these risk factors occur at the time of donor nephrectomy and therefore cannot be used to counsel donors pre-operatively. Our study adds to these findings by identifying preoperative predictors of perceived financial burden.…”

Section: Discussionmentioning

confidence: 99%

“…However, these studies included exclusively or predominantly patients who underwent an open nephrectomy (15), an operation that required a substantially longer recovery time than the laparoscopic nephrectomy used today (16). A more recent study of LKDs who donated 2003–2015 at a single center found that 26% perceived donation-related financial burden, and that burden was associated with total donation-related costs, time missed from work due to extended recovery, and readmission within 6 months (17). None of these factors, however, would be available preoperatively to predict which donors would perceive financial burden.…”

Section: Introductionmentioning

confidence: 99%

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

Ruck

Holscher

Purnell

et al. 2018

American Journal of Transplantation

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The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. We sought to identify characteristics that predicted higher risk of perceived financial burden. We surveyed 51 living kidney donors (LKDs) who donated from 01/2015 to 3/2016 about socioeconomic characteristics, predonation cost concerns, and perceived financial burden. We tested associations between both self-reported and ZIP code-level characteristics and perceived burden using Fisher's exact test and bivariate modified Poisson regression. Donors who perceived donation-related financial burden were less likely to have an income above their ZIP code median (14% vs. 72%, P = .006); however, they were more likely than donors who did not perceive burden to rent their home (57% vs. 16%, P = .03), have an income <$60 000 (86% vs. 20%, P = .002), or have had predonation cost concerns (43% vs. 7%, P = .03). Perceived financial burden was 3.6-fold as likely among those with predonation cost concerns and 10.6-fold as likely for those with incomes <$60 000. Collecting socioeconomic characteristics and asking about donation-related cost concerns prior to donation might allow transplant centers to target financial support interventions toward potential donors at higher risk of perceiving donation-related financial burden.

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“…12,13,14 Up to 96% of donors have reported out-of-pocket costs with a range of $3,000-$8,000. Costs associated with donor travel to the transplant program, unpaid time off from work during recovery, unforeseen medical costs, and incidentals have been described.…”

Section: Introductionmentioning

confidence: 99%

Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden

et al. 2019

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Purpose: To provide standardized guidance for transplant programs to maximize financial reimbursement related to living donor care, and to minimize financial consequences of evaluation, surgical and follow-up care to living donor candidates and donors. Recent Findings: In 2014, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) “Consensus Conference on Best Practices in Live Kidney Donation” identified inconsistencies in billing practices as a barrier to living donor financial neutrality, and issued a strong recommendation that the transplant community actively pursue strategies and policies to make living donation a financially neutral act, within the framework of federal law. The LDCOP convened a multidisciplinary group of experts to review and synthesize current Medicare regulations and commercial payer practices related to billing for living donor care, and the implications for transplant programs and patients. We developed guidance for transplant program staff related to strategies to consistently and appropriately obtain reimbursement via the Medicare Cost Report by utilizing organ acquisition; coordinate available coverage for donor pretesting, evaluation, hospitalization, follow-up care, and complications; coordinate charges in kidney paired donation; and maximize coverage through private insurance contracting. We also offer recommendations to protect donor confidentiality in the context of billing, and to educate and prepare donor candidates and donors about any remaining gaps in coverage related to donation. Summary: Best practices in billing for living donation-related care should focus on balancing cost recovery, regulatory compliance, and minimized donor burden. Herein we offer 9 recommendations for best practice. We also offer a platform of 7 recommendations for research & advocacy efforts to better understand the climate of living donor medical costs, and to optimize billing practices that support provision of living donor transplant services to all patients who can benefit and to achieve financial neutrality for living donors.

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Financial Burden Borne by Laparoscopic Living Kidney Donors

Abstract: Donors should not have to incur costs or a financial burden to donate; the transplant community should strive to make donation financially neutral.

Cited by 19 publications

References 12 publications

Long-term psychosocial outcomes after nondirected donation: A single-center experience

Long-term psychosocial outcomes after nondirected donation: A single-center experience

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

Billing for Living Kidney Donor Care: Balancing Cost Recovery, Regulatory Compliance, and Minimized Donor Burden

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