Incentive Models to Increase Living Kidney Donation:Encouraging Without Coercing

Abstract

Kidney transplantation is a superior treatment strategy than chronic dialysis for end-stage renal disease patients. However, there is a severe shortage of cadaveric kidneys that are available for transplantation. Therefore many patients are turning to living donors. We describe four models of incentives to improve rates of living kidney donation: the market compensation model, the fixed compensation model, nocompensation model and the expense reimbursement model. We discuss the advantages and disadvantages of each of these models. Any incentive to improve rates of living kidney donation must be accompanied by safeguards. These safeguards will prevent living donors from being viewed primarily as a resource for transplants. These safeguards will also prevent vulnerable individuals from being coerced into donation and will monitor long-term outcomes of donors using a donor registry. We recommend the use of the expense reimbursement model along with these safeguards, in order to increase rates of living kidney donation.

Living-Unrelated Donor Renal Transplantation: An Alternative to Living-Related Donor Transplantation?

“…It is crucial to strike a balance so that patients could benefit from this invaluable organ source while avoiding donor exploitation by stringent scrutiny of any unrelated living donors. 17 …”

Life Insurance for Living Kidney Donors: A Canadian Undercover Investigation

“…Many experts have also advocated provision of insurance to living organ donors (36)(37)(38). Living kidney donation has been shown to be cost saving for society (39), in addition to the numerous benefits for the recipients (40)(41)(42) …”

Financial Incentives for Living Kidney Donation

“…In this study by Barnieh et al, the only system examined would provide direct payments to all living donors, whether that donor was giving a kidney to a loved one or to a stranger. Such an approach reflects the egalitarian notion that equal contributions merit equal compensation, regardless of underlying motivation (5). Paying all living donors would presumably run less risk of "crowding out" altruistic donation than a policy that provided payments only to nondirected donors.…”

“…Estimates of donor financial burden range from $907 to $3089, and compensation would help ensure that donors do not suffer financially from donation (8). Because potential donors would not stand to benefit financially, expense reimbursement could ease concerns about undue and unjust inducement, but it might also fail to generate a meaningful increase in the supply of organs (5). Moreover, in contrast with fixed payment for donation, expense reimbursement is legal in the United States (1).…”

“…The trial should measure psychological, financial, and physical outcomes after donation. Existing protections for potential live donors will be necessary, such as use of independent donor advocates, separation of donor and recipient evaluation teams, and ability to opt-out from donation with dignity at any time (5). Additional protections may also be needed, such as a "cooling off" period between evaluation and donation to allow transplant teams multiple opportunities to assess donor motives and comprehension.…”