Living donor financial assistance programs in liver transplantation: The global perspective

Abstract

Living donor liver transplantation (LDLT) has increased availability of liver transplantation, particularly in countries with limited access to deceased organ donors. It is unclear how individual countries address the financial impact of donation for potential living donors. Herein, living liver donor financial supports were examined, focusing on countries performing ≥10 LDLT per year in the World Health Organization Transplant Observatory. Categories included health insurance coverage, reimbursement of lost wages, employment protection, and other incentives designed to promote living liver donation. Overall, 26 countries have some form of asssistance in removing disincentives to ease the financial burden of living donation, ranging from childcare, accommodations, meals, and travel reimbursement, to coverage of medical complications post-donation. Most countries provide donation-related medical coverage. Fourteen provide reimbursement of lost wages and/or paid time off. Several unique programs were designed to incentivize living donation, including free entry to museums and observatories, parking and airline discounts, and exemptions on mortgages and medical deductibles. This study highlights the broad range of programs designed to support living liver donation in high-volume LDLT countries. The data collected in this study can provide a framework for other nations to propose and implement ethical reimbursement and incentivization for living liver donors.

Potential association between public medical insurance, waitlist mortality, and utilization of living donor liver transplantation: An analysis of the Scientific Registry of Transplant Recipients

“…Other potential solutions to support living liver donors include programs to ethically reimburse lost wages and provide compensation of out‐of‐pocket costs associated with donation, similar to the Donor Shield Program offered by the National Kidney Registry 38–40 . Standardizing the extent and time period of coverage of donation‐related medical expenses would also improve donor safety and reduce barriers to living donation 41 …”

“…[38][39][40] Standardizing the extent and time period of coverage of donation-related medical expenses would also improve donor safety and reduce barriers to living donation. 41 This study is limited in that it is a retrospective data review of a national database. Many of the nuances of insurance coverage could not be captured in our study.…”

Edging Closer to Commonplace: Assessing the Growth of Living Donor Liver Transplantation in the United States

“…( 7 ) Similarly, some states have passed or are considering legislation to provide financial support for donors for expenses or missed time from work related to living donation in the form of tax credits or employer reimbursement. ( 8 )…”

“…(7) Similarly, some states have passed or are considering legislation to provide financial support for donors for expenses or missed time from work related to living donation in the form of tax credits or employer reimbursement. (8) Removing barriers to donation, sharing best practices in donor and recipient selection along with the technical aspects of LDLT, and appropriate tracking of granular outcomes as centers start or grow their programs will be paramount as we enter a new era of LDLT in the United States.…”

Why People Oppose Trade Institutions - On Morality, Fairness and Risky Actions

“…Kidney exchange is legal in many countries, but this does not involve any payment to the donors (see, e.g.,Roth and Wang, 2020).6 A summary of existing incentive schemes is given inEmamaullee et al (2020).…”