Removing Disincentives to Kidney Donation: A Quantitative Analysis

McCormick, Frank; Held, Philip J.; Chertow, Glenn M.; Peters, Thomas G.; Roberts, John P.

doi:10.1681/asn.2019030242

Cited by 24 publications

(21 citation statements)

References 26 publications

(33 reference statements)

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“…The cost effectiveness of a reimbursement programme is achieved from treating more patients with a transplant rather than with a more costly treatment modality, that is, dialysis. 22 Tong conducted interviews of 110 transplant nephrologists and surgeons from 43 transplantation programmes in 12 countries in Europe, Australasia and North America, and compiled their opinions on financial remunerations and kidney donations. The study revealed that a majority of the respondents consider that minimising disincentives support equity and justice in living kidney donation, and prioritising the removal of disincentives for LDs is acceptable.…”

Section: Discussionmentioning

confidence: 99%

“… 16 20 21 At the same time, prior research indicates that the burden on LDs is so substantial that significant increase in the number of donors would be possible if some of these burdens were removed. 22 23 The global effort to comply with the law in the presence of various burdens faced by the donors has sparked a debate over whether kidney donors should be compensated. Some experts in this area strongly oppose to the idea due to the risk of possible exploitation of the poor, excessive motivations generating a semimarket for the kidneys, adverse selection and commercialisation of the human body.…”

Section: Discussionmentioning

confidence: 99%

“…Becker and Elias estimates that for a kidney, an amount of US$15 000 and for a liver, an amount of US$38 000 would enable markets to function. 22 27 Other scholars claim that some form of non-cash, in-kind benefits could help reduce the shortage of human organs and tissue, thereby reducing the wait time for a transplant and improving quality of life among patients 19 22–24 28 29 At the societal level, the economic benefit of a reimbursement programme is rather well established. The cost effectiveness of a reimbursement programme is achieved from treating more patients with a transplant rather than with a more costly treatment modality, that is, dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…The cost effectiveness of a reimbursement programme is achieved from treating more patients with a transplant rather than with a more costly treatment modality, that is, dialysis. 22 …”

Section: Discussionmentioning

confidence: 99%

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The impact of country reimbursement programmes on living kidney donations

et al. 2020

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IntroductionLiving-donor kidney transplantation is the gold standard treatment for patients with end-stage kidney disease. However, potential donors ubiquitously face financial as well as logistical barriers. To remove these disincentives from living kidney donations, the governments of 23 countries have implemented reimbursement programmes that shift the burdens of non-medical costs from donors to the governments or private entities. However, scientific evidence for the effectiveness of these programmes is scarce. The present study investigates whether these reimbursement programmes designed to ease the financial and logistical barriers succeeded in increasing the number of living kidney donations at the country level. The study examined within-country variations in the timing of such reimbursement programmes.MethodThe study applied the difference-in-difference (two-way panel fixed-effect) technique on the Poisson distribution to estimate the effects of these reimbursement programmes on a 17 year long (2000–2016) dataset covering 109 countries where living donor kidney transplants were performed.ResultsThe results indicated that reimbursement programmes have a statistically significant positive effect. Overall, the model predicted that reimbursement programmes increased country-level donation numbers by a factor of 1.12–1.16.ConclusionReimbursement programmes may be an effective approach to alleviate the kidney shortage worldwide. Further analysis is warranted on the type of reimbursement programmes and the ethical dimension of each type of such programmes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…The cost effectiveness of a reimbursement programme is achieved from treating more patients with a transplant rather than with a more costly treatment modality, that is, dialysis. 22 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The impact of country reimbursement programmes on living kidney donations

et al. 2020

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“…A recent study from the Journal of the American Society of Nephrology estimates that, for the typical donor, travel and lost wages comprise a disincentive greater than $8000 1. Medicare currently does not reimburse for lost wages, childcare, transportation or lodging as part of its payments to hospitals that perform transplants.…”

Section: National Kidney Registry Expands Donor Shield Protectionsmentioning

confidence: 99%

Robotic Surgery for Obese Patients

Pullen¹

2020

American Journal of Transplantation

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Voucher-Based Kidney Donation and Redemption for Future Transplant

et al. 2021

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IMPORTANCEPolicy makers, transplant professionals, and patient organizations agree that there is a need to increase the number of kidney transplants by facilitating living donation. Vouchers for future transplant provide a means of overcoming the chronological incompatibility that occurs when the ideal time for living donation differs from the time at which the intended recipient actually needs a transplant. However, uncertainty remains regarding the actual change in the number of living kidney donors associated with voucher programs and the capability of voucher redemptions to produce timely transplants.OBJECTIVE To examine the consequences of voucher-based kidney donation and the capability of voucher redemptions to provide timely kidney allografts. DESIGN, SETTING, AND PARTICIPANTSThis multicenter cohort study of 79 transplant centers across the US used data from the National Kidney Registry from January 1, 2014, to January 31, 2021, to identify all family vouchers and patterns in downstream kidney-paired donations. The analysis included living kidney donors and recipients participating in the National Kidney Registry family voucher program.EXPOSURES A voucher was provided to the intended recipient at the time of donation. Vouchers had no cash value and could not be sold, bartered, or transferred to another person. When a voucher was redeemed, a living donation chain was used to return a kidney to the voucher holder.MAIN OUTCOMES AND MEASURES Deidentified demographic and clinical data from each kidney donation were evaluated, including the downstream patterns in kidney-paired donation. Voucher redemptions were separately evaluated and analyzed.RESULTS Between 2014 and 2021, 250 family voucher-based donations were facilitated. Each donation precipitated a transplant chain with a mean (SD) length of 2.3 (1.6) downstream kidney transplants, facilitating 573 total transplants. Of those, 111 transplants (19.4%) were performed in highly sensitized recipients. Among 250 voucher donors, the median age was 46 years (range, 19-78 years), and 157 donors (62.8%) were female, 241 (96.4%) were White, and 104 (41.6%) had blood type O. Over a 7-year period, the waiting time for those in the National Kidney Registry exchange pool decreased by more than 3 months. Six vouchers were redeemed, and 3 of those redemptions were among individuals with blood type O. The time from voucher redemption to kidney transplant ranged from 36 to 155 days. CONCLUSIONS AND RELEVANCEIn this study, the family voucher program appeared to mitigate a major disincentive to living kidney donation, namely the reluctance to donate a kidney in the present that could be redeemed in the future if needed. The program facilitated kidney donations that may not otherwise have occurred. All 6 of the redeemed vouchers produced timely kidney transplants, indicating the capability of the voucher program.

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Removing Disincentives to Kidney Donation: A Quantitative Analysis

Cited by 24 publications

References 26 publications

The impact of country reimbursement programmes on living kidney donations

The impact of country reimbursement programmes on living kidney donations

Robotic Surgery for Obese Patients

Voucher-Based Kidney Donation and Redemption for Future Transplant

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