The Cost-Effectiveness of Using Payment to Increase Living Donor Kidneys for Transplantation

Abstract

SummaryBackground and objectives For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors.Design, setting, participants, & measurements Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data.Results Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively.Conclusion Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors.

Economic Analysis of the Treatment of End-stage Renal Disease Treatment: Living-donor Kidney Transplantation Versus Hemodialysis

“…Some investigators have proposed that living donation be remunerated to increase the number of kidneys available for transplantation and to increase the cost-effectiveness of the treatment of ESRD [14]. Although donor remuneration could encourage kidney donation, thus reducing morbidity and mortality, it is prohibited in Spain.…”

Paying for Altruism: The Case of Organ Donation Revisited

“…Momentum for those policies has slowed considerably in the wake of the string of findings that existing incentives have had minimal impact. Yet policies that further expand the pool of donors have enormous potential benefits; for example, even a 5% increase in living donations could add roughly 11,000 qualityadjusted life years for ESRD sufferers (Barnieh et al, 2013).…”

Focus Group Study of Public Opinion About Paying Living Kidney Donors in Australia

“…The focus group guide (Supplemental Material) was based on a systematic review of community attitudes to living organ donation (31), recent articles on financial compensation and incentives for living kidney donors (7,18,19,25,(32)(33)(34)(35), and discussion among the research team. A.T. and/or A.F.R.…”