The direct and indirect economic costs incurred by living kidney donors—a systematic review

Clarke, Katherine S; Klarenbach, Scott; Vlaicu, Sorina; Yang, Robert C.; Garg, Amit X.

doi:10.1093/ndt/gfl069

Cited by 117 publications

(112 citation statements)

References 50 publications

Supporting

Mentioning

104

Contrasting

Unclassified

Order By: Relevance

“…In our study, some respondents were denied health or life insurance (1.8% and 2.1%, respectively). Given the demographic characteristics of respondents versus nonrespondents, we believe those are an underestimate: More nonrespondents were from groups (younger, male, and ethnic minorities) that are less likely to have health insurance at donation (42). Additionally, lack of health insurance may impede some from seeking medical or psychological follow-up.…”

Section: Discussionmentioning

confidence: 99%

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

Jacobs¹,

Gross²,

Messersmith³

et al. 2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Background and objectives Most kidney donors view their experience positively, but some may experience psychosocial and financial burdens. We hypothesized that certain donor characteristics, poor outcome of the recipient, negative perceptions of care, and lack of support may be associated with poor psychosocial outcomes for donors.Design, setting, participants, & measurements The Renal and Lung Living Donors Evaluation Study (RELIVE) examined long-term medical and psychosocial outcomes for kidney donors (at three U.S. transplant centers) who donated between 1963 and 2005. Standardized questionnaires evaluated donor perspectives, recovery time, social support, motivation, financial impact, insurability after donation, and current psychological status. Questionnaires were mailed to 6909 donors.Results Questionnaires were returned by 2455 donors, who had donated 17610 years earlier (range, 5-48 years), a response rate of 36%. Most (95%) rated their overall donation experience as good to excellent. Rating the overall donor experience more negatively was associated with donor complications, psychological difficulties, recipient graft failure, and longer time since donation. Nine percent (n=231) reported one or more of the following poor psychosocial outcomes: fair or poor overall donor experience, financial burden, regret or discomfort with decision to donate, or psychological difficulties since donation. Recipient graft failure was the only predictor for reporting one or more of these poor psychosocial outcomes (odds ratio, 1.77; 95% confidence interval, 1.33 to 2.34). Donors with lower educational attainment experienced greater financial burden. One of five employed donors took unpaid leave; 2% reported health and life insurability concerns.Conclusions Although the majority of donors viewed their overall donation experience positively, almost 1 in 10 donors reported at least one negative consequence related to donation. Recipient graft failure was associated with poor psychosocial outcome, defined as one or more of these negative consequences. Some donors were financially disadvantaged, and some experienced insurance difficulties. Interventions to avoid negative psychosocial and financial consequences are warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

Jacobs¹,

Gross²,

Messersmith³

et al. 2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…These may include direct out-of-pocket expenses (i.e., travel, lodging, meals, parking, dependent care, and some uncovered medical expenses) and indirect costs (i.e., lost wages, use of employer-sponsored paid time off, and effect of insurability or premium rates) (Table 1) (4). Total estimated costs for LKDs range from $0-$20,000, with an average of approximately $5000 (4,16,17). In a 2014 Canadian study, Klarenbach et al reported that 96% of LKDs had experienced negative financial consequences from donation, with 47% reporting lost wages (16).…”

Section: Background On Systemic Barriers To Living Kidney Donationmentioning

confidence: 99%

Living-Donor Kidney Transplantation

Tushla

Rudow

Milton

et al. 2015

Clinical Journal of the American Society of Nephrology

108

113

View full text Add to dashboard Cite

Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.

show abstract

“…The LDKT and LKD financial concerns of patients and potential donors are not unfounded (41)(42)(43). The workgroup noted the likelihood that the financial effect of LKD is a significant driver of disparities in LDKT, both for those in lower socioeconomic classes and for many members of minority groups.…”

Section: Incomementioning

confidence: 99%

“…Although this topic was explored in more depth in another workgroup (44), the finances of access to care and burdens of LKD were central to our workgroup's discussion. Unfortunately, living donor costs have not been systematically captured by the transplant community, although some have estimated total costs to range from $0 to $20,000, with an average of approximately $5000 (41)(42)(43)45). Concern about these costs deters both transplant candidates from talking to others about possible donation and potential living donors from pursuing donation (46).…”

Section: Incomementioning

confidence: 99%

Living Donor Kidney Transplantation

Rodrigue

Kazley

Mandelbrot

et al. 2015

Clinical Journal of the American Society of Nephrology

109

View full text Add to dashboard Cite

Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.

show abstract

The direct and indirect economic costs incurred by living kidney donors—a systematic review

Cited by 117 publications

References 50 publications

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

Living-Donor Kidney Transplantation

Living Donor Kidney Transplantation

Contact Info

Product

Resources

About