The Living Donor Lost Wages Trial: Study Rationale and Protocol

Abstract

Purpose of review This paper describes the background, rationale, and design of an NIH-funded, single-center study to test the impact of offering reimbursement for donor lost wages incurred during the post-nephrectomy recovery period on the live donor kidney transplant (LDKT) rate in newly evaluated kidney transplant candidates, to examine whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and to determine whether higher reimbursement amounts lead to higher LDKT rates. Recent findings LDKT is the optimal treatment for renal failure. However, living kidney donation has declined in the past decade, particularly among men, younger adults, blacks, and low-income adults. There is evidence that donation-related costs may deter both transplant candidates and potential donors from considering LDKT. Lost wages is a major source of financial loss for some living donors and, unlike travel and lodging expenses, is not reimbursed by financial assistance programs. Summary The study addresses the transplant community’s call to reduce the financial burden of living donation and examine its impact on LDKT rates. Findings have the potential to influence policy, clinical practice, LDKT access, and income-related and racial disparities in LDKT and living donation.

Removing Disincentives to Kidney Donation: A Quantitative Analysis

“…This article contains the following supplemental material online at http:// jasn.asnjournals.org/lookup/suppl/doi: 10…”

“…8 The government is currently sponsoring clinical trials at seven research centers to determine the effects of reimbursing lost wages of organ donors. 9,10 In March of 2019, 34 members of Congress signed a letter to the Secretary of Health and Human Services, urging the Secretary to administratively expand the mandate of NLDAC to include lost wages and other expenses incurred by living organ donors. 11 On July 10, 2019, President Donald Trump issued an executive order to reimburse living donors for extra expenses associated with organ donation, such as lost wages and childcare.…”

Financial compensation for organ donors

“…Financially, the donor payments would be subsidized by dialysis cost savings. This model remains untested, but trials have been proposed to evaluate government-regulated strategies to increase organ donation, including financial incentives and reimbursements [32,45,46].…”

Wages, Travel, and Lodging Reimbursement by the National Kidney Registry: An Important Step Toward Financial Neutrality for Living Kidney Donors in the United States

“…Published research on barriers to living donation consistently name financial concerns about out-ofpocket and indirect costs as a critical deterrent to living donation for both recipients and donors considering living donation. 2,[6][7][8] As defined in the 2018 edition of the Declaration of Istanbul on Organ Trafficking and Transplant Tourism, "financial neutrality" means that the donors and their families neither lose nor profit financially as a result of donation. 15 Compared with several other countries such as Australia, Canada, and the Netherlands, the United States has less comprehensive living donor financial reimbursement programs, resulting in donors frequently incurring unreimbursed predonation and postdonation expenses.…”