Living Kidney Donors Commonly Incur Out-of-Pocket Expenses

Marlene Busko

August 18, 2006

August 18, 2006 — While people who donate a kidney are generally reimbursed for medical care, they often pay for other costs and may experience substantial economic losses, according to a literature review.

"We now have some general findings that donors incur costs, that these costs are quite common, and it appears that some donors incur quite severe financial hardships," coauthor Scott Klarenbach, MD, from the University of Alberta in Edmonton, told Medscape.

By shedding light on this largely undocumented subject, the review paves the way for prospective research that could be used to guide informed consent and determine "fair" compensation for living kidney donors, they suggest.

The review was published in the July issue of Nephrology Dialysis Transplantation.

Honest Compensation vs Financial Gain

Living-donor kidney transplantation has been increasing in many countries in the past decade, and it offers advantages such as survival rates that are 15% higher than for cadaveric transplantation, Claude Jacobs, MD, from the Hôpital de la Pitié in Paris, France, writes in an editorial accompanying the article. He adds that, nevertheless, serious reservations remain about this procedure, including concerns about medical risks and ensuring that organs are donated for altruistic reasons.

"The heart of the matter lies in clearly delineating the 'thin red line" that should not be crossed between totally legitimate reimbursement of all unequivocally justified out-of-pocket expenses borne by donors prior to, during, and after organ donation and the slippery slope of transforming an honest compensation into a covert form of financial gain for organ donation," Dr. Jacobs writes.

Led by Katherine S. Clarke, MD, from University of Western Ontario in London, the investigators searched for articles that quantified the economic impact, monetary value, and time frame of living kidney donors' costs. Direct costs included travel, accommodation, long-distance phone calls, and medical care not covered by insurance. Indirect costs included lost income as well as costs for hiring caregivers and domestic help. All monetary data were converted to 2004 US dollars.

The researchers identified 35 studies from 12 countries that described costs incurred by individuals who were donors between 1964 and 2003. Most studies were from the United States (17), followed by Western Europe (12), Australia (2), Canada (2), Iran (1), and Japan (1).

Better Understanding of Costs

No single study comprehensively quantified all expenses of living kidney donors. One US study reported that overall costs averaged $837 per donor, ranging from $0 to $28,906. Costs for travel and accommodation were experienced by 99% and 88% of donors, respectively, in 1 US study. Three studies (from Canada, the United States, and the United Kingdom) reported that 14% to 30% of donors lost income. One study from Germany and 1 from Australia found that 3% of donors resigned or were fired from their jobs as a result of physical limitations following surgery. A US study found that compared with nondonors, donors were 37% less likely to have long-term growth in household income. Caregiver costs were incurred by 9% to 44% of donors.

The authors acknowledge that the review has several limitations. The primary studies provided incomplete cost data, the time frame was long, and the costs were underreported. Dr. Jacobs writes that despite these flaws, the review points the way to further research that could provide more robust data to guide donor-reimbursement policies. The team has already begun a pilot, prospective follow-up study that will look at the medical, psychosocial, and economic risks of living kidney donation, Dr. Klarenbach told Medscape.

The study was supported by the Canadian Institutes of Health Research and the Canadian Council for Donation and Transplantation.

Nephrol Dial Transplant. 2006;21:1952-1960, 1764-1765.


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