title: 'It's a regional thing': financial impact of renal transplantation on live donors.
abstract: BACKGROUND
  There has been no research exploring the financial impact on the live renal donor in terms of testing, hospitalisation and surgery for kidney removal (known as nephrectomy). The only mention of financial issues in relation to live renal transplantation is the recipients' concerns in relation to monetary payment for the gift of a kidney and the recipients' desire to pay for the costs associated with the nephrectomy. The discussion in this article posits a new direction in live renal donor research; that of understanding the financial impact of live renal donation on the donor to inform health policy and supportive care service delivery. The findings have specific relevance for live renal donors living in rural and remote locations of Australia.
  
  
  METHODS
  The findings are presented from the first interview (time 1: T1) of a set of four times (time 1 to time 4: T1-T4) from a longitudinal study that explored the experience of live renal donors who were undergoing kidney removal (nephrectomy) at the Renal Transplantation Unit at the Princess Alexandra Hospital, Brisbane, Australia. A qualitative methodological approach was used that involved semi-structured interviews with prospective living kidney donors (n=20). The resulting data were analysed using the qualitative research methods of coding and thematic analysis.
  
  
  RESULTS
  The findings indicate that live renal donors in non-metropolitan areas report significant financial concerns in relation to testing, hospitalisation and surgery for nephrectomy. These include the fact that bulk billing (no cost to the patient for practitioner's service) is not always available, that individuals have to pay up-front and that free testing at local public hospitals is not available in some areas. In addition, non-metropolitan donors have to fund the extra cost of travel and accommodation when relocating for the nephrectomy to the specialist metropolitan hospital.
  
  
  CONCLUSIONS
  Live renal transplantation is an important new direction in medical care that has excellent long-term results for individuals diagnosed with end-stage renal disease. An essential element of the transplantation procedure is the voluntary donation of a healthy kidney by the live renal donor. Such an altruistic gift, which has no personal health benefit for the donor, is to be applauded and supported. The present research demonstrates that for some donors, particularly those living outside the metropolitan area, the gift may also include a range of financial costs to the donor. There is no prior research available on the financial impact of live renal donation for individuals living in non-metropolitan areas. Thus, this article is a seminal work in the area. The findings affirm 'rural disadvantage' by demonstrating that it is the live renal donors in non-metropolitan areas who are reporting financial concerns in relation to testing, hospitalisation and surgery for nephrectomy. It is the hope and expectation that the reporting on these costs will encourage further work in this area and the findings will be used for health policy and service delivery considerations.
authors.affiliation: Griffith University, Logan Campus, Meadowbrook, Queensland, Australia. pmcgrathgu@gmail.com
authors.forename: Pam
authors.initials: P
authors.lastname: McGrath
authors.forename: Hamish
authors.initials: H
authors.lastname: Holewa
mesh_terms: D000328:Adult; D001315:Australia; D003362:Cost-Benefit Analysis; D005260:Female; D005102:Health Expenditures; D054625:Healthcare Disparities / Q000191:economics; D006650:Histocompatibility Testing / Q000191:economics; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007407:Interviews as Topic; D016030:Kidney Transplantation / Q000191:economics* / Q000523:psychology*; D019520:Living Donors; D008137:Longitudinal Studies; D008297:Male; D009392:Nephrectomy / Q000191:economics*; D011184:Postoperative Period; D036301:Qualitative Research; D012424:Rural Population; D012648:Self Care / Q000191:economics; D014195:Travel / Q000191:economics