Perspectives of transplant physicians and surgeons on reimbursement, compensation, and incentives for living kidney donors.
BACKGROUND
The shortage of donors for organ transplantation has stimulated debate on financial incentives for living kidney donors. This study aims to describe the range of attitudes and opinions of transplant physicians on financial reimbursement, compensation, and incentives in living kidney donation.


METHODS
Qualitative study.


METHODS
110 transplant nephrologists and surgeons from 12 countries across 43 transplantation units in Europe, Australasia, and North America.


METHODS
Face-to-face semistructured interviews were conducted.


METHODS
Transcripts were thematically analyzed.


RESULTS
We identified 7 major themes. Prioritizing the removal of disincentives for living kidney donors was largely deemed acceptable. By contrast, provision of financial incentives raised concerns about undermining benevolence, compromising human dignity and value, and traversing market forces. Some contended that financial incentives potentially were legitimate if regulated, arguing that this would maximize utility in transplantation, but most also acknowledged the difficulty and that operational feasibility of a regulated system of financial incentivization may be limited.


CONCLUSIONS
Participants were English speaking and from Western high-income countries; therefore, the transferability of our findings may be limited.


CONCLUSIONS
Transplantation specialists believed that minimizing disincentives would support equity and justice in living kidney donation. Direct financial incentivization for living kidney donors, even in the context of a regulated market, was regarded by most as unjustified because of the potential moral consequences and uncertain feasibility. Removing financial disincentives and safeguarding the intrinsic volunteerism, value, and meaning of donation were viewed to uphold integrity in living kidney donation.
Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia. Electronic address: allison.tong@sydney.edu.au.
Allison
A
Tong
Centre for Transplant and Renal Research, Westmead Hospital, NSW, Westmead, Australia.
Jeremy R
JR
Chapman
Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia; Centre for Transplant and Renal Research, Westmead Hospital, NSW, Westmead, Australia.
Germaine
G
Wong
Sydney School of Public Health, The University of Sydney, Sydney, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Jonathan C
JC
Craig
D000328:Adult; D000368:Aged; D000533:Altruism; D001291:Attitude of Health Personnel; D044362:Australasia; D005060:Europe; D005260:Female; D006291:Health Policy; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000191:economics / Q000941:ethics / Q000523:psychology; D019520:Living Donors / Q000941:ethics / Q000523:psychology / Q000600:supply & distribution; D008297:Male; D008389:Marketing of Health Services / Q000941:ethics / Q000331:legislation & jurisprudence; D008875:Middle Aged; D009398:Nephrology; D009656:North America; D036301:Qualitative Research; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D066231:Surgeons / Q000941:ethics / Q000523:psychology*; D009927:Tissue and Organ Procurement
Kidney transplantation; altruism; donor incentives; donor reimbursement; health policy; interviews; kidney donation; living donor; organ shortage; qualitative research; renal transplant