title: Concerns regarding the financial aspects of kidney transplantation: perspectives of pre-transplant patients and their family members.
abstract: BACKGROUND
  African American and non-African American pre-transplant patients' and their families' concerns about the financial costs of kidney transplantation have not been well studied.
  
  
  METHODS
  We conducted structured group interviews among pre-transplant patients (seven African American, five non-African American) and their family members (six African American, five non-African American) to identify their concerns about transplant health insurance coverage, out-of-pocket expenses, and living donor expenses. We reviewed transcribed group audio recordings and identified common discussion themes.
  
  
  RESULTS
  African American and non-African American patients and family members expressed uncertainty about which transplant-related costs were covered by health insurance and wanted information about how to choose insurance policies accordingly. Patients were particularly concerned about the impact of pre-existing illness on securing optimal health insurance, while family members wanted information about non-insurance-based financial resources. Both patients and family members expressed concern about paying for immunosuppressant medications and about gradual loss of insurance benefits after transplantation. Both patients and family members also expressed concern about potential financial hardships for living donors.
  
  
  CONCLUSIONS
  African American and non-African American pre-transplant patients and families expressed a broad range of concerns about transplant health insurance policies, out-of-pocket expenses, non-insurance-based financial resources, and resources to address donors' financial burden. Efforts to improve education and develop more comprehensive transplant insurance policies are needed to facilitate informed decision-making for potential transplant recipients and donors.
authors: Renal, Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
authors: Sumitha
authors: S
authors: Ganji
authors: Patti L
authors: PL
authors: Ephraim
authors: Jessica M
authors: JM
authors: Ameling
authors: Tanjala S
authors: TS
authors: Purnell
authors: LaPricia L
authors: LL
authors: Lewis-Boyer
authors: L Ebony
authors: LE
authors: Boulware
mesh_terms: D000328:Adult; D003657:Decision Making; D005006:Ethnicity; D005190:Family; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D006801:Humans; D007676:Kidney Failure, Chronic / Q000191:economics* / Q000601:surgery; D016030:Kidney Transplantation / Q000191:economics*; D019520:Living Donors; D008297:Male; D008875:Middle Aged
keywords: end-stage renal disease; kidney transplantation; patient perspective; qualitative research; shared decision-making