title: Focus group study of public opinion about paying living kidney donors in Australia.
abstract: OBJECTIVE
  The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors.
  
  
  METHODS
  Twelve focus groups were conducted with 113 participants recruited from the general public in three Australian states in February 2013. Thematic analysis was used to analyze the transcripts.
  
  
  RESULTS
  Five themes were identified: creating ethical impasses (commodification of the body, quandary of kidney valuation, pushing moral boundaries), corrupting motivations (exposing the vulnerable, inevitable abuse, supplanting altruism), determining justifiable risk (compromising kidney quality, undue harm, accepting a confined risk, trusting protective mechanisms, right to autonomy), driving access (urgency of organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets), and honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense). Reimbursement and justifiable recompense are considered by the Australian public as a legitimate way of supporting donors and reducing disadvantage. Financial payment beyond reimbursement is regarded as morally reprehensible, with the potential for exploitative commercialism. Some contend that regulated compensation could be a defensible strategy to increased donation rates provided that mechanisms are in place to protect donors.
  
  
  CONCLUSIONS
  The perceived threat to community values of human dignity, goodwill, and fairness suggests that there could be strong public resistance to any form of financial inducements for living kidney donors. Policy priorities addressing the removal of disincentives may be more acceptable to the public.
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; allison.tong@sydney.edu.au.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia;
authors.forename: Angelique F
authors.initials: AF
authors.lastname: Ralph
authors.affiliation: The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia;
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia;
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; and.
authors.forename: John S
authors.initials: JS
authors.lastname: Gill
authors.affiliation: Department of Medicine, University of Chicago, Chicago, Illinois.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Josephson
authors.affiliation: Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia;
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001315:Australia; D035881:Compensation and Redress / Q000941:ethics; D016265:Conflict of Interest; D003415:Crime / Q000191:economics; D004644:Emotions; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006302:Health Services Research; D054625:Healthcare Disparities / Q000191:economics; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics* / Q000941:ethics; D016030:Kidney Transplantation / Q000191:economics* / Q000941:ethics / Q000379:methods / Q000523:psychology; D019520:Living Donors / Q000941:ethics / Q000523:psychology / Q000600:supply & distribution; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010465:Perception; D011639:Public Opinion; D018570:Risk Assessment; D012307:Risk Factors; D055815:Young Adult
keywords: kidney donation; kidney transplantation; quality of life