title: Living-Donor Kidney Transplantation: Reducing Financial Barriers to Live Kidney Donation--Recommendations from a Consensus Conference.
abstract: Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.
authors.affiliation: University Transplant Program, Rush University Medical Center, Chicago, Illinois; Lara_E_Tushla@rush.edu.
authors.forename: Lara
authors.initials: L
authors.lastname: Tushla
authors.affiliation: Recanati Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York;
authors.forename: Dianne LaPointe
authors.initials: DL
authors.lastname: Rudow
authors.affiliation: University of Texas Health Science Center of San Antonio, San Antonio, Texas;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Milton
authors.affiliation: Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
authors.forename: James R
authors.initials: JR
authors.lastname: Rodrigue
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; and.
authors.forename: Jesse D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Transplant Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hays
mesh_terms: D032921:Consensus; D004651:Employment; D006297:Health Services Accessibility / Q000191:economics*; D006798:Housing / Q000191:economics; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D016030:Kidney Transplantation / Q000191:economics* / Q000639:trends; D019520:Living Donors / Q000193:education; D012051:Reimbursement Mechanisms; D012456:Salaries and Fringe Benefits; D014186:Transportation / Q000191:economics
keywords: economic impact; kidney donation; kidney transplantation; organ transplant