title: Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies.
abstract: In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation-related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out-of-pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD "financial neutrality," offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation.
authors.affiliation: Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI.
authors.forename: R
authors.initials: R
authors.lastname: Hays
authors.affiliation: Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
authors.forename: J R
authors.initials: JR
authors.lastname: Rodrigue
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, NY.
authors.forename: D
authors.initials: D
authors.lastname: Cohen
authors.affiliation: Department of Medicine, University of California at Los Angeles, Los Angeles, CA.
authors.forename: G
authors.initials: G
authors.lastname: Danovitch
authors.affiliation: Department of Surgery, University of Minnesota Medical Center-Fairview, Minneapolis, MN.
authors.forename: A
authors.initials: A
authors.lastname: Matas
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: J
authors.initials: J
authors.lastname: Schold
authors.affiliation: Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY.
authors.forename: D
authors.initials: D
authors.lastname: LaPointe Rudow
mesh_terms: D003362:Cost-Benefit Analysis; D005102:Health Expenditures; D006284:Health Plan Implementation; D006291:Health Policy; D006801:Humans; D019458:Insurance Coverage / Q000191:economics; D019520:Living Donors; D009392:Nephrectomy / Q000191:economics*; D016377:Organ Transplantation / Q000191:economics* / Q000331:legislation & jurisprudence*; D009927:Tissue and Organ Procurement / Q000191:economics*; D014186:Transportation / Q000191:economics; D014481:United States
keywords: donors and donation: living; economics; ethics and public policy; kidney transplantation/nephrology; kidney transplantation: living donor; law/legislation; liver transplantation/hepatology; liver transplantation: living donor