title: Barriers to the use of a federal travel grant by living kidney donors.
abstract: Living organ donation involves significant out-of-pocket costs, which burden donor candidates and may be an obstacle to donation. There is a single US grant (the National Living Donor Assistance Center-NLDAC) to cover live donor travel costs. Although there may be center-specific variability in grant utilization, prospective donors-and their intended recipients-must also meet eligibility criteria. In fact, the NLDAC grant is used by <10% of US live donors annually. We studied 154 consecutive kidney donor clinic evaluations (November 1, 2014-August 30, 2015) to determine eligibility and usage patterns during the evaluation process. Of these, 63 (41%) were local, had travel benefits, or declined. Of the remaining 91 prospective donors who might have benefited from grant support, only 29 (32%) obtained the grant. The other 62 (68%) did not meet eligibility screening. The major reason prospective donors were ineligible was that the recipient's household income was outside the required means test (ie, >300% of the federal poverty level) (n=51; 82%). The remaining exclusions (n=11; 18%) included being a nondirected donor, not meeting residency requirements, and "other." Expanding NLDAC eligibility criteria-by broadening the recipient means test or by taking steps to eliminate it from the NLDAC charter-would reduce financial burdens associated with live donation.
authors.affiliation: Transplant Clinic, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Hays
authors.affiliation: University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Amy Elaine
authors.initials: AE
authors.lastname: Thomas
authors.affiliation: University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Erin
authors.initials: E
authors.lastname: Mathias
authors.affiliation: Surgery, School of Medicine and Public Health, University of Wisconsin Hospital, Madison, WI, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Mezrich
authors.affiliation: Medical Director of Kidney and Pancreas Transplantation, University of Wisconsin Hospital, Madison, WI, USA.
authors.forename: Didier A
authors.initials: DA
authors.lastname: Mandelbrot
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005380:Financing, Government / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009927:Tissue and Organ Procurement / Q000191:economics*; D014195:Travel / Q000191:economics*; D055815:Young Adult
keywords: economics; ethics; incentives; kidney transplantation; living donation