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Sandal S, Horton A, Fortin MC. Advancing a Paradigm Shift to Approaching Health Systems in the Field of Living-Donor Kidney Transplantation: An Opinion Piece. Can J Kidney Health Dis 2022; 9:20543581221079486. [PMID: 35237443 PMCID: PMC8882925 DOI: 10.1177/20543581221079486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology,
Department of Medicine, McGill University Health Centre, Montreal, QC,
Canada
- The Metabolic Disorders and
Complications Program, Research Institute of the McGill University Health
Centre, Montreal, QC, Canada
| | - Anna Horton
- The Metabolic Disorders and
Complications Program, Research Institute of the McGill University Health
Centre, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Division of Nephrology,
Department of Medicine, Centre hospitalier de l’Université de Montréal, QC,
Canada
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada
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2
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Garg N, Waterman AD, Ranasinghe O, Warnke L, Morris J, Cooper M, Mandelbrot DA. Wages, Travel, and Lodging Reimbursement by the National Kidney Registry: An Important Step Toward Financial Neutrality for Living Kidney Donors in the United States. Transplantation 2021; 105:2606-2611. [PMID: 33675322 DOI: 10.1097/tp.0000000000003721] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since 2007, the National Living Donor Assistance Center has provided the most financial support to US living donors meeting specific income criteria by reimbursing travel, meal, and lodging expenses. In 2019, the National Kidney Registry started providing lost wages, travel, and lodging reimbursement via their Donor Shield program. Donor Shield is automatically provided to donors who participate in kidney paired donation through the National Kidney Registry or who donate at a Donor Shield Direct center, without any income restrictions. METHODS The support donors across the United States received from the Donor Shield program between January 2019 and February 2020 was studied. RESULTS During the study period, 326 (25.9%) of the 1260 donors covered by Donor Shield, from 46 programs received reimbursements amounting to a total of $647 384.45, with $472 389.97 (73.0%) covering lost wages. Median reimbursement per donor was $1813.80 (range, $44.0-$165.63). Eighty-one percent of 108 reimbursed donors who were surveyed reported that the lack of these reimbursements would have posed a financial hardship, and 4% said they would have been unable to donate without this support. CONCLUSIONS Expansion of lost wages reimbursement programs to all donors in the United States would be an important step toward achieving financial neutrality for this unique population and could also help meet the growing demand for transplantable organs by increasing living donation rates.
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Affiliation(s)
- Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Amy D Waterman
- Division of Nephrology, University of California, Los Angeles, Los Angeles, CA
- Terasaki Institute of Biomedical Innovation, Los Angeles, CA
| | - Omesh Ranasinghe
- Division of Nephrology, University of California, Los Angeles, Los Angeles, CA
| | | | | | | | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Abstract
BACKGROUND Living kidney donors incur donation-related expenses, but how these expenses impact postdonation mental health is unknown. METHODS In this prospective cohort study, the association between mental health and donor-incurred expenses (both out-of-pocket costs and lost wages) was examined in 821 people who donated a kidney at one of the 12 transplant centers in Canada between 2009 and 2014. Mental health was measured by the RAND Short Form-36 Health Survey along with Beck Anxiety Inventory and Beck Depression Inventory. RESULTS A total of 209 donors (25%) reported expenses of >5500 Canadian dollars. Compared with donors who incurred lower expenses, those who incurred higher expenses demonstrated significantly worse mental health-related quality of life 3 months after donation, with a trend towards worse anxiety and depression, after controlling for predonation mental health-related quality of life and other risk factors for psychological distress. Between-group differences for donors with lower and higher expenses on these measures were no longer significant 12 months after donation. CONCLUSIONS Living kidney donor transplant programs should ensure that adequate psychosocial support is available to all donors who need it, based on known and unknown risk factors. Efforts to minimize donor-incurred expenses and to better support the mental well-being of donors need to continue. Further research is needed to investigate the effect of donor reimbursement programs, which mitigate donor expenses, on postdonation mental health.
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Fu R, Sekercioglu N, Hishida M, Coyte PC. Economic Consequences of Adult Living Kidney Donation: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:592-601. [PMID: 33840438 DOI: 10.1016/j.jval.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/16/2020] [Accepted: 10/03/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Current guidelines mandate organ donation to be financially neutral such that it neither rewards nor exploits donors. This systematic review was conducted to assess the magnitude and type of costs incurred by adult living kidney donors and to identify those at risk of financial hardship. METHODS We searched English-language journal articles and working papers assessing direct and indirect costs incurred by donors on PubMed, MEDLINE, Scopus, the National Institute for Health Research Economic Evaluation Database, Research Papers in Economics, and EconLit in 2005 and thereafter. Estimates of total costs, types of costs, and characteristics of donors who incurred the financial burden were extracted. RESULTS Sixteen studies were identified involving 6158 donors. Average donor-borne costs ranged from US$900 to US$19 900 (2019 values) over the period from predonation evaluation to the end of the first postoperative year. Less than half of donors sought financial assistance and 80% had financial loss. Out-of-pocket payments for travel and health services were the most reported items where lost income accounted for the largest proportion (23.2%-83.7%) of total costs. New indirect cost items were identified to be insurance difficulty, exercise impairment, and caregiver income loss. Donors from lower-income households and those who traveled long distances reported the greatest financial hardship. CONCLUSIONS Most kidney donors are undercompensated. Our findings highlight gaps in donor compensation for predonation evaluation, long-distance donations, and lifetime insurance protection. Additional studies outside of North America are needed to gain a global prospective on how to provide for financial neutrality for kidney donors.
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Affiliation(s)
- Rui Fu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Nigar Sekercioglu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Manabu Hishida
- Department of Nephrology, Nagoya University Graduate School of Medicine, Ibaraki, Japan
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Maghen A, Mendoza G, Vargas GB, Connor SE, Nassiri S, Kwan L, Wood EL, Lalezari J, Friedman S, Waterman AD, George S, Maliski SL, Veale JL. How Can We Help Alleviate the Financial Concerns of Non-Directed (Altruistic) Living Kidney Donors? Prog Transplant 2020; 31:19-26. [PMID: 33292055 DOI: 10.1177/1526924820978589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The recent increase in non-directed donors (NDDs) in the United States (U.S.) may help reduce the overwhelming number of patients on the waitlist. However, non-directed donation may be limiting its full potential. Out-of-pocket donation costs upward of $8,000 may be a barrier to potential donors with altruistic tendencies, but inadequate financial support. This study aimed to describe the financial concerns of 31 U.S. NDDs. METHODS We conducted qualitative interviews and administered quantitative demographic surveys between April 2013 and April 2015. Interview transcripts were analyzed using grounded theory techniques to describe and expand on themes relevant to the NDD experience. FINDINGS We identified 4 sub-themes related to the theme of financial concerns: (1) direct costs related to transportation, lodging, and parking, (2) indirect costs of lost wages encountered from taking time off work to recover from surgery, (3) sources of financial support, and (4) suggestions for alleviating donor financial burden. Two thirds of participants (20) expressed concerns about direct and indirect donation costs. 11 NDDs reported the negative impact of direct costs,15 NDDs had concerns about indirect costs; only 7 donors received supplemental financial support from state mandates and transplant programs. DISCUSSION Understanding the financial concerns of NDDs may guide improvements in the NDD donation experience that could support individuals who are interested in donating but lack the financial stability to donate. Removing financial disincentives may help increase nondirected donation rates, increase the living donor pool, and the number of kidneys available for transplantation.
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Affiliation(s)
- Ariella Maghen
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Georgina Mendoza
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Grecia B Vargas
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sarah E Connor
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sima Nassiri
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Erika L Wood
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jonathan Lalezari
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sarah Friedman
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Amy D Waterman
- Division of Nephrology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.,Terasaki Research Institute, Los Angeles, CA, USA
| | - Sheba George
- Department of Community Health Sciences, 25808UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Sally L Maliski
- Office of the Dean, University of Kansas Medical Center School of Nursing, Kansas City, KS, USA
| | - Jeffrey L Veale
- Department of Urology, 12222David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Habbous S, Barnieh L, Klarenbach S, Manns B, Sarma S, Begen MA, Litchfield K, Lentine KL, Singh S, Garg AX. Evaluating multiple living kidney donor candidates simultaneously is more cost-effective than sequentially. Kidney Int 2020; 98:1578-1588. [DOI: 10.1016/j.kint.2020.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/13/2020] [Accepted: 06/04/2020] [Indexed: 01/11/2023]
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Using electronic AKI alerts to define the epidemiology of acute kidney injury in renal transplants. J Nephrol 2020; 34:829-838. [PMID: 33259046 PMCID: PMC8192326 DOI: 10.1007/s40620-020-00869-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023]
Abstract
Background Little is known regarding the impact of acute kidney injury (AKI) on renal transplant outcome. Our aim was to define the incidence and outcome of AKI in renal transplant patients using data collected from a national AKI electronic alert system Methods The study represents a prospective national cohort study collecting data on 1224 renal transplants recipients with a functioning renal transplant, between April 2015 and March 2019. Results Four hundred forty patients experienced at least one episode of AKI giving an incidence rate of 35.4%. Sixty-four point seven% of episodes were AKI stage 1, 7.3% AKI stage 2 and 28% AKI stage 3. Only 6.2% of episodes occurred in the context of rejection. Forty-three point five% of AKI episodes were associated with sepsis. AKI was associated with pre-existing renal dysfunction, and a primary renal diagnosis of diabetic nephropathy. AKI was more prevalent in recipients from a donor after cardiac death (26.4% vs. 21.4%, p < 0.05) compared to the non-AKI cohort. Following AKI, 30-day mortality was 19.8% and overall mortality was 34.8%, compared to 8.4% in the non AKI cohort (RR 4.06, 95% CI 3.1–5.3, p < 0.001). Graft survival (GS), and death censored graft survival (DCGS) censored at 4 years, in the AKI cohort were significantly lower than in the non AKI group (p < 0.0001 for GS and DCGS). Conclusion The study provides a detailed characterisation of AKI in renal transplant recipients highlighting its significant negative impact on patient and graft survival.
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Emamaullee J, Tenorio L, Khan S, Butler C, Kim S, Tucker‐Seeley R, Kwon Y, Shapiro J, Saigal S, Sher L, Genyk Y. Living donor financial assistance programs in liver transplantation: The global perspective. Clin Transplant 2020; 34:e14073. [DOI: 10.1111/ctr.14073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/23/2020] [Accepted: 08/22/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Juliet Emamaullee
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Lisa Tenorio
- School of Medicine St. Louis University St. Louis MissouriUSA
| | - Sara Khan
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Chante Butler
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Susan Kim
- University of Southern California Transplant Institute Los Angeles CaliforniaUSA
| | | | - Yong Kwon
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - James Shapiro
- Department of Surgery University of Alberta Edmonton Alberta Canada
| | | | - Linda Sher
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Yuri Genyk
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
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Lam NN, Dipchand C, Fortin MC, Foster BJ, Ghanekar A, Houde I, Kiberd B, Klarenbach S, Knoll GA, Landsberg D, Luke PP, Mainra R, Singh SK, Storsley L, Gill J. Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Can J Kidney Health Dis 2020; 7:2054358120918457. [PMID: 32577294 PMCID: PMC7288834 DOI: 10.1177/2054358120918457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose of review: To review an international guideline on the evaluation and care of living
kidney donors and provide a commentary on the applicability of the
recommendations to the Canadian donor population. Sources of information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO)
Clinical Practice Guideline on the Evaluation and Care of Living Kidney
Donors and compared this guideline to the Canadian 2014 Kidney Paired
Donation (KPD) Protocol for Participating Donors. Methods: A working group was formed consisting of members from the Canadian Society of
Transplantation and the Canadian Society of Nephrology. Members were
selected to have representation from across Canada and in various
subspecialties related to living kidney donation, including nephrology,
surgery, transplantation, pediatrics, and ethics. Key findings: Many of the KDIGO Guideline recommendations align with the KPD Protocol
recommendations. Canadian researchers have contributed to much of the
evidence on donor evaluation and outcomes used to support the KDIGO
Guideline recommendations. Limitations: Certain outcomes and risk assessment tools have yet to be validated in the
Canadian donor population. Implications: Living kidney donors should be counseled on the risks of postdonation
outcomes given recent evidence, understanding the limitations of the
literature with respect to its generalizability to the Canadian donor
population.
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Affiliation(s)
- Ngan N Lam
- Division of Nephrology, University of Calgary, AB, Canada
| | | | | | - Bethany J Foster
- Division of Pediatric Nephrology, McGill University, Montréal, QC, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, ON, Canada
| | - Isabelle Houde
- Division of Nephrology, Centre Hospitalier de l'Université de Québec, Québec City, Canada
| | - Bryce Kiberd
- Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | | | - Greg A Knoll
- Division of Nephrology, University of Ottawa, ON, Canada
| | - David Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Patrick P Luke
- Division of Urology, Western University, London, ON, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, Canada
| | - Sunita K Singh
- Division of Nephrology, University of Toronto, ON, Canada
| | - Leroy Storsley
- Section of Nephrology, University of Manitoba, Winnipeg, Canada
| | - Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada
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Mathur AK, Stewart Lewis ZA, Warren PH, Walters MC, Gifford KA, Xing J, Goodrich NP, Bennett R, Brownson A, Ellefson J, Felan G, Gray B, Hays RE, Klein-Glover C, Lagreco S, Metzler N, Provencher K, Walz E, Warmke K, Merion RM, Ojo AO. Best practices to optimize utilization of the National Living Donor Assistance Center for the financial assistance of living organ donors. Am J Transplant 2020; 20:25-33. [PMID: 31680449 DOI: 10.1111/ajt.15684] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 01/25/2023]
Abstract
Living organ donors face direct costs when donating an organ, including transportation, lodging, meals, and lost wages. For those most in need, the National Living Donor Assistance Center (NLDAC) provides reimbursement to defray travel and subsistence costs associated with living donor evaluation, surgery, and follow-up. While this program currently supports 9% of all US living donors, there is tremendous variability in its utilization across US transplant centers, which may limit patient access to living donor transplantation. Based on feedback from the transplant community, NLDAC convened a Best Practices Workshop on August 2, 2018, in Arlington, VA, to identify strategies to optimize transplant program utilization of this valuable resource. Attendees included team members from transplant centers that are high NLDAC users; the NLDAC program team; and Advisory Group members. After a robust review of NLDAC data and engagement in group discussions, the workgroup identified concrete best practices for administrative and transplant center leadership involvement; for individuals filing NLDAC applications at transplant centers; and to improve patient education about potential financial barriers to living organ donation. Multiple opportunities were identified for intervention to increase transplant programs' NLDAC utilization and reduce financial burdens inhibiting expansion of living donor transplantation in the United States.
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Affiliation(s)
| | - Zoe A Stewart Lewis
- Transplant Surgery, New York University Langone Medical Center, New York, New York
| | | | | | | | - Jiawei Xing
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | | | - Ada Brownson
- Augusta University Transplant Program, Augusta, Georgia
| | - Jill Ellefson
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | - Gerardo Felan
- University of Texas Health Science Center, San Antonio, Texas
| | | | - Rebecca E Hays
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | | | | | | | | | - Emily Walz
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kara Warmke
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
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