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Massey EK, Rule AD, Matas AJ. Living Kidney Donation: A Narrative Review of Mid- and Long-term Psychosocial Outcomes. Transplantation 2024:00007890-990000000-00794. [PMID: 38886889 DOI: 10.1097/tp.0000000000005094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Living kidney donors make a significant contribution to alleviating the organ shortage. The aim of this article is to provide an overview of mid- and long-term (≥12 mo) living donor psychosocial outcomes and highlight areas that have been understudied and should be immediately addressed in both research and clinical practice. We conducted a narrative review by searching 3 databases. A total of 206 articles were included. Living donors can be divided into those who donate to an emotionally or genetically related person, the so-called directed donors, or to an emotionally or genetically unrelated recipient, the so-called nondirected donors. The most commonly investigated (bio)psychosocial outcome after living donation was health-related quality of life. Other generic (bio)psychological outcomes include specific aspects of mental health such as depression, and fatigue and pain. Social outcomes include financial and employment burdens and problems with insurance. Donation-specific psychosocial outcomes include regret, satisfaction, feelings of abandonment and unmet needs, and benefits of living kidney donation. The experience of living donation is complex and multifaceted, reflected in the co-occurrence of both benefits and burden after donation. Noticeably, no interventions have been developed to improve mid- or long-term psychosocial outcomes among living donors. We highlight areas for methodological improvement and identified 3 areas requiring immediate attention from the transplant community in both research and clinical care: (1) recognizing and providing care for the minority of donors who have poorer long-term psychosocial outcomes after donation, (2) minimizing donation-related financial burden, and (3) studying interventions to minimize long-term psychosocial problems.
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Affiliation(s)
- Emma K Massey
- Erasmus Medical Center Transplant Institute, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam, Zuid Holland, the Netherlands
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Arthur J Matas
- Department of Surgery, Transplantation Division, University of Minnesota, Minneapolis, MN
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2
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Ambagtsheer F, Bunnik E, Pengel LHM, Reinders MEJ, Elias JJ, Lacetera N, Macis M. Public Opinions on Removing Disincentives and Introducing Incentives for Organ Donation: Proposing a European Research Agenda. Transpl Int 2024; 37:12483. [PMID: 38644936 PMCID: PMC11027084 DOI: 10.3389/ti.2024.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/04/2024] [Indexed: 04/23/2024]
Abstract
The shortage of organs for transplantations is increasing in Europe as well as globally. Many initiatives to the organ shortage, such as opt-out systems for deceased donation and expanding living donation, have been insufficient to meet the rising demand for organs. In recurrent discussions on how to reduce organ shortage, financial incentives and removal of disincentives, have been proposed to stimulate living organ donation and increase the pool of available donor organs. It is important to understand not only the ethical acceptability of (dis)incentives for organ donation, but also its societal acceptance. In this review, we propose a research agenda to help guide future empirical studies on public preferences in Europe towards the removal of disincentives and introduction of incentives for organ donation. We first present a systematic literature review on public opinions concerning (financial) (dis)incentives for organ donation in European countries. Next, we describe the results of a randomized survey experiment conducted in the United States. This experiment is crucial because it suggests that societal support for incentivizing organ donation depends on the specific features and institutional design of the proposed incentive scheme. We conclude by proposing this experiment's framework as a blueprint for European research on this topic.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Eline Bunnik
- Department of Medical Ethics, Philosophy and History of Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Liset H. M. Pengel
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marlies EJ Reinders
- Department of Internal Medicine, Nephrology and Kidney Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Julio J. Elias
- Department of Economics, School of Business, University of CEMA, Buenos Aires, Argentina
| | | | - Mario Macis
- Carey Business School, Johns Hopkins University, Baltimore, MD, United States
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3
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Nemati M, Zhang H, Sloma M, Bekbolsynov D, Wang H, Stepkowski S, Xu KS. Predicting kidney transplant survival using multiple feature representations for HLAs. Artif Intell Med 2023; 145:102675. [PMID: 37925205 DOI: 10.1016/j.artmed.2023.102675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/14/2023] [Accepted: 10/02/2023] [Indexed: 11/06/2023]
Abstract
Kidney transplantation can significantly enhance living standards for people suffering from end-stage renal disease. A significant factor that affects graft survival time (the time until the transplant fails and the patient requires another transplant) for kidney transplantation is the compatibility of the Human Leukocyte Antigens (HLAs) between the donor and recipient. In this paper, we propose 4 new biologically-relevant feature representations for incorporating HLA information into machine learning-based survival analysis algorithms. We evaluate our proposed HLA feature representations on a database of over 100,000 transplants and find that they improve prediction accuracy by about 1%, modest at the patient level but potentially significant at a societal level. Accurate prediction of survival times can improve transplant survival outcomes, enabling better allocation of donors to recipients and reducing the number of re-transplants due to graft failure with poorly matched donors.
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Affiliation(s)
- Mohammadreza Nemati
- Department of Electrical Engineering and Computer Science, University of Toledo, 2801 W Bancroft St, Toledo, 43606, OH, United States; Department of Computer and Data Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, 44106, OH, United States
| | - Haonan Zhang
- Department of Electrical Engineering and Computer Science, University of Toledo, 2801 W Bancroft St, Toledo, 43606, OH, United States
| | - Michael Sloma
- Department of Electrical Engineering and Computer Science, University of Toledo, 2801 W Bancroft St, Toledo, 43606, OH, United States
| | - Dulat Bekbolsynov
- Department of Medical Microbiology and Immunology, University of Toledo, United States
| | - Hong Wang
- Department of Engineering Technology, University of Toledo, United States
| | - Stanislaw Stepkowski
- Department of Medical Microbiology and Immunology, University of Toledo, United States
| | - Kevin S Xu
- Department of Electrical Engineering and Computer Science, University of Toledo, 2801 W Bancroft St, Toledo, 43606, OH, United States; Department of Computer and Data Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, 44106, OH, United States.
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4
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Semrau L, Matas AJ. A regulated system of incentives for living kidney donation: Clearing the way for an informed assessment. Am J Transplant 2022; 22:2509-2514. [PMID: 35751488 PMCID: PMC9796749 DOI: 10.1111/ajt.17129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 01/25/2023]
Abstract
The kidney shortage continues to be a crisis for our patients. Despite numerous attempts to increase living and deceased donation, annually in the United States, thousands of candidates are removed from the kidney transplant waiting list because of either death or becoming too sick to transplant. To increase living donation, trials of a regulated system of incentives for living donation have been proposed. Such trials may show: (1) a significant increase in donation, and (2) that informed, incentivized donors, making an autonomous decision to donate, have the same medical and psychosocial outcomes as our conventional donors. Given the stakes, the proposal warrants careful consideration. However, to date, much discussion of the proposal has been unproductive. Objections commonly leveled against it: fail to engage with it; conflate it with underground, unregulated markets; speculate without evidence; and reason fallaciously, favoring rhetorical impact over logic. The present paper is a corrective. It identifies these common errors so they are not repeated, thus allowing space for an assessment of the proposal on its merits.
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Affiliation(s)
- Luke Semrau
- Department of PhilosophyBloomsburg UniversityBloomsburgPennsylvaniaUSA
| | - Arthur J. Matas
- Division of Transplantation, Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
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5
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Roth AE, Marino IR, Krawiec KD, Rees MA. Criminal, Legal, and Ethical Kidney Donation and Transplantation: A Conceptual Framework to Enable Innovation. Transpl Int 2022; 35:10551. [PMID: 35874307 PMCID: PMC9306490 DOI: 10.3389/ti.2022.10551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/23/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Alvin E. Roth
- Department of Economics, Stanford University, Stanford, CA, United States
| | - Ignazio R. Marino
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Michael A. Rees
- Department of Urology, University of Toledo Medical Center, Toledo, OH, United States
- Alliance for Paired Kidney Donation, Toledo, OH, United States
- *Correspondence: Michael A. Rees,
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6
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Zhuang J, Guidry A. A Content Analysis of Living Organ Donation Materials from Certified Transplant Centers. HEALTH COMMUNICATION 2021; 36:2002-2009. [PMID: 32847410 DOI: 10.1080/10410236.2020.1813392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the fact that living organ donation has the great potential to reduce the shortage of transplantable organs, it is still surrounded by many misconceptions, ethical concerns, and myths. Research conducted to understand factors contributing to public misconceptions related to living organ donation is rare. This research takes a content analytic approach to uncover how living organ donation is portrayed in materials developed and delivered by transplant centers across 11 regions. A total of 332 unique materials were analyzed. The results revealed that living kidney donation dominated the corpus of data whereas other living organ donations were largely overlooked. Benefits and risks associated with living organ donation were relatively evenly presented; however, social support necessary to donors and recipients and available resources to obtain social support were not sufficiently addressed. Embedded in these materials were 46 personal narrative stories. Analysis of these stories showed a focus on undirected living organ donation and revealed a wide range of emotional experiences. Significant regional differences were found in several themes, such as benefits and risks, and social support. Inconsistent information regarding living organ donation was present. Practical implications are discussed.
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Affiliation(s)
- Jie Zhuang
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University
| | - Ashley Guidry
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University
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Affiliation(s)
- Arthur J Matas
- Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis
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8
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Veale JL, Nassiri N, Capron AM, Danovitch GM, Gritsch HA, Cooper M, Redfield RR, Kennealey PT, Kapur S. Voucher-Based Kidney Donation and Redemption for Future Transplant. JAMA Surg 2021; 156:812-817. [PMID: 34160572 DOI: 10.1001/jamasurg.2021.2375] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Policy makers, transplant professionals, and patient organizations agree that there is a need to increase the number of kidney transplants by facilitating living donation. Vouchers for future transplant provide a means of overcoming the chronological incompatibility that occurs when the ideal time for living donation differs from the time at which the intended recipient actually needs a transplant. However, uncertainty remains regarding the actual change in the number of living kidney donors associated with voucher programs and the capability of voucher redemptions to produce timely transplants. Objective To examine the consequences of voucher-based kidney donation and the capability of voucher redemptions to provide timely kidney allografts. Design, Setting, and Participants This multicenter cohort study of 79 transplant centers across the US used data from the National Kidney Registry from January 1, 2014, to January 31, 2021, to identify all family vouchers and patterns in downstream kidney-paired donations. The analysis included living kidney donors and recipients participating in the National Kidney Registry family voucher program. Exposures A voucher was provided to the intended recipient at the time of donation. Vouchers had no cash value and could not be sold, bartered, or transferred to another person. When a voucher was redeemed, a living donation chain was used to return a kidney to the voucher holder. Main Outcomes and Measures Deidentified demographic and clinical data from each kidney donation were evaluated, including the downstream patterns in kidney-paired donation. Voucher redemptions were separately evaluated and analyzed. Results Between 2014 and 2021, 250 family voucher-based donations were facilitated. Each donation precipitated a transplant chain with a mean (SD) length of 2.3 (1.6) downstream kidney transplants, facilitating 573 total transplants. Of those, 111 transplants (19.4%) were performed in highly sensitized recipients. Among 250 voucher donors, the median age was 46 years (range, 19-78 years), and 157 donors (62.8%) were female, 241 (96.4%) were White, and 104 (41.6%) had blood type O. Over a 7-year period, the waiting time for those in the National Kidney Registry exchange pool decreased by more than 3 months. Six vouchers were redeemed, and 3 of those redemptions were among individuals with blood type O. The time from voucher redemption to kidney transplant ranged from 36 to 155 days. Conclusions and Relevance In this study, the family voucher program appeared to mitigate a major disincentive to living kidney donation, namely the reluctance to donate a kidney in the present that could be redeemed in the future if needed. The program facilitated kidney donations that may not otherwise have occurred. All 6 of the redeemed vouchers produced timely kidney transplants, indicating the capability of the voucher program.
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Affiliation(s)
- Jeffrey L Veale
- Kidney Transplant Exchange Program, UCLA Health, Department of Urology, David Geffen School of Medicine at ULCA, University of California, Los Angeles, Los Angeles
| | - Nima Nassiri
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Alexander M Capron
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles.,Gould School of Law, University of Southern California, Los Angeles
| | - Gabriel M Danovitch
- Kidney Transplant Exchange Program, UCLA Health, Department of Urology, David Geffen School of Medicine at ULCA, University of California, Los Angeles, Los Angeles
| | - H Albin Gritsch
- Kidney Transplant Exchange Program, UCLA Health, Department of Urology, David Geffen School of Medicine at ULCA, University of California, Los Angeles, Los Angeles
| | - Matthew Cooper
- Department of Surgery, Georgetown University School of Medicine, Washington, DC.,National Kidney Registry, Babylon, New York
| | - Robert R Redfield
- Department of Surgery, University of Wisconsin School of Medicine, Madison
| | | | - Sandip Kapur
- Department of Surgery, Weill-Cornell School of Medicine, New York, New York
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9
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Nemati M, Zhang H, Sloma M, Bekbolsynov D, Wang H, Stepkowski S, Xu KS. Predicting Kidney Transplant Survival Using Multiple Feature Representations for HLAs. Artif Intell Med 2021. [DOI: 10.1007/978-3-030-77211-6_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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10
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Toufeeq Khan TF, Mirza I, Rashid T, Anwar N. Unrelated donors in kidney transplantation: Myths and the gruesome reality. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:563-567. [PMID: 32394939 DOI: 10.4103/1319-2442.284041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Taqi F Toufeeq Khan
- Department of Nephrology and Transplantation, Rehman Medical Institute, Peshawar, Pakistan
| | - Irfan Mirza
- Department of Nephrology and Transplantation, Rehman Medical Institute, Peshawar, Pakistan
| | - Tahir Rashid
- Department of Nephrology and Transplantation, Rehman Medical Institute, Peshawar, Pakistan
| | - Nisar Anwar
- Department of Nephrology and Transplantation, Rehman Medical Institute, Peshawar, Pakistan
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11
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Kulkarni S, Ladin K. Ethical principles governing organ transplantation apply to paired exchange programs. Am J Transplant 2020; 20:1223-1224. [PMID: 32022980 PMCID: PMC7217160 DOI: 10.1111/ajt.15807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 01/22/2020] [Accepted: 02/02/2020] [Indexed: 01/25/2023]
Abstract
The fair and equitable allocation of kidneys in paired exchange programs requires that patient‐level factors are the primary drivers of how chains are constructed and how end‐chain kidneys are allocated. See http://onlinelibrary.wiley.com/doi/10.1111/ajt.15778/abstract for the article from Verbesey et al.
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Affiliation(s)
| | - Keren Ladin
- Departments of Community Health and Occupational TherapyTufts UniversityMedfordMAUSA
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12
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Bastani B. The present and future of transplant organ shortage: some potential remedies. J Nephrol 2019; 33:277-288. [PMID: 31399908 DOI: 10.1007/s40620-019-00634-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/30/2019] [Indexed: 12/24/2022]
Abstract
Transplantation remains the modality of choice for patients with end stage renal disease (ESRD). However, while there has been a steady rise in the number of patients with ESRD the supply of donors (combine living and deceased) has fallen far behind the need, resulting in an increasing number of qualified patients remaining on the wait-list, and thousands being removed from the list every year because of death or becoming too sick for transplantation. This has also fed to transplant tourism around the world. Several countries have implemented a variety of policies to overcome their organ shortage that are presented in this article. There is an urgent need for developing policies geared to the cultural norms of different societies and universally accepted ethical principles to remedy this public health issue.
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Affiliation(s)
- Bahar Bastani
- Division of Nephrology, Saint Louis University Hospital, Saint Louis University School of Medicine, 3635 Vista Avenue, Saint Louis, MO, 63110, USA.
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13
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McCormick F, Held PJ, Chertow GM, Peters TG, Roberts JP. Removing Disincentives to Kidney Donation: A Quantitative Analysis. J Am Soc Nephrol 2019; 30:1349-1357. [PMID: 31345987 DOI: 10.1681/asn.2019030242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
| | - Philip J Held
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Glenn M Chertow
- Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Thomas G Peters
- Department of Surgery, University of Florida, Jacksonville, Florida; and
| | - John P Roberts
- Department of Surgery, University of California, San Francisco, San Francisco, California
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14
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15
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Opinions of Health Care Personnel Regarding Disincentives and Incentives for Living Kidney Donation at a Single Center. Transplant Proc 2018; 50:3053-3058. [PMID: 30577165 DOI: 10.1016/j.transproceed.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/19/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transplant societies continue to actively concentrate on increasing rates of living kidney donation (LKD) to bridge the gap between individuals awaiting transplantation and the number of kidneys available. A widely discussed strategy to increase living donation rates is the provision of incentives and removal of disincentives. Though opinions of the public regarding this strategy have been studied, the opinions of health care providers, including younger professionals, are less clear. We studied the opinions of medical students and other health care providers on strategies to increase LKD to determine if opinions were different among those < 25 or ≥ 25 years of age. METHODS A simple cross-sectional survey was conducted at an academic medical center. Participants included medical students and employees in Internal Medicine, General Surgery, and the Organ Transplantation Center. Pearson's χ2 and Fisher's exact test were conducted on the responses regarding disincentives and incentives to determine whether opinions differed based on age. RESULTS Six hundred and twenty-four participants completed the survey. There was no statistical difference in opinions between groups on reimbursing transportation costs, loss of wages, or childcare costs, but those aged ≥ 25 were more agreeable with covering food/lodging costs compared to those < 25 (96.5% vs 90.7%, P = .009). Respondents < 25 years old were more willing to donate a kidney for a financial incentive (P = .0002) accepting a median amount of $25,000. CONCLUSIONS Health care personnel broadly support removing financial disincentives for living kidney donation, and those ≥ 25 were more in favor of covering food/lodging costs compared to those < 25. Those < 25 years old were more likely to accept financial incentives towards donating their kidney compared to those ≥ 25 years.
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Held PJ, McCormick F, Chertow GM, Peters TG, Roberts JP. Would government compensation of living kidney donors exploit the poor? An empirical analysis. PLoS One 2018; 13:e0205655. [PMID: 30485269 PMCID: PMC6261427 DOI: 10.1371/journal.pone.0205655] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 09/12/2018] [Indexed: 11/18/2022] Open
Abstract
Government compensation of kidney donors would likely increase the supply of kidneys and prevent the premature deaths of tens of thousands of patients with kidney failure each year. The major argument against it is that it would exploit the poor who would be more likely to accept the offers of compensation. This overlooks the fact that many poor patients desperately need a kidney transplant and would greatly benefit from an increased supply of kidneys. The objective of this study is to empirically test the hypothesis that government compensation of kidney donors would exploit the poor. Exploitation is defined by economists and several noted ethicists as paying donors less than the fair market value of their kidney. Exploitation is expressed in monetary terms and compared with the economic benefit recipients receive from a transplant. Data are from the Scientific Registry of Transplant Recipients and the United States Renal Data System annual data reports. Educational attainment is used as a proxy for income. We estimate that if the government rewards living donors with a package of non-cash benefits worth $75,000 per kidney, donors would not be exploited. Much more important, this compensation would likely end the kidney shortage, enabling many more patients with kidney failure to obtain transplants and live longer and healthier lives. The value of kidney transplantation to a U.S. recipient is about $1,330,000, which is an order of magnitude greater than any purported exploitation of a living donor (zero to $75,000). Consequently, the aggregate net benefit to the poor alone from kidney transplantation would increase to about $12 billion per year from $1 billion per year currently. Most of the benefit would accrue to poor kidney recipients. But poor donors would receive the fair market value of their kidney, and hence would not be exploited. If the government wanted to ensure that donors also received a net benefit, it could easily do so by increasing the compensation above $75,000 per donor.
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Affiliation(s)
- Philip J. Held
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, United States of America
- * E-mail:
| | - Frank McCormick
- Independent Researcher, Walnut Creek, California, United States of America
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Thomas G. Peters
- Department of Surgery, University of Florida, Jacksonville, Florida, United States of America
| | - John P. Roberts
- Department of Surgery, University of California San Francisco, San Francisco, California, United States of America
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17
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Wiseman AC. Protecting Donors and Safeguarding Altruism in the United States: The Living Donor Protection Act. Clin J Am Soc Nephrol 2018; 13:790-792. [PMID: 29523678 PMCID: PMC5969491 DOI: 10.2215/cjn.13681217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Alexander C Wiseman
- Division of Renal Diseases and Hypertension, Transplant Center, University of Colorado Denver, Aurora, Colorado
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18
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Dorflinger LM, Kulkarni S, Thiessen C, Klarman S, Fraenkel L. Assessing Living Donor Priorities Through Nominal Group Technique. Prog Transplant 2018; 28:29-35. [PMID: 29243533 PMCID: PMC5735019 DOI: 10.1177/1526924817746682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The need for kidneys for transplantation continues to far surpass the number of donors. Although studies have shown that most people are aware of and support the idea of living donation, it remains unclear what motivates individuals who are aware, knowledgeable, and in support of donation to actually donate, or conversely, what deters them from donating. Utilizing nominal group technique, 30 individuals participated in 4 groups in which they brainstormed factors that would impact willingness to be a living donor and voted on which factors they deemed most important. Responses were analyzed and categorized into themes. Factors that influence the donation decision, from most to least important as rated by participants, were altruism, relationship to recipient, knowledge, personal risk/impact, convenience/access, cost, support, personal benefit, and religion. Participants reported a significant lack of information about donation as well as lack of knowledge about where and how to obtain information that would motivate them to donate or help make the decision to donate. Findings suggest that public campaign efforts seeking to increase rates of living donation should appeal to altruism and increase knowledge about the impact (or lack thereof) of donation on lifestyle factors and future health, and transplant programs should aim to maximize convenience and minimize donor burden. Future research should examine whether tailoring public campaigns to address factors perceived as most salient by potential donors reduces the significant gap in supply of and demand for kidneys.
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Denu RA, Mendonca EA, Fost N. Potential yield of imminent death kidney donation. Am J Transplant 2018; 18:486-491. [PMID: 28975705 PMCID: PMC5937230 DOI: 10.1111/ajt.14524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 09/18/2017] [Accepted: 09/21/2017] [Indexed: 01/25/2023]
Abstract
About 99 000 people are waiting for a kidney in the United States, and many will die waiting. The concept of "imminent death" donation, a type of living donation, has been gaining attention among physicians, patients, and ethicists. We estimated the number of potential imminent death kidney donors at the University of Wisconsin Hospital and Clinics by assessing the number of annual deaths in individuals with normal kidney function. Based on a previous survey suggesting that one-third of patients might be willing to donate at imminent death, we estimate that between 76 and 396 people in the state of Wisconsin would be medically eligible and willing to donate each year at the time of imminent death. We extrapolated these numbers to all transplant centers in the United States, estimating that between 5925 and 31 097 people might be eligible and willing to donate each year. Our results suggest that allowing donation at imminent death and including discussions about organ donation in end-of-life planning could substantially reduce the nation's kidney waiting list while providing many more donors the opportunity to give this gift.
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Affiliation(s)
- Ryan A. Denu
- Department of Medicine, University of Wisconsin, Madison, WI, USA
| | - Eneida A. Mendonca
- Departments of Pediatrics and Biostatistics & Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Norman Fost
- Departments of Pediatrics and Medical History and Bioethics, University of Wisconsin-Madison, Madison, WI, USA
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Thiessen C, Jaji Z, Joyce M, Zimbrean P, Reese P, Gordon EJ, Kulkarni S. Opting out: a single-centre pilot study assessing the reasons for and the psychosocial impact of withdrawing from living kidney donor evaluation. JOURNAL OF MEDICAL ETHICS 2017; 43:756-761. [PMID: 28258071 DOI: 10.1136/medethics-2016-103512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 11/15/2016] [Accepted: 02/03/2017] [Indexed: 06/06/2023]
Abstract
Understanding why individuals opt out of living donation is crucial to enhancing protections for all living donors and to identify modifiable barriers to donation. We developed an ethical approach to conducting research on individuals who opted out of living kidney donation and applied it in a small-scale qualitative study at one US transplant centre. The seven study participants (64% response rate) had varied reasons for opting out, the most prominent of which was concern about the financial burden from lost wages during the postoperative period. Several reported feeling alone during their decision-making process. Although no participants used an alibi, a centre-provided statement of non-eligibility to donate, all believed that centres should offer alibis to help preserve donor autonomy. Given the complexity of participants' decisions and the emotions they experienced before and after deciding not to donate, we suggest approaches for independent living donor advocates to support this population. This study demonstrates that research on individuals who opt out of donation is feasible and yields valuable insight into methods to improve the evaluation experience for potential living donors.
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Affiliation(s)
- Carrie Thiessen
- Department of Surgery, Section of Organ Transplantation and Immunology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Zainab Jaji
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Michael Joyce
- Department of Surgery, Section of Organ Transplantation and Immunology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Paula Zimbrean
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Peter Reese
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elisa J Gordon
- Department of Surgery, Comprehensive Transplant Center, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sanjay Kulkarni
- Department of Surgery, Section of Organ Transplantation and Immunology, Yale School of Medicine, New Haven, Connecticut, USA
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22
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Barnieh L, Collister D, Manns B, Lam NN, Shojai S, Lorenzetti D, Gill JS, Klarenbach S. A Scoping Review for Strategies to Increase Living Kidney Donation. Clin J Am Soc Nephrol 2017; 12:1518-1527. [PMID: 28818845 PMCID: PMC5586566 DOI: 10.2215/cjn.01470217] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/12/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The literature on strategies to increase the number of potential living kidney donors is extensive and has yet to be characterized. Scoping reviews are a novel methodology for systematically assessing a wide breadth of a given body of literature and may be done before conducting a more targeted systematic review. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a scoping review and summarized the evidence for existing strategies to increase living kidney donation. RESULTS Our review identified seven studies that tested interventions using rigorous methods (i.e., randomized, controlled trials) and outcome measures, all of which focused on using education targeted at potential recipients to increase living donation. Of these, two studies that targeted the potential recipients' close social network reported statistically significant results. Other interventions were identified, but their effect was assessed through quasiexperimental or observational study designs. CONCLUSIONS We identified an important gap in the literature for evidence-based strategies to increase living kidney donation. From the limited data available, strategies directed at potential recipients and their social networks are the most promising. These results can inform transplant programs that are considering strategies to increase living kidney donation and highlight the need for conduct of high-quality study to increase living donation.
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Affiliation(s)
- Lianne Barnieh
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - David Collister
- Division of Nephrology, Department of Medicine, McMaster University, St. Joseph’s Hospital, Hamilton, Ontario, Canada
| | - Braden Manns
- Department of Community Health Sciences and
- Department of Medicine, Institute of Public Health and Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada; and
| | - Ngan N. Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Diane Lorenzetti
- Department of Medicine, Institute of Public Health and Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada; and
| | - John S. Gill
- Division of Nephrology, Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Klarenbach
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
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23
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 198] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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24
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Psychosocial Outcomes 3 to 10 Years After Donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study. Transplantation 2017; 100:1257-69. [PMID: 27152918 DOI: 10.1097/tp.0000000000001144] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies of liver donors' psychosocial outcomes focus on the short term and rely largely on quality-of-life measures not specific to donation. We sought to examine long-term donation effects on 3 psychosocial domains: perceived physical, emotional, and socioeconomic outcomes. METHODS Individuals donating 3 to 10 years previously at 9 centers were eligible for telephone surveys. Survey responses were examined descriptively. Cluster analysis was used to identify distinct donor groups based on response profiles across psychosocial domains. Potential predictors of response profiles were evaluated with regression analysis. RESULTS Five hundred seventeen donors (66%) participated (M = 5.8 years postdonation, SD = 1.9). Fifteen percent to 48% of donors endorsed current donation-related physical health problems and concerns, and 7%-60% reported socioeconomic concerns (eg, insurance difficulties, financial expenditures). However, on average, donors experienced high psychological growth, and 90% felt positively about donation. Cluster analysis revealed 5 donor groups. One group showed high psychological benefit, with little endorsement of physical or socioeconomic concerns (15% of donors). Four groups showed less favorable profiles, with varying combinations of difficulties. The largest such group showed high endorsement of physical concerns and financial expenditures, and only modest psychological benefit (31% of donors). Men and nonHispanic whites were most likely to have unfavorable response profiles (Ps < 0.01). Compared with donors aged 19 to 30 years, older donors were less likely to have unfavorable profiles; these differences were significant for donors in the >40 to 50 year age group (Ps < 0.008). CONCLUSIONS Even many years postdonation, donors report adverse physical and socioeconomic effects, but positive emotional effects as well. Identification of response profiles and predictors may improve targeting of postdonation surveillance and care.
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25
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Gill JS, Delmonico F, Klarenbach S, Capron AM. Providing Coverage for the Unique Lifelong Health Care Needs of Living Kidney Donors Within the Framework of Financial Neutrality. Am J Transplant 2017; 17:1176-1181. [PMID: 27888569 DOI: 10.1111/ajt.14147] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 10/21/2016] [Accepted: 11/08/2016] [Indexed: 01/25/2023]
Abstract
Organ donation should neither enrich donors nor impose financial burdens on them. We described the scope of health care required for all living kidney donors, reflecting contemporary understanding of long-term donor health outcomes; proposed an approach to identify donor health conditions that should be covered within the framework of financial neutrality; and proposed strategies to pay for this care. Despite the Affordable Care Act in the United States, donors continue to have inadequate coverage for important health conditions that are donation related or that may compromise postdonation kidney function. Amendment of Medicare regulations is needed to clarify that surveillance and treatment of conditions that may compromise postdonation kidney function following donor nephrectomy will be covered without expense to the donor. In other countries lacking health insurance for all residents, sufficient data exist to allow the creation of a compensation fund or donor insurance policies to ensure appropriate care. Providing coverage for donation-related sequelae as well as care to preserve postdonation kidney function ensures protection against the financial burdens of health care encountered by donors throughout their lives. Providing coverage for this care should thus be cost-effective, even without considering the health care cost savings that occur for living donor transplant recipients.
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Affiliation(s)
- J S Gill
- Division of Nephrology, Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, Canada
| | - F Delmonico
- Harvard Medical School, Massachusetts General Hospital Transplant Center, Boston, MA
| | - S Klarenbach
- University of Alberta, Edmonton, Alberta, Canada
| | - A M Capron
- Gould School of Law and Keck School of Medicine, University of Southern California, Los Angeles, CA
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26
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27
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Stoler A, Kessler JB, Ashkenazi T, Roth AE, Lavee J. Incentivizing Organ Donor Registrations with Organ Allocation Priority. HEALTH ECONOMICS 2017; 26:500-510. [PMID: 27125490 DOI: 10.1002/hec.3328] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 01/22/2016] [Accepted: 01/28/2016] [Indexed: 06/05/2023]
Abstract
How donor organs are allocated for transplant can affect their scarcity. In 2008, Israel's Parliament passed an Organ Transplantation Law granting priority on organ donor waiting lists to individuals who had previously registered as organ donors. Beginning in November 2010, public awareness campaigns advertised the priority policy to the public. Since April 2012, priority has been added to the routine medical criteria in organ allocation decisions. We evaluate the introduction of priority for registered organ donors using Israeli data on organ donor registration from 1992 to 2013. We find that registrations increased when information about the priority law was made widely available. We find an even larger increase in registration rates in the 2 months leading up to a program deadline, after which priority would only be granted with a 3-year delay. We also find that the registration rate responds positively to public awareness campaigns, to the ease of registration (i.e. allowing for registering online and by phone) and to an election drive that included placing registration opportunities in central voting locations. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Avraham Stoler
- Department of Economics, DePaul University and Coherent Economics, Highland Park, IL, USA
| | - Judd B Kessler
- The Wharton School, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Alvin E Roth
- Department of Economics, Stanford University, Stanford, CA, USA
| | - Jacob Lavee
- Tel Aviv University Faculty of Medicine and the Heart Transplantation Unit, Sheba Medical Center, Ramat Gan, Israel
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28
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DiMartini A, Dew MA, Liu Q, Simpson MA, Ladner DP, Smith AR, Zee J, Abbey S, Gillespie BW, Weinrieb R, Mandell MS, Fisher RA, Emond JC, Freise CE, Sherker AH, Butt Z. Social and Financial Outcomes of Living Liver Donation: A Prospective Investigation Within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2). Am J Transplant 2017; 17:1081-1096. [PMID: 27647626 PMCID: PMC5359081 DOI: 10.1111/ajt.14055] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/04/2016] [Accepted: 09/07/2016] [Indexed: 01/25/2023]
Abstract
Because results from single-center (mostly kidney) donor studies demonstrate interpersonal relationship and financial strains for some donors, we conducted a liver donor study involving nine centers within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2) consortium. Among other initiatives, A2ALL-2 examined the nature of these outcomes following donation. Using validated measures, donors were prospectively surveyed before donation and at 3, 6, 12, and 24 mo after donation. Repeated-measures regression models were used to examine social relationship and financial outcomes over time and to identify relevant predictors. Of 297 eligible donors, 271 (91%) consented and were interviewed at least once. Relationship changes were positive overall across postdonation time points, with nearly one-third reporting improved donor family and spousal or partner relationships and >50% reporting improved recipient relationships. The majority of donors, however, reported cumulative out-of-pocket medical and nonmedical expenses, which were judged burdensome by 44% of donors. Lower income predicted burdensome donation costs. Those who anticipated financial concerns and who held nonprofessional positions before donation were more likely to experience adverse financial outcomes. These data support the need for initiatives to reduce financial burden.
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Affiliation(s)
- A DiMartini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, USA,Department of Surgery, University of Pittsburgh, Pittsburgh PA, USA
| | - MA Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, USA,Department of Psychology, University of Pittsburgh, Pittsburgh PA, USA,Department of Epidemiology, University of Pittsburgh, Pittsburgh PA, USA,Department of Biostatistics, University of Pittsburgh, Pittsburgh PA, USA
| | - Q Liu
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - MA Simpson
- Lahey Hospital and Medical Center Clinical Research and Education, Burlington, MA, USA,Department of Transplantation, Burlington, MA, USA
| | - DP Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Chicago, IL, USA,Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - AR Smith
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA,Departments of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - J Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - S Abbey
- Department of Psychiatry, University of Toronto and University Health Network, Toronto ON, CA
| | - BW Gillespie
- Departments of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - R Weinrieb
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - MS Mandell
- Department of Anesthesiology, University of Colorado, Denver CO, USA
| | - RA Fisher
- Department of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA (current affiliation, Beth Israel Deaconess Department of Surgery, Harvard University)
| | - JC Emond
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - CE Freise
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - AH Sherker
- Liver Diseases Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Z Butt
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Chicago, IL, USA,Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago IL, USA,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
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29
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Mittelman M, Thiessen C, Chon WJ, Clayville K, Cronin DC, Fisher JS, Fry-Revere S, Gross JA, Hanneman J, Henderson ML, Ladin K, Mysel H, Sherman LA, Willock L, Gordon EJ. Miscommunicating NOTA Can Be Costly to Living Donors. Am J Transplant 2017; 17:578-580. [PMID: 27599256 DOI: 10.1111/ajt.14036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- M Mittelman
- American Living Organ Donor Network, Philadelphia, PA
| | - C Thiessen
- Yale University School of Medicine, New Haven, CT
| | - W J Chon
- University of Arkansas for Medical Sciences, Little Rock, AR
| | - K Clayville
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - D C Cronin
- Medical College of Wisconsin, Milwaukee, WI
| | - J S Fisher
- Scripps Clinic/Green Hospital, La Jolla, CA
| | - S Fry-Revere
- American Living Organ Donor Network, Center for Ethical Solutions, Washington, DC
| | | | - J Hanneman
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - K Ladin
- Tufts University, Boston, MA
| | - H Mysel
- Living Kidney Donor Network, Winnetka, IL
| | - L A Sherman
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - L Willock
- Biomedical Institutional Review Board, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - E J Gordon
- Northwestern University Feinberg School of Medicine, Chicago, IL
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30
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LaPointe Rudow D, Cohen D. Practical Approaches to Mitigating Economic Barriers to Living Kidney Donation for Patients and Programs. CURRENT TRANSPLANTATION REPORTS 2017. [DOI: 10.1007/s40472-017-0135-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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31
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Kulkarni S, Thiessen C, Formica RN, Schilsky M, Mulligan D, D'Aquila R. The Long-Term Follow-up and Support for Living Organ Donors: A Center-Based Initiative Founded on Developing a Community of Living Donors. Am J Transplant 2016; 16:3385-3391. [PMID: 27500361 DOI: 10.1111/ajt.14005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 07/08/2016] [Accepted: 08/04/2016] [Indexed: 01/25/2023]
Abstract
Transplant professionals recognize that the long-term follow-up of living organ donors is a priority, yet there has been no implemented solution to this problem. This critical gap is essential, because the transplant field is now emphasizing living donation as a means to address the organ shortage. We detail our living donor initiative, which sets several priorities we recognize as fundamental to persons who have donated organs at our transplant center. This intervention attempts to mitigate the donor and center factors that are known to contribute to the lack of long-term follow-up. Beyond that, our goals are aimed at providing ongoing engagement, wellness, clinical data accrual, laboratory follow-up, and social support for our living donors, in continuity. Our ultimate goal is to nurture the development of local living donor community networks by providing social engagement for current and past donors, which also serves as a platform for greater population education on the societal importance of living donation. This initiative is based on joint recognition by our transplant team and our hospital leadership that supporting the long-term welfare of living donors is essential to accomplishing the goal of expanding living donor transplantation. The transplant team and hospital missions are aligned, and both contribute resources to the initiative.
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Affiliation(s)
- S Kulkarni
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT.,Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - C Thiessen
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - R N Formica
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT.,Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - M Schilsky
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT.,Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - D Mulligan
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - R D'Aquila
- The Center for Living Organ Donors, Yale-New Haven Hospital, New Haven, CT.,Office of the President, Yale-New Haven Hospital, New Haven, CT
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33
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Stoler A, Kessler JB, Ashkenazi T, Roth AE, Lavee J. Incentivizing Authorization for Deceased Organ Donation With Organ Allocation Priority: The First 5 Years. Am J Transplant 2016; 16:2639-45. [PMID: 27013023 DOI: 10.1111/ajt.13802] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/25/2016] [Accepted: 03/13/2016] [Indexed: 01/25/2023]
Abstract
The allocation system of donor organs for transplantation may affect their scarcity. In 2008, Israel's Parliament passed the Organ Transplantation Law, which grants priority on waiting lists for transplants to candidates who are first-degree relatives of deceased organ donors or who previously registered as organ donors themselves. Several public campaigns have advertised the existence of the law since November 2010. We evaluated the effect of the law using all deceased donation requests made in Israel during the period 1998-2015. We use logistic regression to compare the authorization rates of the donors' next of kin in the periods before (1998-2010) and after (2011-2015) the public was made aware of the law. The authorization rate for donation in the period after awareness was substantially higher (55.1% vs. 45.0%, odds ratio [OR] 1.43, p = 0.0003) and reached an all-time high rate of 60.2% in 2015. This increase was mainly due to an increase in the authorization rate of next of kin of unregistered donors (51.1% vs. 42.2%). We also found that the likelihood of next-of-kin authorization for donation was approximately twice as high when the deceased relative was a registered donor rather than unregistered (89.4% vs. 44.6%, OR 14.27, p < 0.0001). We concluded that the priority law is associated with an increased authorization rate for organ donation.
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Affiliation(s)
- A Stoler
- Department of Economics, DePaul University, Chicago, IL.,Coherent Economics, Highland Park, IL
| | - J B Kessler
- Department of Business Economics and Public Policy, The Wharton School at the University of Pennsylvania, Philadelphia, PA
| | - T Ashkenazi
- Israel National Transplant Center, State Ministry of Health, Tel-Aviv, Israel
| | - A E Roth
- Department of Economics, Stanford University, Stanford, CA
| | - J Lavee
- Heart Transplantation Unit, Department of Cardiac Surgery, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
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34
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Abstract
PURPOSE OF REVIEW The review discusses issues pertinent to fostering professional and public interest in living donor liver transplantation. We discuss practices that we have adopted at our center, issues that have arisen and provide suggestions to expand live donor transplantation. RECENT FINDINGS To bridge the gap between the current supply and demand of deceased donor organs, the transplant program in Toronto established the busiest live donor liver transplant program in the western world. To date, we have performed 664 live liver donor procedures with no donor deaths and excellent recipient and donor outcomes. To foster and grow live donation, we established a strong culture supporting live donation; hired a full-time, dedicated team of individuals to support the live donor program; obtained financial support for donors through a partnership agreement with the Trillium Gift of Life Network; developed linkages with the media, community service groups and the general public; generated patient education materials; and established a website. SUMMARY With the present and future trends of deceased donation worldwide, we anticipate that live liver donation will remain an important option to fully meet the needs of patients requiring liver transplantation for the foreseeable future.
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35
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Rodrigue JR, Schold JD, Mandelbrot DA, Taber DJ, Phan V, Baliga PK. Concern for Lost Income Following Donation Deters Some Patients From Talking to Potential Living Donors. Prog Transplant 2016; 26:292-298. [PMID: 27495327 DOI: 10.1177/1526924816661332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Some living kidney donors report lost income during recovery from surgery. Little is known about whether concern for living donor's lost income affects the decision to undergo donation evaluation and the willingness of transplant candidates to discuss living kidney donation (LKD) with others. OBJECTIVE To examine whether transplant patients were told by potential donors about lost income concerns and whether patients chose not to discuss LKD with others due to lost income concerns. DESIGN, SETTING, AND PATIENTS Kidney transplant patients (185 wait-listed candidates, 171 deceased donor recipients, and 100 live donor recipients) at 2 centers completed a questionnaire to assess whether concern about donor's lost income was a consideration in discussion about LKD with others. RESULTS One-third (32%) were told by a family member/friend that they were willing to donate but were concerned about potential lost income. The majority of those who expressed financial concern (64%) did not initiate donation evaluation. Many patients (42%) chose not to discuss living donation with a family member/friend due to concern about the impact of lost income on the donor. In the multivariable model, lower annual household income was the only statistically significant predictor of both having a potential donor expressing lost income concern and choosing not to talk to someone because of lost income concern. CONCLUSION Findings from the current study underscore how concern about income loss for living donors may affect decision-making by both transplant candidates and potential donors.
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Affiliation(s)
- James R Rodrigue
- 1 Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Jesse D Schold
- 3 Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - David J Taber
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.,6 Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Van Phan
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Prabhakar K Baliga
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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36
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Silencing Porcine CMAH and GGTA1 Genes Significantly Reduces Xenogeneic Consumption of Human Platelets by Porcine Livers. Transplantation 2016; 100:571-6. [PMID: 26906939 DOI: 10.1097/tp.0000000000001071] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A profound thrombocytopenia limits hepatic xenotransplantation in the pig-to-primate model. Porcine livers also have shown the ability to phagocytose human platelets in the absence of immune-mediated injury. Recently, inactivation of the porcine ASGR1 gene has been shown to decrease this phenomenon. Inactivating GGTA1 and CMAH genes has reduced the antibody-mediated barrier to xenotransplantation; herein, we describe the effect that these modifications have on xenogeneic consumption of human platelets in the absence of immune-mediated graft injury. METHODS Wild type (WT), ASGR1, GGTA1, and GGTA1CMAH knockout pigs were compared for their xenogeneic hepatic consumption of human platelets. An in vitro assay was established to measure the association of human platelets with liver sinusoidal endothelial cells (LSECs) by immunohistochemistry. Perfusion models were used to measure human platelet uptake in livers from WT, ASGR1, GGTA1, and GGTA1 CMAH pigs. RESULTS GGTA1, CMAH LSECs exhibited reduced levels of human platelet binding in vitro when compared with GGTA1 and WT LSECs. In a continuous perfusion model, GGTA1 CMAH livers consumed fewer human platelets than GGTA1 and WT livers. GGTA1 CMAH livers also consumed fewer human platelets than ASGR1 livers in a single-pass model. CONCLUSIONS Silencing the porcine carbohydrate genes necessary to avoid antibody-mediated rejection in a pig-to-human model also reduces the xenogeneic consumption of human platelets by the porcine liver. The combination of these genetic modifications may be an effective strategy to limit the thrombocytopenia associated with pig-to-human hepatic xenotransplantation.
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Hays R, Rodrigue JR, Cohen D, Danovitch G, Matas A, Schold J, LaPointe Rudow D. Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies. Am J Transplant 2016; 16:1973-81. [PMID: 27037542 DOI: 10.1111/ajt.13813] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/13/2016] [Accepted: 03/19/2016] [Indexed: 01/25/2023]
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.
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Affiliation(s)
- R Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - J R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - D Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - G Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - A Matas
- Department of Surgery, University of Minnesota Medical Center-Fairview, Minneapolis, MN
| | - J Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - D LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
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Vogiatzi P. Some considerations on the current debate about typing resolution in solid organ transplantation. Transplant Res 2016; 5:3. [PMID: 26958340 PMCID: PMC4782307 DOI: 10.1186/s13737-016-0032-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 01/28/2016] [Indexed: 11/26/2022] Open
Abstract
Background The shortage of suitable organs and achieved tolerance are uncontested main concerns in transplantation. Long waiting lists for deceased donors and limited numbers of living donors are the current scenarios. Kidney grafts from living donors have better overall survival compared to cadaveric and require less aggressive immunosuppressive regimens. The human leukocyte antigen (HLA) labs have the key role to test the recipient and donors compatibility based on typing and antibody profile. The current standard molecular procedure in solid organ transplantation is low-resolution typing, at the antigen level. Main text In this commentary, the merits of high versus low degree of typing resolution in solid organ transplantation are discussed. Critical questions and reasons to bring high-resolution typing as a routine test in health system are considered. Specifically, with the introduction of the next-generation sequencing (NGS) in HLA, the pros and cons in living donation and benefits after deceased donation are critically evaluated. Conclusion NGS has the potential to improve the transplant rates and the overall graft survival. Alternative strategies to increase in demanding the number of transplants are briefly highlighted.
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Affiliation(s)
- Paraskevi Vogiatzi
- Department of Pathology, Tissue Typing Laboratory, University of Michigan, 2900 Huron Parkway, Ann Arbor, MI 48105 USA
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40
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Held PJ, McCormick F, Ojo A, Roberts JP. A Cost-Benefit Analysis of Government Compensation of Kidney Donors. Am J Transplant 2016; 16:877-85. [PMID: 26474298 PMCID: PMC5057320 DOI: 10.1111/ajt.13490] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 08/10/2015] [Accepted: 08/10/2015] [Indexed: 01/25/2023]
Abstract
From 5000 to 10 000 kidney patients die prematurely in the United States each year, and about 100 000 more suffer the debilitating effects of dialysis, because of a shortage of transplant kidneys. To reduce this shortage, many advocate having the government compensate kidney donors. This paper presents a comprehensive cost-benefit analysis of such a change. It considers not only the substantial savings to society because kidney recipients would no longer need expensive dialysis treatments--$1.45 million per kidney recipient--but also estimates the monetary value of the longer and healthier lives that kidney recipients enjoy--about $1.3 million per recipient. These numbers dwarf the proposed $45 000-per-kidney compensation that might be needed to end the kidney shortage and eliminate the kidney transplant waiting list. From the viewpoint of society, the net benefit from saving thousands of lives each year and reducing the suffering of 100 000 more receiving dialysis would be about $46 billion per year, with the benefits exceeding the costs by a factor of 3. In addition, it would save taxpayers about $12 billion each year.
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Affiliation(s)
- P J Held
- Department of Nephrology, Stanford University, Stanford, CA
| | - F McCormick
- U.S. Economic and Financial Research, Bank of America, San Francisco, CA (retired)
| | - A Ojo
- Department of Nephrology, University of Michigan Health Systems, Ann Arbor, MI
| | - J P Roberts
- Department of Surgery, University of California San Francisco Transplant Service, San Francisco, CA
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Rodrigue JR, Schold JD, Morrissey P, Whiting J, Vella J, Kayler LK, Katz D, Jones J, Kaplan B, Fleishman A, Pavlakis M, Mandelbrot DA. Direct and Indirect Costs Following Living Kidney Donation: Findings From the KDOC Study. Am J Transplant 2016; 16:869-76. [PMID: 26845630 DOI: 10.1111/ajt.13591] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/11/2015] [Accepted: 09/23/2015] [Indexed: 01/25/2023]
Abstract
Some living kidney donors (LKDs) incur costs associated with donation, although these costs are not well characterized in the United States. We collected cost data in the 12 mo following donation from 182 LKDs participating in the multicenter prospective Kidney Donor Outcomes Cohort (KDOC) Study. Most LKDs (n = 167, 92%) had one direct cost or more following donation, including ground transportation (86%), health care (41%), meals (53%), medications (36%), lodging (23%), and air transportation (12%). LKDs missed 33 072 total work hours, 40% of which were unpaid and led to $302 175 in lost wages (mean $1660). Caregivers lost $68 655 in wages (mean $377). Although some donors received financial assistance, 89% had a net financial loss in the 12-mo period, with one-third (33%) reporting a loss exceeding $2500. Financial burden was higher for those with greater travel distance to the transplant center (Spearman's ρ = 0.26, p < 0.001), lower household income (Spearman's ρ = -0.25, p < 0.001), and more unpaid work hours missed (Spearman's ρ = 0.52, p < 0.001). Achieving financial neutrality for LKDs must be an immediate priority for the transplant community, governmental agencies, insurance companies, nonprofit organizations, and society at large.
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Affiliation(s)
- J R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - J D Schold
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - P Morrissey
- Transplant Center, Rhode Island Hospital, Providence, RI
| | - J Whiting
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - J Vella
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - L K Kayler
- Montefiore Einstein Center for Transplantation, Bronx, NY.,Regional Center of Excellence for Transplantation and Kidney Care, Erie County Medical Center, University of Buffalo, Buffalo, NY
| | - D Katz
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - J Jones
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - B Kaplan
- Department of Medicine, University of Arizona, Tucson, AZ.,School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ
| | - A Fleishman
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - M Pavlakis
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - D A Mandelbrot
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Medicine, University of Wisconsin, Madison, WI
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Lugo-Baruqui J, Burke GW, Guerra G, Ruiz P, Ciancio G. Ten-Year Follow-up of a Reused Kidney Graft for Transplant Using Sirolimus for Maintenance Immunosuppression. Transplant Proc 2015; 47:3027-30. [PMID: 26707333 DOI: 10.1016/j.transproceed.2015.10.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 10/20/2015] [Indexed: 11/18/2022]
Abstract
Reused kidney grafts have been transplanted with successful outcomes, though not widely performed in the Unites States. We present the case of a reused kidney graft with 10-year follow-up. The first donation was from a patient who died from a cerebrovascular accident and whose organs were used for a simultaneous pancreas and kidney transplant. After 5 years, the patient died and kidney was considered for donation and reuse. The patient had a virtual crossmatch with the first donor and a complement-dependent and flow-dependent crossmatch with the second donor. Long-term immune suppression was kept with a calcineurin-inhibitor-free regimen with sirolimus to prevent further damage from the first recipient. Control kidney biopsy showed steady progression of previous CNI toxicity without further damage. We describe the immunological basis of reused graft, the technical aspects of procurement and transplantation, as well as the use of Mammalian target of rapamycin for maintenance immunosuppression with good long-term results. Reused kidney grafts can be a good source of kidney grafts when adequate selection between donor and recipients is made and immunosuppression protocol is tailored to the preexisting damage to the original graft.
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Affiliation(s)
- J Lugo-Baruqui
- The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida.
| | - G W Burke
- The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida
| | - G Guerra
- The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Medicine, Division of Nephrology, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida
| | - P Ruiz
- Department of Surgery and Pathology, Transplantation Laboratories and Immunopathology, Miller School of Medicine, University of Miami, Miami, Florida
| | - G Ciancio
- The Lillian Jean Kaplan Renal Transplant Center, Department of Surgery, University of Miami School of Medicine, Miami, Florida; Department of Surgery, University of Miami Miller School of Medicine and Miami Transplant Institute at the Jackson Memorial Hospital, Miami, Florida
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Matas AJ, Hays RE. Little effect of state policies on organ donation in the USA. Nat Rev Nephrol 2015; 11:570-2. [DOI: 10.1038/nrneph.2015.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Organ Donation Among Health Care Providers: Is Giving and Receiving Similar? Transplant Proc 2015; 47:1567-71. [DOI: 10.1016/j.transproceed.2015.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 06/16/2015] [Indexed: 12/23/2022]
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Nobel YR, Forde KA, Wood L, Cartiera K, Munoz-Abraham AS, Yoo PS, Abt PL, Goldberg DS. Racial and ethnic disparities in access to and utilization of living donor liver transplants. Liver Transpl 2015; 21:904-13. [PMID: 25865817 DOI: 10.1002/lt.24147] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 04/02/2015] [Accepted: 04/09/2015] [Indexed: 12/15/2022]
Abstract
Living donor liver transplantation (LDLT) is a comparable alternative to deceased donor liver transplantation and can mitigate the risk of dying while waiting for transplant. Although evidence exists of decreased utilization of living donor kidney transplants among racial minorities, little is known about access to LDLT among racial/ethnic minorities. We used Organ Procurement and Transplantation Network/United Network for Organ Sharing data from February 27, 2002 to June 4, 2014 from all adult liver transplant recipients at LDLT-capable transplant centers to evaluate differential utilization of LDLTs based on race/ethnicity. We then used data from 2 major urban transplant centers to analyze donor inquiries and donor rule-outs based on racial/ethnic determination. Nationally, of 35,401 total liver transplant recipients performed at a LDLT-performing transplant center, 2171 (6.1%) received a LDLT. In multivariate generalized estimating equation models, racial/ethnic minorities were significantly less likely to receive LDLTs when compared to white patients. For cholestatic liver disease, the odds ratios of receiving LDLT based on racial/ethnic group for African American, Hispanic, and Asian patients compared to white patients were 0.35 (95% CI, 0.20-0.60), 0.58 (95% CI, 0.34-0.99), and 0.11 (95% CI, 0.02-0.55), respectively. For noncholestatic liver disease, the odds ratios by racial/ethnic group were 0.53 (95% CI, 0.40-0.71), 0.78 (95% CI, 0.64-0.94), and 0.45 (95% CI, 0.33-0.60) respectively. Transplant center-specific data demonstrated that African American patients received fewer per-patient donation inquiries than white patients, whereas fewer African American potential donors were ruled out for obesity. In conclusion, racial/ethnic minorities receive a disproportionately low percentage of LDLTs, due in part to fewer initial inquiries by potential donors. This represents a major inequality in access to a vital health care resource and demands outreach to both patients and potential donors.
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Affiliation(s)
- Yael R Nobel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kimberly A Forde
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
| | - Linda Wood
- Division of Transplantation, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Katarzyna Cartiera
- Department of Surgery, School of Medicine, Yale University, New Haven, CT
| | | | - Peter S Yoo
- Department of Surgery, School of Medicine, Yale University, New Haven, CT
| | - Peter L Abt
- Division of Transplantation, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - David S Goldberg
- Division of Gastroenterology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
- Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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Waterman AD, Morgievich M, Cohen DJ, Butt Z, Chakkera HA, Lindower C, Hays RE, Hiller JM, Lentine KL, Matas AJ, Poggio ED, Rees MA, Rodrigue JR, LaPointe Rudow D. Living Donor Kidney Transplantation: Improving Education Outside of Transplant Centers about Live Donor Transplantation--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1659-69. [PMID: 26116651 DOI: 10.2215/cjn.00950115] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation's Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidence-based public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in access to LDKT. To accomplish these recommendations, the entire community of professionals and organizations serving kidney patients must work collaboratively toward ensuring accurate, comprehensive, and up-to-date LDKT education for all patients, thereby reducing barriers to LDKT access and increasing LDKT rates.
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Affiliation(s)
- Amy D Waterman
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material.
| | - Marie Morgievich
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - David J Cohen
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Zeeshan Butt
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Harini A Chakkera
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Carrie Lindower
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Rebecca E Hays
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Janet M Hiller
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Krista L Lentine
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Arthur J Matas
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Emilio D Poggio
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Michael A Rees
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - James R Rodrigue
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
| | - Dianne LaPointe Rudow
- Due to the number of contributing authors,the affiliations are provided in the Supplemental Material
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Fisher JS, Butt Z, Friedewald J, Fry-Revere S, Hanneman J, Henderson ML, Ladin K, Mysel H, Preczewski L, Sherman LA, Thiessen C, Gordon EJ. Between Scylla and Charybdis: charting an ethical course for research into financial incentives for living kidney donation. Am J Transplant 2015; 15:1180-6. [PMID: 25833728 DOI: 10.1111/ajt.13234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 12/15/2014] [Accepted: 12/25/2015] [Indexed: 01/25/2023]
Abstract
New approaches to address the kidney scarcity in the United States are urgently needed. The greatest potential source of kidneys is from living donors. Proposals to offer financial incentives to increase living kidney donation rates remain highly controversial. Despite repeated calls for a pilot study to assess the impact of financial compensation on living kidney donation rates, many fear that financial incentives will exploit vulnerable individuals and cast the field of transplantation in a negative public light, ultimately reducing donation rates. This paper provides an ethical justification for conducting a pilot study of a federally regulated approach to providing financial incentives to living kidney donors, with the goal of assessing donors' perceptions.
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Affiliation(s)
- J S Fisher
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic/Green Hospital, La Jolla, CA
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