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Kim E, Sung HC, Kaplow K, Bendersky V, Sidoti C, Muzaale AD, Akhtar J, Levan M, Esayed S, Khan A, Mejia C, Al Ammary F. Donor Perceptions and Preferences of Telemedicine and In-Person Visits for Living Kidney Donor Evaluation. Kidney Int Rep 2024; 9:2453-2461. [PMID: 39156145 PMCID: PMC11328557 DOI: 10.1016/j.ekir.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Living kidney donor evaluation is a lengthy and complex process requiring in-person visits. Access to transplant centers, travel costs, lost wages, and dependent care arrangements are barriers to willing donors initiating evaluation. Telemedicine can help streamline and epedite the evaluation process. We aimed to deeply understand donor experiences and preferences using hybrid telemedicine video/in-person visits to ease access to donor evaluation or counseling. Methods We conducted in-depth, semistructured interviews with donors or donor candidates who completed their evaluation through telemedicine/in-person, or in-person only visits at a tertiary transplant center between November 27, 2019 and March 1, 2021. Enrollment continued until data saturation was reached (interviews with 20 participants) when no new information emerged from additional interviews. Transcripts were analyzed using inductive thematic analysis. Results Eight themes were identified as follows: (i) reducing financial and logistical burdens (minimizing travel time and travel-related expenses), (ii) enhancing flexibility with scheduling (less time off work and child or family caregiver arrangements), (iii) importance of a walkthrough and establishing shared understanding, (iv) supporting information with technology and visual aids, (v) key role of the coordinator, (vi) preferred visit by provider role (meeting donor surgeon in-person to create rapport and engaging primary care provider in donor evaluation/follow-up), (vii) comparing modality differences in human connection, and (viii) opportunity for family and support network engagement (allowing loved ones to be involved in telemedicine visits irrespective of geographic locations and pandemic restrictions). Conclusion Telemedicine/in-person hybrid model can make donor evaluation more accessible and convenient. Our findings help inform about determinants that influence the adoption of telemedicine to initiate donor evaluation to motivate willing donors. In addition, our results call for policy and legislation that support telemedicine services for living donor kidney transplantation across states.
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Affiliation(s)
- Ellie Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hannah C. Sung
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katya Kaplow
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Victoria Bendersky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolyn Sidoti
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jasmine Akhtar
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Macey Levan
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Suad Esayed
- Department of Medicine, University of California Irvine, California, USA
| | - Amir Khan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christina Mejia
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fawaz Al Ammary
- Department of Medicine, University of California Irvine, California, USA
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Mallepeddi S, Patel PD, D'Amico C, Thiessen C. Ethical and Policy Issues Arising in Crowdfunding for Solid Organ Transplantation: A Content Analysis of Newspaper Coverage of Recipient and Donor Fundraising Campaigns. Transplant Proc 2024:S0041-1345(24)00333-6. [PMID: 39013745 DOI: 10.1016/j.transproceed.2024.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/24/2024] [Accepted: 03/18/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Solid organ transplantation improves the quality of life for patients but has significant out-of-pocket expenses for donors and recipients in the USA, leading many to utilize crowdfunding for donations to cover expenses. We sought to characterize crowdfunding for transplant patients and to identify ethical and policy issues. METHODS We obtained newspaper articles that described crowdfunding campaigns for organ transplant patients from Nexis-Uni. Using Nvivo, we identified and analyzed article details, patient characteristics, features of campaigns, additional fundraisers, and policy and ethical issues related to crowdfunding. RESULTS Most sources were published between 2015 and 2020. Of 231 patients identified, 43% were thoracic organ recipients and 42% were kidney recipients. GoFundMe was the most popular platform. 78% of patients reported at least one intended use of crowdfunding; medical expenses were the most cited reason. Ten percent of articles described at least one ethical or policy consideration related to crowdfunding for organ transplant. Concerns included violations of federal laws prohibiting donors from receiving "valuable consideration" for an organ, taxation of funds, loss of Medicaid or disability benefits, accountability for fund usage, and crowdfunding requirements for organ waiting list placement. In several cases, transplants were delayed due to crowdfunding concerns. CONCLUSIONS Our findings reveal crowdfunding characteristics and financial barriers present among transplant patients. Furthermore, our study suggests that the ethical and policy implications for crowdfunding in the transplant population are not yet adequately assessed. National regulations and transplant center policies may need to be modified to address issues raised by patient crowdfunding.
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Affiliation(s)
- Suma Mallepeddi
- University of Michigan Hospital, Ann Arbor, MI, New York University Langone Health, New York, NY
| | - Priyanka D Patel
- University of Michigan Hospital, Ann Arbor, MI, New York University Langone Health, New York, NY
| | - Cara D'Amico
- Department of Surgery, University of Wisconsin, Madison, WI
| | - Carrie Thiessen
- Department of Surgery, University of Wisconsin, Madison, WI.
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Smith AR, Mandell RJ, Goodrich NP, Helmuth ME, Wiseman JB, Gifford KA, Fava MA, Ojo AO, Merion RM, Mathur AK. Living Donor Decision-Making and the Complex Interplay of Finances and Other Motivators, Barriers, and Facilitators. Clin Transplant 2024; 38:e15377. [PMID: 38952192 DOI: 10.1111/ctr.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION The decision to become a living donor requires consideration of a complex, interactive array of factors that could be targeted for clinical, policy, and educational interventions. Our objective was to assess how financial barriers interact with motivators, other barriers, and facilitators during this process. METHODS Data were obtained from a public survey assessing motivators, barriers, and facilitators of living donation. We used multivariable logistic regression and consensus k-means clustering to assess interactions between financial concerns and other considerations in the decision-making process. RESULTS Among 1592 respondents, the average age was 43; 74% were female and 14% and 6% identified as Hispanic and Black, respectively. Among employed respondents (72%), 40% indicated that they would not be able to donate without lost wage reimbursement. Stronger agreement with worries about expenses and dependent care challenges was associated with not being able to donate without lost wage reimbursement (OR = 1.2, 95% CI = 1.0-1.3; OR = 1.2, 95% CI = 1.1-1.3, respectively). Four respondent clusters were identified. Cluster 1 had strong motivators and facilitators with minimal barriers. Cluster 2 had barriers related to health concerns, nervousness, and dependent care. Clusters 3 and 4 had financial barriers. Cluster 3 also had anxiety related to surgery and dependent care. CONCLUSIONS Financial barriers interact primarily with health and dependent care concerns when considering living organ donation. Targeted interventions to reduce financial barriers and improve provider communication regarding donation-related risks are needed.
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Affiliation(s)
- Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- Northwestern University, Chicago, Illinois, USA
| | | | | | - Margaret E Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- University of Michigan Ann Arbor, Ann Arbor, Michigan, USA
| | | | | | - Melissa A Fava
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | | | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- University of Michigan Ann Arbor, Ann Arbor, Michigan, USA
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Crenshaw R, Woods C, Koizumi N, Dave HS, Gentili M, Saleem JJ. Understanding Barriers and Facilitators to Living Kidney Donation Within a Sociotechnical Systems Framework. QUALITATIVE HEALTH RESEARCH 2024; 34:691-702. [PMID: 38229412 DOI: 10.1177/10497323231224706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The objective of this study was to investigate factors influencing one's decision to become a live kidney donor under the framework of sociotechnical systems, by expanding the focus to include larger organizational influences and technological considerations. Semi-structured interviews were conducted with live kidney donors who donated through University of Louisville Health, Trager Transplant Center, a mid-scale transplant program, in the years 2017 through 2019. The interview transcripts were analyzed for barriers and facilitators to live kidney donation within a sociotechnical system. The most salient facilitators included: having an informative, caring, and available care team; the absence of any negative external pressure toward donating; donating to a family or friend; and the ability to take extra time off work for recovery. The most recurrent barriers included: short/medium-term (<1 year) negative health impacts because of donation; the need to make minor lifestyle changes (e.g., less alcohol consumption) after donation; and mental health deterioration stemming from the donation process. The sociotechnical systems framework promotes a balanced system comprised of social, technical, and environmental subsystems. Assessing the facilitators and barriers from the sociotechnical system perspective revealed the importance of and opportunities for developing strategies to promote integration of technical subsystem, such as social media apps and interactive AI platforms, with social and environmental subsystems to enable facilitators and reduce barriers effectively.
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Affiliation(s)
- Rachel Crenshaw
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
- Analytics, Planning, Strategy and Improvement, Brigham and Women's Hospital, Boston, MA, USA
| | - Cary Woods
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Hitarth S Dave
- Division of Nephrology & Hypertension, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Monica Gentili
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
| | - Jason J Saleem
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
- Center for Human Systems Engineering, University of Louisville, Louisville, KY, USA
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Yohanna S, Naylor KL, Sontrop JM, Ribic CM, Clase CM, Miller MC, Madan S, Hae R, Ho J, Roushani J, Parfeniuk S, Jansen M, Shavel S, Richter M, Young K, Cowell B, Lambe S, Margetts P, Piercey K, Tandon V, Boylan C, Wang C, McKenzie S, Longo B, Garg AX. Implementation of a One-Day Living Kidney Donor Assessment Clinic to Improve the Efficiency of the Living Kidney Donor Evaluation: Program Report. Can J Kidney Health Dis 2024; 11:20543581241231462. [PMID: 38410167 PMCID: PMC10896046 DOI: 10.1177/20543581241231462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/22/2023] [Indexed: 02/28/2024] Open
Abstract
Purpose of program A key barrier to becoming a living kidney donor is an inefficient evaluation process, requiring more than 30 tests (eg, laboratory and diagnostic tests), questionnaires, and specialist consultations. Donor candidates make several trips to hospitals and clinics, and often spend months waiting for appointments and test results. The median evaluation time for a donor candidate in Ontario, Canada, is nearly 1 year. Longer wait times are associated with poorer outcomes for the kidney transplant recipient and higher health care costs. A shorter, more efficient donor evaluation process may help more patients with kidney failure receive a transplant, including a pre-emptive kidney transplant (ie, avoiding the need for dialysis). In this report, we describe the development of a quality improvement intervention to improve the efficiency, effectiveness, and patient-centeredness of the donor candidate evaluation process. We developed a One-Day Living Kidney Donor Assessment Clinic, a condensed clinic where interested donor candidates complete all testing and consultations within 1 day. Sources of information The One-Day Living Kidney Donor Assessment Clinic was developed after performing a comprehensive review of the literature, receiving feedback from patients who have successfully donated, and meetings with transplant program leadership from St. Joseph's Healthcare Hamilton. A multistakeholder team was formed that included health care staff from nephrology, transplant surgery, radiology, cardiology, social work, nuclear medicine, and patients with the prior lived experience of kidney donation. In the planning stages, the team met regularly to determine the objectives of the clinic, criteria for participation, clinic schedule, patient flow, and clinic metrics. Methods Donor candidates entered the One-Day Clinic if they completed initial laboratory testing and agreed to an expedited process. If additional testing was required, it was completed on a different day. Donor candidates were reviewed by the nephrologist, transplant surgeon, and donor coordinator approximately 2 weeks after the clinic for final approval. The team continues to meet regularly to review donor feedback, discuss challenges, and brainstorm solutions. Key findings The One-Day Clinic was implemented in March 2019, and has now been running for 4 years, making iterative improvements through continuous patient and provider feedback. To date, we have evaluated more than 150 donor candidates in this clinic. Feedback from donors has been uniformly positive (98% of donors stated they were very satisfied with the clinic), with most noting that the clinic was efficient and minimally impacted work and family obligations. Hospital leadership, including the health care professionals from each participating department, continue to show support and collaborate to create a seamless experience for donor candidates attending the One-Day Clinic. Limitations Clinic spots are limited, meaning some interested donor candidates may not be able to enter a One-Day Clinic the same month they come forward. Implications This patient-centered quality improvement intervention is designed to improve the efficiency and experience of the living kidney donor evaluation, result in better outcomes for kidney transplant recipients, and potentially increase living donation. Our next step is to conduct a formal evaluation of the clinic, measuring qualitative feedback from health care professionals working in the clinic and donor candidates attending the clinic, and measuring key process and outcome measures in donor candidates who completed the one-day assessment compared with those who underwent the usual care assessment. This program evaluation will provide reliable, regionally relevant evidence that will inform transplant centers across the country as they consider incorporating a similar one-day assessment model.
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Affiliation(s)
- Seychelle Yohanna
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Kyla L Naylor
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Jessica M Sontrop
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
| | - Christine M Ribic
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Catherine M Clase
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Matthew C Miller
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Sunchit Madan
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Hae
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jasper Ho
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Jian Roushani
- Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | | | | | | | | | - Shahid Lambe
- St. Joseph's Healthcare Hamilton, ON, Canada
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Peter Margetts
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, ON, Canada
| | - Kevin Piercey
- St. Joseph's Healthcare Hamilton, ON, Canada
- Division of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Vikas Tandon
- Division of Cardiology, McMaster University, Hamilton, ON, Canada
| | - Colm Boylan
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Carol Wang
- Department of Medicine, Western University, London, ON, Canada
| | | | - Barb Longo
- Transplant Ambassador Program, Toronto, ON, Canada
| | - Amit X Garg
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada
- Lawson Health Research Institute, London Health Sciences Centre, ON, Canada
- Department of Medicine, Western University, London, ON, Canada
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Carrigan I, Mathur S, Bourgeois N, Dieudé M, Fantus D, Gongal P, Halpin A, Hirji A, Mansell H, Piotrowski C, Sapir-Pichhadze R, Vinson AJ. Updates in Kidney Transplantation From the 2022 Banff-Canadian Society of Transplantation Joint Meeting: Conference Report. Can J Kidney Health Dis 2023; 10:20543581231209185. [PMID: 38020483 PMCID: PMC10644765 DOI: 10.1177/20543581231209185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose of the Conference The 2022 Banff-Canadian Society of Transplantation Meeting in Banff, Alberta, brought together transplant professionals to review new developments across various aspects of solid organ transplantation (SOT) in Canada. Sources of Information Presentations included consensus recommendations from expert-led forums; experiences with new procedures and legislation; reports from public health data repositories; original clinical and laboratory research; and industry updates regarding novel technologies. Speakers referenced articles and reports published in peer-reviewed journals and online, and unpublished data and preliminary findings. Methods All authors attended presentations in-person or virtually. Recordings of select presentations were available for later review. Summaries emphasize concepts indicated by speakers as new and clinically relevant. Key Findings The COVID-19 pandemic disproportionately affected solid organ transplant recipients (SOTRs), who experience worse outcomes of COVID-19 infection than the general population. Vaccinations demonstrate an attenuated immunological response in SOTRs yet provide meaningful protection. Monoclonal antibodies are effective for both passive immunization and treatment of COVID-19 in SOTRs. Infection control protocols have driven the development of virtual methods for clinical research, such as using home blood draws and virtual follow-up to evaluate vaccine efficacy in SOTRs; and patient care delivery, such as employing telerehabilitation post transplant. Access to living kidney donation is limited by various disincentives experienced by potential donors, which may be overcome by more efficient evaluations including a One-Day Living Kidney Donor Assessment Clinic. The International Donation and Transplantation Legislative and Policy Forum provided a means of establishing consensus guidance for organ donation and transplantation (ODT) program policy to standardize delivery across jurisdictions. The implementation of a deemed consent model for organ and tissue donation in Nova Scotia may provide insight as to whether this model indeed improves access to organs. Canada's Indigenous population experiences unique barriers to transplantation, prompting efforts for more inclusive ODT policy-making. The Pan-Canadian ODT Data and Performance Reporting System Project has defined performance quality indicators, of which iTransplant and other point-of-care software solutions may facilitate collection; however, these endeavors ultimately require information technology infrastructure that exceeds the capabilities of the existing Canadian Organ Replacement Register and Canadian Transplant Registry. Pig-to-human xenotransplantation requires genetic modification of pigs and xenoantibody testing in recipients but may yet prove viable. Serum cell-free DNA, urine biomarkers, and genetic markers offer an alternative to routine biopsy for identifying subclinical rejection. Modified perfusion temperatures and perfusion solutions with hydrogen sulfide donor compounds may improve organ preservation. Molecular compatibility tools provide another means of improving SOTR outcomes, and the Genome Canada Transplant Consortium has been examining important considerations of their implementation. Limitations We were unable to capture all presentations and topics at the meeting due to the sizable quantity and variety. Topics ultimately excluded from this summary include those in pathology including Banff Classification updates; those unique to extra-renal SOT; as well as numerous abstract and poster presentations, allied health provider forums, and business meetings. A portion of the material was presented by speakers prior to peer-review or publication. Implications The various conference presentations summarized in this report identify methods by which individual clinicians and provincial ODT programs may improve access, delivery, and quality of SOT care in Canada, while additionally identifying gaps in the literature that investigators are encouraged to pursue.
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Affiliation(s)
- Ian Carrigan
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Sunita Mathur
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | | | - Mélanie Dieudé
- Department of Microbiology, Infectious Diseases, and Immunology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Daniel Fantus
- Centre de Recherche de Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
- Division of Nephrology, Department of Medicine, Centre Hospitalier de l’Université de Montréal, Montréal, QC, Canada
| | - Patricia Gongal
- Canadian Donation and Transplantation Research Program, Alberta Transplant Institute, University of Alberta, Edmonton, AB, Canada
| | - Anne Halpin
- Alberta Precision Laboratories, Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Alim Hirji
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Holly Mansell
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, Canada
| | - Caroline Piotrowski
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Sapir-Pichhadze
- Department of Medicine, Division of Experimental Medicine, McGill University, Montréal, QC, Canada
| | - Amanda J. Vinson
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
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Skaczkowski G, Barrett A, Olver I, Dollman J, Gunn KM. 'It is a life changing experience': The experiences of living kidney donors who live in rural Australia. Aust J Rural Health 2023; 31:866-877. [PMID: 37335838 DOI: 10.1111/ajr.13008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 03/19/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION A growing body of research has examined the physical, psychological, social and financial impacts of living kidney donation. However, little is known about the unique experiences or additional burdens faced by living donors from regional or remote locations. OBJECTIVE To explore the experiences of living kidney donors who live outside metropolitan centres and to determine how support services could be orientated to better meet their unique needs. DESIGN/SETTING/PARTICIPANTS Seventeen living kidney donors participated in semistructured telephone interviews. Qualitative data were analysed using thematic analysis. FINDINGS Eight themes were identified: (1) donor's emotional well-being is influenced by the recipient's outcome, (2) varied levels of access to medical support and other important services in rural areas, (3) travel takes a toll on time, finances and well-being, (4) varied level of financial impact, (5) medical, emotional and social challenges, (6) both lay and health professional support is valued, (7) varied levels of knowledge and experiences accessing information and (8) a worthwhile experience overall. CONCLUSION Despite many challenges, and travel adding to the complexity, rural living kidney donors generally consider it to be a worthwhile experience. The provision of additional emotional, practical and educational support would be welcomed by this group.
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Affiliation(s)
- Gemma Skaczkowski
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Alison Barrett
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - James Dollman
- Alliance for Research in Exercise, Nutrition and Activity, Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Kate M Gunn
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
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Zhang C, Mathur AK. Breaking Barriers and Bridging Gaps: Advancing Diversity, Equity, and Inclusion in Kidney Transplant Care for Black and Hispanic Patients in the United States. Transpl Int 2023; 36:11455. [PMID: 37829616 PMCID: PMC10565005 DOI: 10.3389/ti.2023.11455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
Kidney transplantation offers better mortality and quality of life outcomes to patients with end-stage renal failure compared to dialysis. Specifically, living donor kidney transplantation is the best treatment for end-stage renal disease, since it offers the greatest survival benefit compared to deceased donor kidney transplant or dialysis. However, not all patients from all racial/ethnic backgrounds enjoy these benefits. While black and Hispanic patients bear the predominant disease burden within the United States, they represent less than half of all kidney transplants in the country. Other factors such as cultural barriers that proliferate myths about transplant, financial costs that impede altruistic donation, and even biological predispositions create a complex maze and can also perpetuate care inaccessibility. Therefore, blanket efforts to increase the overall donation pool may not extend access to vulnerable populations, who may require more targeted attention and interventions. This review uses US kidney transplantation data to substantiate accessibility differences amongst racial minorities as well as provides examples of successful institutional and national systemic level changes that have improved transplantation outcomes for all.
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Affiliation(s)
- Chi Zhang
- Mayo Clinic Arizona, Phoenix, AZ, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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Al Ammary F, Muzaale AD, Tantisattamoa E, Hanna RM, Reddy UG, Bunnapradist S, Kalantar-Zadeh K. Changing landscape of living kidney donation and the role of telemedicine. Curr Opin Nephrol Hypertens 2023; 32:81-88. [PMID: 36444666 PMCID: PMC9713599 DOI: 10.1097/mnh.0000000000000848] [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] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW There has been a decline in living kidney donation over the last two decades. Donors from low-income families or racial/ethnic minorities face greater disproportionate geographic, financial, and logistical barriers to completing lengthy and complex evaluations. This has contributed to the decreased proportion of these subgroups. The authors view telemedicine as a potential solution to this problem. RECENT FINDINGS Since the initial decline of donors in 2005, biologically related donors have experienced a lack of growth across race/ethnicity. Conversely, unrelated donors have emerged as the majority of donors in recent years across race/ethnicity, except for unrelated black donors. Disparities in access to living kidney donation persist. Telemedicine using live-video visits can overcome barriers to access transplant centers and facilitate care coordination. In a U.S. survey, nephrologists, surgeons, coordinators, social workers, and psychologists/psychologists across transplant centers are favorably disposed to use telemedicine for donor evaluation/follow-up beyond the coronavirus disease 2019 pandemic. However, with the waning of relaxed telemedicine regulations under the Public Health Emergency, providers perceive payor policy and out-of-state licensing as major factors hindering telemedicine growth prospects. SUMMARY Permanent federal and state policies that support telemedicine services for living kidney donation can enhance access to transplant centers and help overcome barriers to donor evaluation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ramy M. Hanna
- Department of Medicine, University of California Irvine, Orange, California
| | - Uttam G. Reddy
- Department of Medicine, University of California Irvine, Orange, California
| | - Suphamai Bunnapradist
- Department of Medicine, University of California Los Angeles, Los Angeles, California
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10
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Al Ammary F, Motter JD, Sung HC, Lentine KL, Sharfuddin A, Kumar V, Yadav A, Doshi MD, Virmani S, Concepcion BP, Grace T, Sidoti CN, Yahya Jan M, Muzaale AD, Wolf J. Telemedicine services for living kidney donation: A US survey of multidisciplinary providers. Am J Transplant 2022; 22:2041-2051. [PMID: 35575439 PMCID: PMC9543040 DOI: 10.1111/ajt.17093] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 01/25/2023]
Abstract
Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers' practices and providers' attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate = 66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow-up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out-of-state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Hannah C. Sung
- Department of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Asif Sharfuddin
- Department of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Vineeta Kumar
- Department of MedicineUniversity of AlabamaBirminghamAlabamaUSA
| | - Anju Yadav
- Department of MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Mona D. Doshi
- Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Sarthak Virmani
- Department of MedicineYale UniversityNew HavenConnecticutUSA
| | | | - Terry Grace
- Department of MedicineWake Forest Baptist HealthWinston‐SalemNorth CarolinaUSA
| | | | | | | | - Joshua Wolf
- Piedmont Transplant InstituteAtlantaGeorgiaUSA
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11
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Saunders M, Simpson D. “Can i donate a kidney?” Common questions and simplified answers to the prospective kidney donor. J Natl Med Assoc 2022; 114:S56-S61. [DOI: 10.1016/j.jnma.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Asghari M, Nielsen J, Gentili M, Koizumi N, Elmaghraby A. Identifying internet comments related to living kidney donation: A machine-learning classification approach (Preprint). JMIR Med Inform 2022; 10:e37884. [DOI: 10.2196/37884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
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13
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Orandi BJ, Reed RD, Qu H, Owens G, Brooks S, Killian AC, Kumar V, Sheikh SS, Cannon RM, Anderson DJ, Lewis CE, Locke JE. Donor‐reported barriers to living kidney donor follow‐up. Clin Transplant 2022; 36:e14621. [PMID: 35184328 PMCID: PMC9098679 DOI: 10.1111/ctr.14621] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/08/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite regulations mandating follow-up laboratory testing for living kidney donors, less than half of transplant centers are in compliance. We sought to understand barriers to follow-up testing from the donors' perspective. METHODS We surveyed our center's living kidney donors. Binary logistic regression was used to assess factors associated with follow-up testing completion. RESULTS Of 185 living kidney donors, 110 (59.4%) participated. Among them, 82 (74.5%) completed 6-month laboratory testing, 76 (69.1%) completed 12-month testing, 68 (61.8%) completed both, and 21 (19.0%) completed neither. Six-month testing completion was strongly associated with 12-month testing completion (OR 9.74, 95%CI: 2.23-42.50; p = .002). Those who disagreed with the statements, "Getting labs checked wasn't a priority for me," (OR for completing 6-month testing: 15.05, 95%CI: 3.70-61.18; p < .001; OR for completing 12-month testing: 5.85, 95%CI: 1.94-17.63; p = .002); and, "I forgot to get labs drawn [until I was reminded]" (OR for completing 6-month testing: 6.93, 95%CI: 1.59-30.08; p = .01; OR for completing 12-month testing: 6.55, 95%CI: 1.98-21.63; p = .002) were more likely to complete testing. CONCLUSIONS To our knowledge, this is the only study providing perspective on donor insights regarding the need for follow-up testing post donation. Interventions to influence living donor attitudes toward follow-up testing may improve follow-up.
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Affiliation(s)
- Babak J. Orandi
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Rhiannon D. Reed
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Haiyan Qu
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Grace Owens
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Sydney Brooks
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - A. Cozette Killian
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Vineeta Kumar
- University of Alabama at Birmingham Department of Medicine Division of Nephrology Birmingham AL United States
| | - Saulat S. Sheikh
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Robert M. Cannon
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Douglas J. Anderson
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
| | - Cora E. Lewis
- University of Alabama at Birmingham School of Public Health Department of Epidemiology Birmingham AL United States
| | - Jayme E. Locke
- University of Alabama at Birmingham Department of Surgery Division of Transplantation Birmingham AL United States
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14
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Zazoulina J, Khehra K, Gill J. Motivators and Barriers to Living Donor Kidney Transplant as Perceived by Past and Potential Donors. Can J Kidney Health Dis 2022; 9:20543581221137179. [PMID: 36419528 PMCID: PMC9677302 DOI: 10.1177/20543581221137179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background: For patients with end-stage kidney disease, living donor kidney transplant is
the treatment of choice due to improved patient outcomes, longer graft
survival, and reduced expenses compared with other forms of renal
replacement therapy. However, organ shortage remains a challenge, and living
donation rates have stagnated in recent years, particularly among men. Objective: To understand the motivators and barriers for past and potential living
kidney transplant donors and inform policy and practice changes that support
donors in the future. Methods: Past and potential living donors in British Columbia, Canada in the preceding
2 years were surveyed. Motivators and barriers were examined in 5
categories: family pressures and domestic responsibilities, finances, the
recovery process, complications, and the transplant evaluation process.
Participants ranked statements in each category on a Likert-type scale. Results: A total of 138 responses were collected. In both women and men, policies that
address family and domestic responsibilities and finances were most strongly
identified as motivators to donate. A large proportion of women and men
reported that guaranteed job security (47% women and 38% of men), paid time
off (51% of women and 42% of men), reimbursement of lost wages (49% of women
and 38% of men), and protections to guarantee no impact on future
insurability (62% of women and 52% of men) were significant motivators to
donate. Timely and efficient medical evaluation was considered to be an
important motivator for donation, with 52% of men and 43% of women reporting
support for a “fast-track” option for evaluation to allow for a more rapid
evaluation process. Median barrier and motivator scores were similar between
women and men. Conclusion: Policies to decrease financial burden, ensure job security, improve childcare
support, and offer a fast-track medical evaluation may motivate potential
living kidney donors, irrespective of gender.
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Affiliation(s)
| | - Keesha Khehra
- The University of British Columbia, Vancouver, Canada
| | - Jagbir Gill
- The University of British Columbia, Vancouver, Canada
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15
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Husain SA, King KL, Adler JT, Mohan S. Racial disparities in living donor kidney transplantation in the United States. Clin Transplant 2021; 36:e14547. [PMID: 34843124 DOI: 10.1111/ctr.14547] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/18/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
Living donor kidney transplant (LDKT) is the best treatment for end-stage kidney disease, but there are racial disparities in LDKT rates. To study putative mechanisms of these disparities, we identified 58 752 adult kidney transplant candidates first activated on the United States kidney transplant waitlist 2015-2016 and defined four exposure groups by race/primary payer: African American/Medicaid, African American/NonMedicaid, Non-African American/Medicaid, Non-African American/NonMedicaid. We performed competing risk regression to compare risk of LDKT between groups. Among included candidates, 30% had African American race and 9% had Medicaid primary payer. By the end of follow up, 16% underwent LDKT. The cumulative incidence of LDKT was lowest for African American candidates regardless of payer. Compared to African American/Non-Medicaid candidates, the adjusted likelihood of LDKT was higher for both Non-African American/Medicaid (HR 1.60, 95%CI 1.43-1.78) and Non-African American/Non-Medicaid candidates (HR 2.66, 95%CI 2.50-2.83). Results were similar when analyzing only candidates still waitlisted > 2 years after initial activation or candidates with type O blood. Among 9639 candidates who received LDKT, only 13% were African American. Donor-recipient relationships were similar for African American and Non-African American recipients. These findings indicate African American candidates have a lower incidence of LDKT than candidates of other races, regardless of primary payer.
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Affiliation(s)
- S Ali Husain
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.,The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Kristen L King
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.,The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA
| | - Joel T Adler
- Department of Surgery, Division of Transplant Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sumit Mohan
- Department of Medicine, Division of Nephrology, Columbia University Medical Center, New York, New York, USA.,The Columbia University Renal Epidemiology (CURE) Group, New York, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
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16
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Telehealth Use by Living Kidney Donor Transplant Programs During the COVID-19 Pandemic and Beyond: a Practical Approach. CURRENT TRANSPLANTATION REPORTS 2021; 8:257-262. [PMID: 34812402 PMCID: PMC8597544 DOI: 10.1007/s40472-021-00339-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review COVID-19 pandemic led to a decline in living kidney donor evaluations and transplants. This was due to concerns for donor and recipient safety, restrictions on elective cases, and diversion of staff and resources in centers with a higher incidence of COVID-19 infections. Telehealth was explored as a strategy to continue living donor evaluations during the pandemic, but faced barriers including restrictive physician licensing, reduced reimbursement, lack of infrastructure, prohibitive local policies, limited exam, and personal biases. This review highlights these barriers and potential solutions. Recent Findings Telehealth usage in the transplant population improves medication adherence, reduces hospitalization rates for recipients, and makes living donor evaluation convenient. Transplant centers have implemented telehealth successfully for living kidney donor evaluations. Broad use of telemedicine will be possible only if policies support the changing landscape of healthcare delivery. Summary Telehealth may increase access to timely kidney transplants by expediting living kidney donor evaluations. However, supportive infrastructure, regulatory policies, and reimbursement are needed to sustain access to telehealth for living kidney donor evaluation and care.
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17
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Al Ammary F, Concepcion BP, Yadav A. The Scope of Telemedicine in Kidney Transplantation: Access and Outreach Services. Adv Chronic Kidney Dis 2021; 28:542-547. [PMID: 35367022 DOI: 10.1053/j.ackd.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 12/23/2022]
Abstract
Access to transplant centers is a key barrier for kidney transplant evaluation and follow-up care for both the recipient and donor. Potential kidney transplant recipients and living kidney donors may face geographic, financial, and logistical challenges in engaging with a transplant center and maintaining post-transplant continuity of care. Telemedicine via synchronous video visits has the potential to overcome the access barrier to transplant centers. Transplant centers can start the evaluation process for potential recipients and donors via telemedicine, especially for those who have challenges to come for an in-person visit or when there are restrictions on clinic capacities, such as during a pandemic. Similarly, transplant centers can use telemedicine to sustain post-transplant follow-up care while avoiding the burden of travel and its associated costs. However, expansion to telemedicine-based kidney transplant services is substantially dependent on telemedicine infrastructure, insurer policy, and state regulations. In this review, we discuss the practice of telemedicine in kidney transplantation and its implications for expanding access to kidney transplant services and outreach from pretransplant evaluation to post-transplant follow-up care for the recipient and donor.
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18
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Park S, Park J, Kang E, Lee JW, Kim Y, Park M, Kim K, Kim HJ, Han M, Cho JH, Lee JP, Lee S, Kim SW, Park SM, Chae DW, Chin HJ, Kim YC, Kim YS, Choi I, Lee H. Economic Impact of Donating a Kidney on Living Donors: A Korean Cohort Study. Am J Kidney Dis 2021; 79:175-184.e1. [PMID: 34419516 DOI: 10.1053/j.ajkd.2021.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/04/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Although existing studies have reported adverse health outcomes after kidney donation, its socioeconomic impact on living donors requires further study. STUDY DESIGN A retrospective observational cohort study including a matched comparison group. SETTING & PARTICIPANTS 1,285 living kidney donors from 7 tertiary hospitals between 2003 and 2016, and a matched comparison group consisting of the same number of health screening examinees with similar baseline clinical characteristics and socioeconomic status. All participants were receiving Korean national health insurance. EXPOSURE Kidney donation as reflected in the Korean National Health Insurance System (NHIS) database. OUTCOME Changes in household economic status estimated by Korean national health insurance fees and changes in employment status reflected in the NHIS database. ANALYTICAL APPROACH The outcomes of the donor group and matched control group were compared annually using multivariable logistic regression analyses adjusted for clinical and demographic characteristics. RESULTS The median ages of the donors and matched controls were 45 and 46 years, respectively; 44.6% of both groups were male. Compared to the comparison group, living donors were at higher risk of being unemployed or losing employment during the first 2 years after donation (eg, first-year loss of employment: odds ratio (OR), 2.27 [95% CI, 1.55-3.33]); however, this association did not persist. Donors also had a significantly lower odds of improvement in economic status (OR, 0.57 [95% CI, 0.47-0.71]) and a higher odds of deterioration in financial status (OR, 1.54 [95% CI, 1.23-1.93]) in the first year after transplantation and subsequently. LIMITATIONS Unmeasured differences between donors and matched controls creating residual selection bias and confounding. CONCLUSIONS Living kidney donors may suffer loss of employment and poor economic status after their voluntary donation. The socioeconomic impact on these donors should be considered in conjunction with the potential long-term adverse health outcomes after donation.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jina Park
- Department of Biostatistics, College of Medicine, Korea University, Seoul, South Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jang Wook Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Yaerim Kim
- Department of Internal Medicine, School of Medicine, Keimyung University, Daegu, South Korea
| | - Minsu Park
- Department of Information and Statistics, Chungnam National University, Daejeon, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University, Seoul, South Korea
| | - Hyo Jeong Kim
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Miyeun Han
- Department of Internal Medicine, Pusan National University Hospital, Pusan, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University, Daegu, South Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Boramae Medical Center, Seoul National University, Seoul, South Korea
| | - Sik Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, South Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Sang Min Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ho Jun Chin
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong Chul Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Insun Choi
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Hajeong Lee
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea.
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19
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Filler G, de Ferris MEDG, Elliott L. Marginal parent donors-Process and ethics. Pediatr Transplant 2021; 25:e14062. [PMID: 34076958 DOI: 10.1111/petr.14062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 12/24/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Pre-emptive kidney transplantation for end-stage kidney disease in children has many advantages and may lead to the consideration of marginal parent donors. METHODS Using the example of the transplant of a kidney with medullary sponge disease from a parent to the child, we review the ethical framework for working up such donors. RESULTS The four principles of health ethics include autonomy (the right of the patient to retain control over his/her own body); beneficence (healthcare providers must do all they can do to benefit the patient in each situation); non-maleficence ("first do no harm"-providers must consider whether other people or society could be harmed by a decision made, even if it is made for the benefit of an individual patient) and justice (there should be an element of fairness in all medical decisions). Highly motivated donors may derive significant psychological benefit from their donation and may thus be willing to incur more risk. The transplantation team and, ideally, an independent donor advocate team must make a judgment about the acceptability of the risk-benefit ratio for particular potential donors, who must also make their own assessment. The transplantation team and donor advocate team must be comfortable with the risk-benefit ratio before proceeding. CONCLUSIONS An independent donor advocacy team that focuses on the donor needs is needed with sufficient multidisciplinary ethical, social, and psychological expertise. The decision to accept or reject the donor should be within the authority of the independent donor advocacy team and not the providers or the donor.
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Affiliation(s)
- Guido Filler
- Departments of Paediatrics and Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.,The Lilibeth Caberto Kidney Clinical Research Unit, Western University, London, ON, Canada.,Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | | | - Launa Elliott
- Department of Ethics, London Health Sciences Centre, London, ON, Canada
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20
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Abstract
BACKGROUND Living kidney donors incur donation-related expenses, but how these expenses impact postdonation mental health is unknown. METHODS In this prospective cohort study, the association between mental health and donor-incurred expenses (both out-of-pocket costs and lost wages) was examined in 821 people who donated a kidney at one of the 12 transplant centers in Canada between 2009 and 2014. Mental health was measured by the RAND Short Form-36 Health Survey along with Beck Anxiety Inventory and Beck Depression Inventory. RESULTS A total of 209 donors (25%) reported expenses of >5500 Canadian dollars. Compared with donors who incurred lower expenses, those who incurred higher expenses demonstrated significantly worse mental health-related quality of life 3 months after donation, with a trend towards worse anxiety and depression, after controlling for predonation mental health-related quality of life and other risk factors for psychological distress. Between-group differences for donors with lower and higher expenses on these measures were no longer significant 12 months after donation. CONCLUSIONS Living kidney donor transplant programs should ensure that adequate psychosocial support is available to all donors who need it, based on known and unknown risk factors. Efforts to minimize donor-incurred expenses and to better support the mental well-being of donors need to continue. Further research is needed to investigate the effect of donor reimbursement programs, which mitigate donor expenses, on postdonation mental health.
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21
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Ross LF, Thistlethwaite JR. Gender and race/ethnicity differences in living kidney donor demographics: Preference or disparity? Transplant Rev (Orlando) 2021; 35:100614. [PMID: 33857733 PMCID: PMC8627424 DOI: 10.1016/j.trre.2021.100614] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 11/25/2022]
Abstract
In the United States, women are over-represented and Blacks are under-represented as living kidney donors. A traditional bioethics approach would state that as long as living donors believe that the benefits of participation outweigh the risks and harms (beneficence) and they give a voluntary and informed consent, then the demographics reflect a mere difference in preferences. Such an analysis, however, ignores the social, economic and cultural determinants as well as various forms of structural discrimination (e.g., racism, sexism) that may imply that the distribution is less voluntary than may appear initially. The distribution also raises justice concerns regarding the fair recruitment and selection of living donors. We examine the differences in living kidney donor demographics using a vulnerabilities analysis and argue that these gender and racial differences may not reflect mere preferences, but rather, serious justice concerns that need to be addressed at both the individual and systems level.
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Affiliation(s)
- Lainie Friedman Ross
- Carolyn and Matthew Bucksbaum Professor of Clinical Ethics, Professor of Pediatrics, Medicine, Surgery and the College, Associate Director of the MacLean Center for Clinical Medical Ethics, Co-Director of the Institute for Translational Medicine, University of Chicago, United States of America.
| | - J Richard Thistlethwaite
- Professor Emeritus of Surgery, Section on Transplantation Surgery, Faculty Emeritus of the MacLean Center for Clinical Medical Ethics, University of Chicago, United States of America
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22
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Fu R, Sekercioglu N, Hishida M, Coyte PC. Economic Consequences of Adult Living Kidney Donation: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:592-601. [PMID: 33840438 DOI: 10.1016/j.jval.2020.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/16/2020] [Accepted: 10/03/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Current guidelines mandate organ donation to be financially neutral such that it neither rewards nor exploits donors. This systematic review was conducted to assess the magnitude and type of costs incurred by adult living kidney donors and to identify those at risk of financial hardship. METHODS We searched English-language journal articles and working papers assessing direct and indirect costs incurred by donors on PubMed, MEDLINE, Scopus, the National Institute for Health Research Economic Evaluation Database, Research Papers in Economics, and EconLit in 2005 and thereafter. Estimates of total costs, types of costs, and characteristics of donors who incurred the financial burden were extracted. RESULTS Sixteen studies were identified involving 6158 donors. Average donor-borne costs ranged from US$900 to US$19 900 (2019 values) over the period from predonation evaluation to the end of the first postoperative year. Less than half of donors sought financial assistance and 80% had financial loss. Out-of-pocket payments for travel and health services were the most reported items where lost income accounted for the largest proportion (23.2%-83.7%) of total costs. New indirect cost items were identified to be insurance difficulty, exercise impairment, and caregiver income loss. Donors from lower-income households and those who traveled long distances reported the greatest financial hardship. CONCLUSIONS Most kidney donors are undercompensated. Our findings highlight gaps in donor compensation for predonation evaluation, long-distance donations, and lifetime insurance protection. Additional studies outside of North America are needed to gain a global prospective on how to provide for financial neutrality for kidney donors.
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Affiliation(s)
- Rui Fu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Nigar Sekercioglu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Manabu Hishida
- Department of Nephrology, Nagoya University Graduate School of Medicine, Ibaraki, Japan
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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23
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Psychological and Socioeconomic Outcomes Among Directed and Non-directed Living Kidney Donors. CURRENT TRANSPLANTATION REPORTS 2021. [DOI: 10.1007/s40472-021-00314-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Rota-Musoll L, Brigidi S, Molina-Robles E, Oriol-Vila E, Perez-Oller L, Subirana-Casacuberta M. An intersectional gender analysis in kidney transplantation: women who donate a kidney. BMC Nephrol 2021; 22:59. [PMID: 33593306 PMCID: PMC7885450 DOI: 10.1186/s12882-021-02262-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/12/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Living-donor transplantation is the best treatment option in patients with chronic kidney failure. Global data show that women are less likely to be kidney recipients than men but are more likely to become living kidney donors. We explored the experience of women who donate a kidney to relatives with biological and socio-cultural ties and to understand the similarities and differences in their experience. METHODS A qualitative hermeneutic phenomenological study with an intersectional analysis of gender. Ten women donors accepted in the transplant evaluation period participated, all of whom donated a kidney to a pre-dialysis relative. Two categories were included: women with biological kinship ties (mothers, sisters) and women who have a socio-cultural relationship (wives) with kidney recipient. The data were collected through semi-structured in-depth interviews and analysed using thematic analysis. RESULTS Women donate their kidneys in a convinced manner, without worrying about their health, with an optimistic and positive attitude, and without believing that they are acting heroically. Women with biological kinship ties see it as a 'naturalization thing'. In contrast, wives donate conditioned by gender roles, but also as a form of empowerment and as a personal benefit: they donate in order to avoid taking on carer role for their husband and as a way of protecting their children. CONCLUSION The study's findings expand the conception of kidney donation as solely altruistic and may help professionals to pay attention to the complexity and intersectionality of features present in women who are living kidney donors.
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Affiliation(s)
- Laura Rota-Musoll
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Serena Brigidi
- Department of Anthropology, Philosophy and Social Work in the University of Rovira i Virgili (URV), Tarragona, Catalunya, Spain.
| | - Esmeralda Molina-Robles
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Ester Oriol-Vila
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | | | - Mireia Subirana-Casacuberta
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
- Department of Nursing Management, Parc Taulí Health Corporation Consortium, Sabadell, Catalunya, Spain
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Tomer N, Small A, Mirza O, Palese M. Evidence of Resilience in Kidney Donors: A New York Statewide Cohort Analysis. Transplant Proc 2021; 53:803-807. [PMID: 33551185 DOI: 10.1016/j.transproceed.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Donor nephrectomy (DN) is a procedure performed to provide recipients with a kidney to treat end-stage renal disease. The following analysis evaluated depression diagnosis in DN patients compared to controls. METHODS DN patients and matched controls were identified between 2000 and 2009 from the Statewide Planning and Research Cooperative System database. Cohorts were tracked for depression incidence. Multivariable logistic regression was used to determine independent predictors of a postoperative depression diagnosis. RESULTS The total study cohort included 2108 DN cases and 2108 controls. In both donors and controls, the baseline rate of depression was 0.95% (n = 20). The 5-year incidence of depression diagnosis after exposure increased in both cohorts (donors: 2.5%, n = 53; controls: 7.2%, n = 152; P < .001). The 5-year relative risk for developing depression was 2.65 (CI 1.59-4.42, P = .0002) in donors and 7.60 (CI 4.79-12.07, P < .001) in controls. On multivariable regression, being a donor was associated with reduced risk of developing postoperative depression (OR = 0.322, CI 0.233-0.445, P < .001), and the greatest risk factor for postoperative depression was a prior depressive diagnosis (OR = 7.811, CI 3.814-15.997, P < .001). CONCLUSION Our analysis shows that the strongest risk factor for depression was a prior diagnosis of depression. However, willingness to undergo donor nephrectomy is associated with less subsequent depression than the control population, suggesting that kidney donors may be a more resilient cohort.
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Affiliation(s)
- Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Small
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Omar Mirza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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26
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Menjivar A, Torres X, Manyalich M, Fehrman-Ekholm I, Papachristou C, de Sousa-Amorim E, Paredes D, Hiesse C, Yucetin L, Oppenheimer F, Kondi E, Peri JM, Kvarnström N, Ballesté C, Dias L, Frade IC, Lopes A, Diekmann F, Revuelta I. Psychosocial risk factors for impaired health-related quality of life in living kidney donors: results from the ELIPSY prospective study. Sci Rep 2020; 10:21343. [PMID: 33288792 PMCID: PMC7721886 DOI: 10.1038/s41598-020-78032-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Living kidney donors' follow-up is usually focused on the assessment of the surgical and medical outcomes. Whilst the psychosocial follow-up is advocated in literature. It is still not entirely clear which exact psychosocial factors are related to a poor psychosocial outcome of donors. The aim of our study is to prospectively assess the donors' psychosocial risks factors to impaired health-related quality of life at 1-year post-donation and link their psychosocial profile before donation with their respective outcomes. The influence of the recipient's medical outcomes on their donor's psychosocial outcome was also examined. Sixty donors completed a battery of standardized psychometric instruments (quality of life, mental health, coping strategies, personality, socio-economic status), and ad hoc items regarding the donation process (e.g., motivations for donation, decision-making, risk assessment, and donor-recipient relationship). Donors' 1-year psychosocial follow-up was favorable and comparable with the general population. So far, cluster-analysis identified a subgroup of donors (28%) with a post-donation reduction of their health-related quality of life. This subgroup expressed comparatively to the rest, the need for more pre-donation information regarding surgery risks, and elevated fear of losing the recipient and commitment to stop their suffering.
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Affiliation(s)
- Ana Menjivar
- Medical School, University of Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Torres
- Psychiatry and Clinical Psychology Service, Institut Clinic de Neurociencies, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marti Manyalich
- Medical School, University of Barcelona, Barcelona, Spain.,Transplant Assessorial Unit, Medical Direction, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ingela Fehrman-Ekholm
- Karolinska Institutet, Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Papachristou
- Department for Internal Medicine and Psychosomatics, Charité, University Medicine, Berlin, Germany.,School of Psychology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Erika de Sousa-Amorim
- Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - David Paredes
- Medical School, University of Barcelona, Barcelona, Spain.,Donation and Transplant Coordination Section, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Christian Hiesse
- Service de Néphrologie et de Transplantation Rénale, Hôpital Foch, Suresnes Cedex, France
| | - Levent Yucetin
- Organ Transplant Coordination, Antalya Medical Park Hospital, Antalya, Turkey
| | - Federico Oppenheimer
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Entela Kondi
- Medical School, University of Barcelona, Barcelona, Spain.,Transplant Assessorial Unit, Medical Direction, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Josep Maria Peri
- Psychiatry and Clinical Psychology Service, Institut Clinic de Neurociencies, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Niclas Kvarnström
- Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chloë Ballesté
- Medical School, University of Barcelona, Barcelona, Spain
| | - Leonidio Dias
- Nephrology and Transplant Departments, Hospital Geral de Santo António, Porto, Portugal
| | - Inês C Frade
- Liaison-Psychiatry and Health Psychology Unit, Hospital Geral de Santo António, Porto, Portugal
| | - Alice Lopes
- Liaison-Psychiatry and Health Psychology Unit, Hospital Geral de Santo António, Porto, Portugal
| | - Fritz Diekmann
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ignacio Revuelta
- Medical School, University of Barcelona, Barcelona, Spain. .,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain.
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27
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Habbous S, Barnieh L, Klarenbach S, Manns B, Sarma S, Begen MA, Litchfield K, Lentine KL, Singh S, Garg AX. Evaluating multiple living kidney donor candidates simultaneously is more cost-effective than sequentially. Kidney Int 2020; 98:1578-1588. [DOI: 10.1016/j.kint.2020.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/13/2020] [Accepted: 06/04/2020] [Indexed: 01/11/2023]
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28
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Lee SS, Sielski MW, Charpentier KP. Association Between the Economic Environment and the Living Organ Donation Rate: Evidence and Implications. J Am Coll Surg 2020; 232:187-194.e5. [PMID: 33197569 DOI: 10.1016/j.jamcollsurg.2020.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We studied the contribution of the economic environment to an individual's decision to donate an organ by examining the relationship between the unemployment rate and the living donation rate. STUDY DESIGN We obtained living organ donation data from the Organ Procurement and Transplant Network (OPTN) containing 134,138 organ donation events from 1990 through 2016. We obtained monthly unemployment rates from the Bureau of Labor Statistics (BLS) from 1990 through 2016, and obtained quarterly real gross domestic product (real GDP) by state from the Bureau of Economic Analysis (BEA) from 2005 through 2016. We conducted graphical and statistical analysis with regression modeling using state and time fixed effects. RESULTS Descriptive graphical plots suggest that unlike the unemployment rate, the donation rate is non-cyclical over time, implying little association between the two factors. This is conferred by a linear regression model using state and calendar month fixed effects, where we found no significant association between the unemployment and donation rates (95% CI [-0.004, 0.008], interpreted as the change in number of donations per 100,000 people associated with 1% change in the unemployment rate). We also did not find any significant association between the real GDP and the donation rates. Subgroup analysis by sex, race, and age also revealed no significant associations. CONCLUSIONS The unemployment rate and the real GDP do not appear to be associated with the living organ donation rate, suggesting that the economic environment may not play a major role in the decision to donate an organ.
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Affiliation(s)
- Sean S Lee
- Warren Alpert Medical School, Brown University, Providence, RI
| | - Michael W Sielski
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Wharton School of Business, University of Pennsylvania, Philadelphia, PA
| | - Kevin P Charpentier
- Department of Surgery, Rhode Island Hospital Providence, RI; Department of Signature Healthcare, Brockton, MA.
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Abstract
PURPOSE OF REVIEW Although the first successful kidney transplantation 65 years ago was performed with a living donor kidney, the number of living donor kidney transplantations has increased especially during the last 2 decades. The enlargement of living donor programs was made possible by new modes of living donation and by expansion of the living donor pool. At the same time, the long-term risks of kidney donation have been better delineated. In this review, the latest developments on these topics are summarized. RECENT FINDINGS While the results of ABO-incompatible living kidney transplantation are superior to those of deceased donor transplantation, recent meta-analyses show a reduced patient and graft survival as compared with ABO compatible transplantation as well as increased risk of severe infection and bleeding. Kidney paired donation programs can be extended by including compatible couples and by advanced donation, although the latter raises ethical concerns. Living donors appear to have a higher risk of end-stage renal disease and this is especially true for obese donors and probably also for black donors with an APOL1 high-risk genotype. The importance of psychosocial outcomes after living kidney donation is increasingly recognized. SUMMARY Living donor kidney transplantation remains the optimal treatment option for patients with end-stage renal disease. To increase the donor pool, a well developed paired kidney donation program and sufficient reimbursement of costs associated with donation are essential ingredients. Other ways of expanding the donor pool, such as ABO-incompatible transplantation, use of higher risk donors, providing donors with financial incentives and advanced donation are associated with medical, ethical and logistical complications. There should be a careful selection and follow-up of living kidney donors with attention for medical consequences as well as for psychosocial outcomes.
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30
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Emamaullee J, Tenorio L, Khan S, Butler C, Kim S, Tucker‐Seeley R, Kwon Y, Shapiro J, Saigal S, Sher L, Genyk Y. Living donor financial assistance programs in liver transplantation: The global perspective. Clin Transplant 2020; 34:e14073. [DOI: 10.1111/ctr.14073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/23/2020] [Accepted: 08/22/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Juliet Emamaullee
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Lisa Tenorio
- School of Medicine St. Louis University St. Louis MissouriUSA
| | - Sara Khan
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Chante Butler
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Susan Kim
- University of Southern California Transplant Institute Los Angeles CaliforniaUSA
| | | | - Yong Kwon
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - James Shapiro
- Department of Surgery University of Alberta Edmonton Alberta Canada
| | | | - Linda Sher
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
| | - Yuri Genyk
- Division of Hepatobiliary and Abdominal Organ Transplant Surgery University of Southern California Los Angeles CaliforniaUSA
- Keck School of Medicine University of Southern California Los Angeles CaliforniaUSA
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31
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Rota-Musoll L, Subirana-Casacuberta M, Oriol-Vila E, Homs-Del Valle M, Molina-Robles E, Brigidi S. The experience of donating and receiving a kidney: A systematic review of qualitative studies. J Ren Care 2020; 46:169-184. [PMID: 31868304 DOI: 10.1111/jorc.12309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The experiences described by people who have undergone kidney transplant are complex. Understanding how donors and recipients experience kidney transplantation can help us to design strategies that provide a more person-centred health care. OBJECTIVES To review articles that report the experiences of donors and recipients in the living-donor kidney transplantation process. METHOD A systematic review of qualitative studies was carried out. PubMed, Scopus, Web of Science, CINAHL and PsycINFO databases were used to search for articles published in English, French and Spanish between 2005 and 2018. RESULTS Twenty-nine articles were included in this review. For recipients, receiving a kidney is a positive experience (positive feelings and significant experience) that also involves certain difficulties and stressors (making a difficult decision, fears and worries). The experience of the donors is positive as they are motivated to improve the life of the recipient. They are committed to donating and use coping strategies as well as experiencing personal growth. On the contrary, being a donor involves certain difficulties and stressors (personal investment, mental, physical and economic impact and overcoming opposition) and a perception of deficiency in the health system (lack of information and attentiveness). CONCLUSION Donating and receiving a kidney is a positive experience that involves certain difficulties and a variety of stressors for both the donors and recipients. Moreover, the donors note deficiencies in the health system.
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Affiliation(s)
- Laura Rota-Musoll
- Consorci Hospitalari de Vic, Nephrology, Vic, Barcelona, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Mireia Subirana-Casacuberta
- Department of Nursing Management, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Ester Oriol-Vila
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
| | | | - Esmeralda Molina-Robles
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Serena Brigidi
- Faculty of Health Science and Welfare, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
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Lam NN, Dipchand C, Fortin MC, Foster BJ, Ghanekar A, Houde I, Kiberd B, Klarenbach S, Knoll GA, Landsberg D, Luke PP, Mainra R, Singh SK, Storsley L, Gill J. Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Can J Kidney Health Dis 2020; 7:2054358120918457. [PMID: 32577294 PMCID: PMC7288834 DOI: 10.1177/2054358120918457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose of review: To review an international guideline on the evaluation and care of living
kidney donors and provide a commentary on the applicability of the
recommendations to the Canadian donor population. Sources of information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO)
Clinical Practice Guideline on the Evaluation and Care of Living Kidney
Donors and compared this guideline to the Canadian 2014 Kidney Paired
Donation (KPD) Protocol for Participating Donors. Methods: A working group was formed consisting of members from the Canadian Society of
Transplantation and the Canadian Society of Nephrology. Members were
selected to have representation from across Canada and in various
subspecialties related to living kidney donation, including nephrology,
surgery, transplantation, pediatrics, and ethics. Key findings: Many of the KDIGO Guideline recommendations align with the KPD Protocol
recommendations. Canadian researchers have contributed to much of the
evidence on donor evaluation and outcomes used to support the KDIGO
Guideline recommendations. Limitations: Certain outcomes and risk assessment tools have yet to be validated in the
Canadian donor population. Implications: Living kidney donors should be counseled on the risks of postdonation
outcomes given recent evidence, understanding the limitations of the
literature with respect to its generalizability to the Canadian donor
population.
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Affiliation(s)
- Ngan N Lam
- Division of Nephrology, University of Calgary, AB, Canada
| | | | | | - Bethany J Foster
- Division of Pediatric Nephrology, McGill University, Montréal, QC, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, ON, Canada
| | - Isabelle Houde
- Division of Nephrology, Centre Hospitalier de l'Université de Québec, Québec City, Canada
| | - Bryce Kiberd
- Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | | | - Greg A Knoll
- Division of Nephrology, University of Ottawa, ON, Canada
| | - David Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Patrick P Luke
- Division of Urology, Western University, London, ON, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, Canada
| | - Sunita K Singh
- Division of Nephrology, University of Toronto, ON, Canada
| | - Leroy Storsley
- Section of Nephrology, University of Manitoba, Winnipeg, Canada
| | - Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada
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33
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The need for a living donor wellness program. Curr Opin Organ Transplant 2020; 25:311-315. [PMID: 32487890 DOI: 10.1097/mot.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Living donation has a tremendous impact in bridging the gap between the shortage of organs and the growing list of transplant candidates but remains underutilized as a percentage of total transplants performed. This review focuses on obesity and social determinants of health as potential barriers to the expansion of living kidney donation. RECENT FINDINGS The growing rate of obesity and associated metabolic syndrome make many potential donors unacceptable as donor candidates because of the future risk for developing chronic health conditions, such as hypertension and diabetes. There is also increasing evidence demonstrating socioeconomic differences and racial disparities potentially limit access to living donation in certain populations. These potentially modifiable factors are not exclusive of each other and together serve as significant contributing factors to lower rates of living donation. SUMMARY Living donors make sacrifices to provide the gift of life to transplant recipients, despite the potential risks to their own health. Studies describing risk factors to living donation call attention to the overall need for more action to prioritize and promote the health and well being of living donors.
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Mathur AK, Hong BA, Goodrich NP, Xing J, Warren PH, Gifford KA, Merion RM, Ojo AO. Satisfaction with life and depressive symptoms in living organ donors and non‐donors: New insights from the National Living Donor Assistance Center. Clin Transplant 2020; 34:e13838. [DOI: 10.1111/ctr.13838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Amit K. Mathur
- Transplant Surgery Mayo Clinic Phoenix AZ USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Phoenix Phoenix AZ USA
| | - Barry A. Hong
- Psychiatric Washington University School of Medicine St. Louis MO USA
| | | | - Jiawei Xing
- Arbor Research Collaborative for Health Ann Arbor MI USA
| | | | | | | | - Akinlolu O. Ojo
- Medical School Administration, University of Kansas School of Medicine Kansas KS USA
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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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Barnieh L, Klarenbach S, Arnold J, Cuerden M, Knoll G, Lok C, Sontrop JM, Miller M, Ramesh Prasad GV, Przech S, Garg AX. Nonreimbursed Costs Incurred by Living Kidney Donors: A Case Study From Ontario, Canada. Transplantation 2019; 103:e164-e171. [PMID: 31246933 DOI: 10.1097/tp.0000000000002685] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Living donors may incur out-of-pocket costs during the donation process. While many jurisdictions have programs to reimburse living kidney donors for expenses, few programs have been evaluated. METHODS The Program for Reimbursing Expenses of Living Organ Donors was launched in the province of Ontario, Canada in 2008 and reimburses travel, parking, accommodation, meals, and loss of income; each category has a limit and the maximum total reimbursement is $5500 CAD. We conducted a case study to compare donors' incurred costs (out-of-pocket and lost income) with amounts reimbursed by Program for Reimbursing Expenses of Living Organ Donors. Donors with complete or partial cost data from a large prospective cohort study were linked to Ontario's reimbursement program to determine the gap between incurred and reimbursed costs (n = 159). RESULTS The mean gap between costs incurred and costs reimbursed to the donors was $1313 CAD for out-of-pocket costs and $1802 CAD for lost income, representing a mean reimbursement gap of $3115 CAD. Nondirected donors had the highest mean loss for out-of-pocket costs ($2691 CAD) and kidney paired donors had the highest mean loss for lost income ($4084 CAD). There were no significant differences in the mean gap across exploratory subgroups. CONCLUSIONS Reimbursement programs minimize some of the financial loss for living kidney donors. Opportunities remain to remove the financial burden of living kidney donors.
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Affiliation(s)
- Lianne Barnieh
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jennifer Arnold
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Meaghan Cuerden
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Greg Knoll
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Charmaine Lok
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jessica M Sontrop
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Matthew Miller
- Division of Nephrology and Transplantation, McMaster University, Hamilton, ON, Canada
| | | | - Sebastian Przech
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
| | - Amit X Garg
- Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada
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Lo AL, Sonnenberg EM, Abt PL. Evolving swaps in transplantation: global exchange, vouchers, liver, and trans-organ paired exchange. Curr Opin Organ Transplant 2019; 24:161-166. [PMID: 30730354 PMCID: PMC6759363 DOI: 10.1097/mot.0000000000000621] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW With the ongoing organ shortage, several mechanisms to facilitate organ exchanges and expand the scope of living kidney or liver donation have been proposed. Although each addresses at least one barrier to transplantation, these innovative programs raise important ethical, logistical, and regulatory considerations. RECENT FINDINGS This review addresses four recent proposals to expand living donor transplantation. For kidney transplantation, we discuss global paired exchange and advanced donation programs ('vouchers') and for liver transplantation, liver paired exchange. Lastly, this review considers trans-organ exchange. We explore the conceptual framework of the exchange, current status, benefits, and concerns for implementation among each of these evolving pathways. SUMMARY Through highlighting novel mechanisms in organ exchange, greater awareness, discussion, or support can occur to create more avenues for transplantation. These innovative mechanisms require regulations and safeguards for donors to ensure informed consent, and proper follow-up is maintained.
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Affiliation(s)
- Alexis L. Lo
- Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Elizabeth M. Sonnenberg
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA
| | - Peter L. Abt
- Perelman School of Medicine, Hospital of the University of Pennsylvania, Department of Surgery, Philadelphia, PA
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Lentine KL, Lam NN, Segev DL. Risks of Living Kidney Donation: Current State of Knowledge on Outcomes Important to Donors. Clin J Am Soc Nephrol 2019; 14:597-608. [PMID: 30858158 PMCID: PMC6450354 DOI: 10.2215/cjn.11220918] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the past decade, there have been increasing efforts to better define and quantify the short- and long-term risks of living kidney donation. Recent studies have expanded upon the previous literature by focusing on outcomes that are important to potential and previous donors, applying unique databases and/or registries to follow large cohorts of donors for longer periods of time, and comparing outcomes with healthy nondonor controls to estimate attributable risks of donation. Leading outcomes important to living kidney donors include kidney health, surgical risks, and psychosocial effects of donation. Recent data support that living donors may experience a small increased risk of severe CKD and ESKD compared with healthy nondonors. For most donors, the 15-year risk of kidney failure is <1%, but for certain populations, such as young, black men, this risk may be higher. New risk prediction tools that combine the effects of demographic and health factors, and innovations in genetic risk markers are improving kidney risk stratification. Minor perioperative complications occur in 10%-20% of donor nephrectomy cases, but major complications occur in <3%, and the risk of perioperative death is <0.03%. Generally, living kidney donors have similar or improved psychosocial outcomes, such as quality of life, after donation compared with before donation and compared with nondonors. Although the donation process should be financially neutral, living kidney donors may experience out-of-pocket expenses and lost wages that may or may not be completely covered through regional or national reimbursement programs, and may face difficulties arranging subsequent life and health insurance. Living kidney donors should be fully informed of the perioperative and long-term risks before making their decision to donate. Follow-up care allows for preventative care measures to mitigate risk and ongoing surveillance and reporting of donor outcomes to inform prior and future living kidney donors.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri; .,Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada; and
| | - Dorry L Segev
- Department of Surgery and .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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McCormick F, Held PJ, Chertow GM. The Terrible Toll of the Kidney Shortage. J Am Soc Nephrol 2018; 29:2775-2776. [PMID: 30420419 DOI: 10.1681/asn.2018101030] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
| | - Philip J Held
- Division of Nephrology, Stanford University School of Medicine, Stanford University, Stanford, California
| | - Glenn M Chertow
- Division of Nephrology, Stanford University School of Medicine, Stanford University, Stanford, California
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