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Semrau L, Matas AJ. A regulated system of incentives for living kidney donation: Clearing the way for an informed assessment. Am J Transplant 2022; 22:2509-2514. [PMID: 35751488 PMCID: PMC9796749 DOI: 10.1111/ajt.17129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/07/2022] [Accepted: 06/19/2022] [Indexed: 01/25/2023]
Abstract
The kidney shortage continues to be a crisis for our patients. Despite numerous attempts to increase living and deceased donation, annually in the United States, thousands of candidates are removed from the kidney transplant waiting list because of either death or becoming too sick to transplant. To increase living donation, trials of a regulated system of incentives for living donation have been proposed. Such trials may show: (1) a significant increase in donation, and (2) that informed, incentivized donors, making an autonomous decision to donate, have the same medical and psychosocial outcomes as our conventional donors. Given the stakes, the proposal warrants careful consideration. However, to date, much discussion of the proposal has been unproductive. Objections commonly leveled against it: fail to engage with it; conflate it with underground, unregulated markets; speculate without evidence; and reason fallaciously, favoring rhetorical impact over logic. The present paper is a corrective. It identifies these common errors so they are not repeated, thus allowing space for an assessment of the proposal on its merits.
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Affiliation(s)
- Luke Semrau
- Department of PhilosophyBloomsburg UniversityBloomsburgPennsylvaniaUSA
| | - Arthur J. Matas
- Division of Transplantation, Department of SurgeryUniversity of MinnesotaMinneapolisMinnesotaUSA
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2
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Chow KM, Ahn C, Dittmer I, Au DKS, Cheung I, Cheng YL, Lau CS, Yeung DTK, Li PKT. Introducing Incentives and Reducing Disincentives in Enhancing Deceased Organ Donation and Transplantation. Semin Nephrol 2022; 42:151268. [PMID: 36577641 DOI: 10.1016/j.semnephrol.2022.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Despite the effectiveness of solid organ transplantation, progress to close the gap between donor organs and demand remains slow. An organ shortage increases the waiting time for transplant and involves significant costs including patient morbidity and mortality. Against the background of a low deceased organ donation rate, this article discusses the option of introducing incentives and removing disincentives to deceased organ donation. Perspectives from ethics, general public opinion, and the health care profession are examined to ensure a comprehensive appraisal and illustrate different facets of opinion on this complex area. Special cultural and psychosocial considerations in Asia, including the family based consent model, are discussed.
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Affiliation(s)
- Kai Ming Chow
- Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Curie Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ian Dittmer
- Department of Renal Medicine, Auckland City Hospital, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Derrick Kit-Sing Au
- Centre for Bioethics, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ian Cheung
- Cluster Services Division, Hospital Authority, Kowloon, Hong Kong
| | - Yuk Lun Cheng
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong
| | - Chak Sing Lau
- Department of Medicine, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong, China
| | | | - Philip Kam-Tao Li
- Department of Medicine and Therapeutics, Carol and Richard Yu PD Research Centre, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
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3
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Jackson KR, Haugen CE, Segev DL. Kidneys for Sale: Are We There Yet? (Commentary on Kidneys for Sale: Empirical Evidence From Iran). Transpl Int 2022; 35:10635. [PMID: 35845548 PMCID: PMC9281362 DOI: 10.3389/ti.2022.10635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Kyle R. Jackson
- Department of Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Christine E. Haugen
- Department of Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University, Baltimore, MD, United States
- Department of Surgery, New York University, New York, NY, United States
- *Correspondence: Dorry L. Segev,
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Kim S, Sin SM, Lee HY, Park UJ, Kim HT, Roh YN. Survey for the Opinion of Medical Students and Medical Staff on a Financial Incentive System for Deceased Organ Donation in an Asian Country. Transplant Proc 2019; 51:2508-2513. [PMID: 31473008 DOI: 10.1016/j.transproceed.2019.04.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Financial incentives for deceased organ donation are associated with many controversial ethical issues. This study examines the perspectives of medical students and staff members on financial incentives for the families of brain-dead organ donors. METHODOLOGY A structured survey form was used between December 7, 2017 and January 28, 2018 to elicit opinions on financial incentives for the families of brain-dead organ donors. Forty-three medical staff members and 81 medical students participated in the survey voluntarily. The opinions on the financial incentive system and the relationship between willingness to give information about organ donation to families and a financial incentive system were assessed. RESULTS The majority of the participants (81.4%) had positive thoughts on organ donation. More than half of the participants (60.5%) thought that the financial incentive system did not erode the ethical purity of organ donation. As charge doctors, most respondents (84.6%) were willing to give information about organ donation to family members in the presence of financial incentives. However, the percentage decreased significantly to 60.5% when financial incentive was no longer factored into consideration (P < .001). LIMITATION The study population is small, and the participants are not representative of the general population. CONCLUSION The opinions of medical students and medical staff on financial incentives for deceased organ donation were generally positive. Financial incentives proved to be a potential influencing factor as an option of organ donation to be given to families.
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Affiliation(s)
- Sanghoon Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea
| | - Seon Min Sin
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyun Yong Lee
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea
| | - Ui Jun Park
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea
| | - Hyoung Tae Kim
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea
| | - Young-Nam Roh
- Division of Transplantation and Vascular Surgery, Department of Surgery, Keimyung University, Dongsan Medical Center, Daegu, Republic of Korea.
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Mai K, Boldt A, Hau HM, Kirschfink M, Schiekofer S, Keller F, Beige J, Giannis A, Sack U, Rasche FM. Immunological Alterations due to Hemodialysis Might Interfere with Early Complications in Renal Transplantation. Anal Cell Pathol (Amst) 2019; 2019:8389765. [PMID: 31019876 PMCID: PMC6452532 DOI: 10.1155/2019/8389765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/04/2019] [Accepted: 02/18/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Chronic or intercurrent alterations of the immune system in patients with end-stage renal disease (CKD) and intermittent hemodialysis (CKD5D, HD) have been attributed to an acute rejection of renal allograft. METHODS Leukocyte subsets in flow cytometry, complement activation, and concentrations of TGFβ, sCD30 (ELISA), and interleukins (CBA) of fifteen patients eligible for renal transplantation were analyzed before, during, and after a regular HD. RESULTS Before HD, the median proportion of CD8+ effector cells, CD8+ CCR5+ effector cells, and HLA-DR+ regulatory T cells as well as the median concentration of soluble CD30 increased and naive CD8+ T cells decreased. During HD, there was a significant decrease in CD4- CD8- T cells (p < 0.001) and an increase in CD25+ T cells (p = 0.026), sCD30 (p < 0.001), HLA-DR+ regulatory T cells (p = 0.005), and regulatory T cells (p = 0.003). TGFβ and sCD30 increased significantly over time. The activity of the classical complement pathway started to slightly increase after the first hour of HD and lasted until fifteen minutes after finishing dialysis. The decrease in the functional activity of the alternative pathway was only transient and was followed by a significant increase within 15 minutes after finishing the treatment. CONCLUSION HD might interact with the allograft outcome by influencing T cell subsets and activation of the complement system in a biphasic course.
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Affiliation(s)
- Kristin Mai
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Leipzig, Germany
- Department of Internal Medicine, Neurology and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Boldt
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular and Thoracic Surgery, University Hospital Leipzig, Leipzig, Germany
| | | | - Stephan Schiekofer
- Center for Geriatric Medicine, Bezirksklinikum Regensburg, Regensburg, Germany
- Sigmund Freud PrivatUniversität, Wien, Österreich, Austria
| | - Frieder Keller
- Medical Department I, Nephrology Division, University Hospital Ulm, Ulm, Germany
| | - Joachim Beige
- Department of Nephrology, KfH Renal Unit, Hospital St. Georg, Leipzig, Germany
- Martin-Luther-University Halle/Wittenberg, Halle, Germany
| | | | - Ulrich Sack
- Institute of Clinical Immunology, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Franz Maximilian Rasche
- Department of Internal Medicine, Neurology and Dermatology, Clinic for Endocrinology and Nephrology, Section of Nephrology, University Hospital Leipzig, Leipzig, Germany
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Piccoli GB, Cabiddu G, Breuer C, Jadeau C, Testa A, Brunori G. Dialysis Reimbursement: What Impact Do Different Models Have on Clinical Choices? J Clin Med 2019; 8:jcm8020276. [PMID: 30823518 PMCID: PMC6406585 DOI: 10.3390/jcm8020276] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 12/15/2022] Open
Abstract
Allowing patients to live for decades without the function of a vital organ is a medical miracle, but one that is not without cost both in terms of morbidity and quality of life and in economic terms. Renal replacement therapy (RRT) consumes between 2% and 5% of the overall health care expenditure in countries where dialysis is available without restrictions. While transplantation is the preferred treatment in patients without contraindications, old age and comorbidity limit its indications, and low organ availability may result in long waiting times. As a consequence, 30–70% of the patients depend on dialysis, which remains the main determinant of the cost of RRT. Costs of dialysis are differently defined, and its reimbursement follows different rules. There are three main ways of establishing dialysis reimbursement. The first involves dividing dialysis into a series of elements and reimbursing each one separately (dialysis itself, medications, drugs, transportation, hospitalisation, etc.). The second, known as the capitation system, consists of merging these elements in a per capita reimbursement, while the third, usually called the bundle system, entails identifying a core of procedures intrinsically linked to treatment (e.g., dialysis sessions, tests, intradialyitc drugs). Each one has advantages and drawbacks, and impacts differently on the organization and delivery of care: payment per session may favour fragmentation and make a global appraisal difficult; a correct capitation system needs a careful correction for comorbidity, and may exacerbate competition between public and private settings, the latter aiming at selecting the least complex cases; a bundle system, in which the main elements linked to the dialysis sessions are considered together, may be a good compromise but risks penalising complex patients, and requires a rapid adaptation to treatment changes. Retarding dialysis is a clinical and economical goal, but the incentives for predialysis care are not established and its development may be unfavourable for the provider. A closer cooperation between policymakers, economists and nephrologists is needed to ensure a high quality of dialysis care.
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Affiliation(s)
- Giorgina Barbara Piccoli
- Department of Clinical and Biological Sciences, University of Torino Italy, 10100 Torino, Italy.
- Nephrologie, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | | | - Conrad Breuer
- Direction, Centre Hospitalier Le Mans, 72000 Le Mans, France.
| | - Christelle Jadeau
- Centre de Recherche Clinique, Centre Hospitalier Le Mans, 72000 Le Mans, France.
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Platz TT, Siersbæk N, Østerdal LP. Ethically Acceptable Compensation for Living Donations of Organs, Tissues, and Cells: An Unexploited Potential? APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:1-14. [PMID: 30143995 DOI: 10.1007/s40258-018-0421-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The number of living donations of human organs, tissues, and cells falls far short of the need. Market-like arrangements to increase donation rates have been proposed, but they are broadly considered unacceptable due to ethical concerns and are therefore not policy relevant in most countries. The purpose of this paper is to explore a different approach to increasing living donations, namely through the use of ethically acceptable compensation of donors. We review the compensation practices in Europe and find a lack of reimbursement of incurred costs and lack of compensation for non-monetary losses, which create disincentives for donation. We draw on a well-known philosophical theory to explain why donors are rarely fully compensated and why many existing proposals to raise donation rates are seen as controversial or even unethical. We present and discuss three categories of compensation with the potential to increase donation rates in an ethically acceptable way.
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Affiliation(s)
- Trine Tornøe Platz
- Department of Economics, Copenhagen Business School, Porcelænshaven 16A, 2000, Frederiksberg, Denmark.
| | - Nikolaj Siersbæk
- Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Lars Peter Østerdal
- Department of Economics, Copenhagen Business School, Porcelænshaven 16A, 2000, Frederiksberg, Denmark
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8
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Opinions of Health Care Personnel Regarding Disincentives and Incentives for Living Kidney Donation at a Single Center. Transplant Proc 2018; 50:3053-3058. [PMID: 30577165 DOI: 10.1016/j.transproceed.2018.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/19/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Transplant societies continue to actively concentrate on increasing rates of living kidney donation (LKD) to bridge the gap between individuals awaiting transplantation and the number of kidneys available. A widely discussed strategy to increase living donation rates is the provision of incentives and removal of disincentives. Though opinions of the public regarding this strategy have been studied, the opinions of health care providers, including younger professionals, are less clear. We studied the opinions of medical students and other health care providers on strategies to increase LKD to determine if opinions were different among those < 25 or ≥ 25 years of age. METHODS A simple cross-sectional survey was conducted at an academic medical center. Participants included medical students and employees in Internal Medicine, General Surgery, and the Organ Transplantation Center. Pearson's χ2 and Fisher's exact test were conducted on the responses regarding disincentives and incentives to determine whether opinions differed based on age. RESULTS Six hundred and twenty-four participants completed the survey. There was no statistical difference in opinions between groups on reimbursing transportation costs, loss of wages, or childcare costs, but those aged ≥ 25 were more agreeable with covering food/lodging costs compared to those < 25 (96.5% vs 90.7%, P = .009). Respondents < 25 years old were more willing to donate a kidney for a financial incentive (P = .0002) accepting a median amount of $25,000. CONCLUSIONS Health care personnel broadly support removing financial disincentives for living kidney donation, and those ≥ 25 were more in favor of covering food/lodging costs compared to those < 25. Those < 25 years old were more likely to accept financial incentives towards donating their kidney compared to those ≥ 25 years.
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Kidney Paired Donation and the "Valuable Consideration" Problem: The Experiences of Australia, Canada, and the United States. Transplantation 2018; 101:1996-2002. [PMID: 29633981 DOI: 10.1097/tp.0000000000001778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
As organ donation rates remain unable to meet the needs of individuals waiting for transplants, it is necessary to identify reasons for this shortage and develop solutions to address it. The introduction of kidney paired donation (KPD) programs represents one such innovation that has become a valuable tool in donation systems around the world. Although KPD has been successful in increasing kidney donation and transplantation, there are lingering questions about its legality. Donation through KPD is done in exchange for-and with the expectation of-a reciprocal kidney donation and transplantation. It is this reciprocity that has caused concern about whether KPD complies with existing law. Organ donation systems around the world are almost universally structured to legally prohibit the commercial exchange of organs. Australia, Canada, and the United States have accomplished this goal by prohibiting the exchange of an organ for "valuable consideration," which is a legal term that has not historically been limited to monetary exchange. Whether or not KPD programs violate this legislative prohibition will depend on the specific legislative provision being considered, and the legal system and case law of the particular jurisdiction in question. This article compares the experiences of Australia, Canada, and the United States in determining the legality of KPD and highlights the need for legal clarity and flexibility as donation and transplantation systems continue to evolve.
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Rodrigue JR, Fleishman A, Carroll M, Evenson AR, Pavlakis M, Mandelbrot DA, Baliga P, Howard DH, Schold JD. The Living Donor Lost Wages Trial: Study Rationale and Protocol. CURRENT TRANSPLANTATION REPORTS 2018; 5:45-54. [PMID: 29805957 PMCID: PMC5967265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE OF REVIEW This paper describes the background, rationale, and design of an NIH-funded, single-center study to test the impact of offering reimbursement for donor lost wages incurred during the post-nephrectomy recovery period on the live donor kidney transplant (LDKT) rate in newly evaluated kidney transplant candidates, to examine whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and to determine whether higher reimbursement amounts lead to higher LDKT rates. RECENT FINDINGS LDKT is the optimal treatment for renal failure. However, living kidney donation has declined in the past decade, particularly among men, younger adults, blacks, and low-income adults. There is evidence that donation-related costs may deter both transplant candidates and potential donors from considering LDKT. Lost wages is a major source of financial loss for some living donors and, unlike travel and lodging expenses, is not reimbursed by financial assistance programs. SUMMARY The study addresses the transplant community's call to reduce the financial burden of living donation and examine its impact on LDKT rates. Findings have the potential to influence policy, clinical practice, LDKT access, and income-related and racial disparities in LDKT and living donation.
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Affiliation(s)
- James R. Rodrigue
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Aaron Fleishman
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - Michaela Carroll
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - Amy R. Evenson
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Martha Pavlakis
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | | | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - David H. Howard
- Department of Health Policy and Management, Emory University, Atlanta, GA
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
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12
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Semrau L. Reassessing the Likely Harms to Kidney Vendors in Regulated Organ Markets. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2017; 42:634-652. [DOI: 10.1093/jmp/jhx025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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13
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Naylor KL, McKenzie S, Cherry C, McArthur E, Li AH, McCallum MK, Kim SJ, Prakash V, Knoll GA, Garg AX. Evaluation of a Hockey Deceased Organ Donation Awareness Campaign: A Population-Based Cohort Study. Can J Kidney Health Dis 2017; 4:2054358117717252. [PMID: 28748101 PMCID: PMC5507377 DOI: 10.1177/2054358117717252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background: The Kidney Foundation of Canada developed a pilot campaign to educate persons attending junior hockey league games in London, Ontario, Canada, on deceased organ donation. Objective: To evaluate the impact of a hockey campaign on the number of new organ and tissue donor registrants. Design: Population-based retrospective cohort study. Setting: Residents of London, Ontario. Patients: We included 255 476 individuals eligible to register for organ donation with a London, Ontario postal code. Measurements: We compared the number of new deceased organ donor registrants in London, Ontario, during the campaign period (March 12 to April 16, 2015) with 3 different time periods (December 30, 2014 to February 3, 2015; February 4 to March 11, 2015; April 17 to May 22, 2015). We also compared registration rates in London with 2 Ontario cities (Kitchener-Waterloo and Hamilton) matching in a 1:1 ratio on age, sex, and income quintile. Methods: To compare registrations across time periods, we used binomial regression with an identity link function and generalized estimating equations with an independence correlation structure. We used modified Poisson regression to compare registration rates between cities. Results: During the campaign period, there were slightly more registrations (1218 registered of 252 832 unregistered individuals [0.48%]) compared with an earlier time period (risk difference: 0.09%; 95% confidence interval [CI]: 0.05%-0.12%). However, there was no significant difference compared with 2 time periods immediately before and after the campaign. London had slightly more registrations during the campaign period compared with the matched city of Hamilton (1180 registered of 236 582 unregistered individuals [0.50%] vs 490 registered of 236 582 unregistered individuals [0.21%]; risk ratio: 2.41; 95% CI: 2.17-2.68). The registration rate in London did not significantly differ from Kitchener-Waterloo. Limitations: Unable to conclude whether the minor increase in deceased organ donor registration was the result of the campaign or other factors (e.g., simultaneous organ registration events, seasonality). Conclusions: Overall, a minor increase in deceased organ donor registration was observed during the hockey organ donation awareness campaign; however, the specific impact of the campaign on organ donor registration could not be determined.
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Affiliation(s)
- Kyla L Naylor
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan McKenzie
- The Kidney Foundation of Canada, Western Canada Branch, Calgary, Alberta, Canada
| | - Cindy Cherry
- The Kidney Foundation of Canada, Mississauga, Ontario, Canada
| | - Eric McArthur
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Alvin H Li
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
| | - Megan K McCallum
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - S Joseph Kim
- University Health Network, University of Toronto, Ontario, Canada
| | | | - Gregory A Knoll
- Division of Nephrology, Department of Medicine, Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.,Division of Nephrology, Western University, London, Ontario, Canada
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14
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Rodrigue JR, Schold JD, Mandelbrot DA, Taber DJ, Phan V, Baliga PK. Concern for Lost Income Following Donation Deters Some Patients From Talking to Potential Living Donors. Prog Transplant 2016; 26:292-298. [PMID: 27495327 DOI: 10.1177/1526924816661332] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CONTEXT Some living kidney donors report lost income during recovery from surgery. Little is known about whether concern for living donor's lost income affects the decision to undergo donation evaluation and the willingness of transplant candidates to discuss living kidney donation (LKD) with others. OBJECTIVE To examine whether transplant patients were told by potential donors about lost income concerns and whether patients chose not to discuss LKD with others due to lost income concerns. DESIGN, SETTING, AND PATIENTS Kidney transplant patients (185 wait-listed candidates, 171 deceased donor recipients, and 100 live donor recipients) at 2 centers completed a questionnaire to assess whether concern about donor's lost income was a consideration in discussion about LKD with others. RESULTS One-third (32%) were told by a family member/friend that they were willing to donate but were concerned about potential lost income. The majority of those who expressed financial concern (64%) did not initiate donation evaluation. Many patients (42%) chose not to discuss living donation with a family member/friend due to concern about the impact of lost income on the donor. In the multivariable model, lower annual household income was the only statistically significant predictor of both having a potential donor expressing lost income concern and choosing not to talk to someone because of lost income concern. CONCLUSION Findings from the current study underscore how concern about income loss for living donors may affect decision-making by both transplant candidates and potential donors.
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Affiliation(s)
- James R Rodrigue
- 1 Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Jesse D Schold
- 3 Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | | | - David J Taber
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.,6 Department of Pharmacy, Ralph H. Johnson VA Medical Center, Charleston, SC, USA
| | - Van Phan
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Prabhakar K Baliga
- 5 Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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15
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Piccoli GB, Sacchetti L, Verzè L, Cavallo F. Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney? Philos Ethics Humanit Med 2015; 10:13. [PMID: 26684455 PMCID: PMC4683780 DOI: 10.1186/s13010-015-0033-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/05/2015] [Indexed: 05/08/2023] Open
Abstract
Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of "reverse" informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties.
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Affiliation(s)
- Giorgina Barbara Piccoli
- SS Nephrology, Department of Clinical and Biological Sciences University of Torino, Torino, Italy.
- AOU san Luigi Gonzaga, Regione Gonzole 10, Orbassano, Torino, Italy.
| | - Laura Sacchetti
- EBM Course, Torino Medical School, University of Torino, Torino, Italy.
| | - Laura Verzè
- EBM Course, Torino Medical School, University of Torino, Torino, Italy.
| | - Franco Cavallo
- EBM Course, Torino Medical School, University of Torino, Torino, Italy
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Kuddus RH, Mehrizy RS, Minaie A, El-Saidi MA, El Ezzi AA. Motivation for organ donation among college students in the United States. Transplant Proc 2015; 46:2046-9. [PMID: 25131104 DOI: 10.1016/j.transproceed.2014.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The majority of the patients presently waiting for an organ are waiting for a kidney. Living kidney donation by about 0.1% of the adult population of a nation may completely eliminate kidney shortage. We investigated the concerns of college students toward charitable and compensated organ donation. METHODS A 40-question survey was conducted. The respondents were students of the Biology Department of Utah Valley University, Orem, Utah, United States. The data were tabulated and analyzed. Tests of association among potentially linked attributes and the difference between two independent proportions were performed at the 0.05 level of significance and P-values were also calculated using XLSTAT software. RESULTS The participants (n = 321) were 47% male, 53% female, 89% Caucasian, and 93% healthy, and 7% of the respondents had some health conditions. Of the respondents, 55% were ages 18 to 25 and 40% were ages 26 to 50 years; 43% were unmarried or single, 57% were married, and 85% had health insurance. About 65% of the respondents lived in small cities and the rest lived in large cities (23%) or the countryside (9%). There was no significant association between gender, level of education, location of living, and household income in relation to belief in organ donation with or without compensation, except that males favored compensated organ donation over females (P = .004). Rumors on organ theft and extraction of organ from questionable brain-dead patients had not negatively affected the decision of participants on being listed as organ donors in their driver's license (P = .0001). Those who considered organ donation ethically acceptable also believed that a person has the right to sale a kidney (P = .015) and the donor party should be somehow compensated (P = .001). CONCLUSIONS A large percentage of college students supports compensated organ donation and considers that compensation will increase organ donation.
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Affiliation(s)
- R H Kuddus
- Department of Biology, Utah Valley University, Orem, Utah, USA.
| | - R S Mehrizy
- Department of Computer Science, Utah Valley University, Orem, Utah, USA
| | - A Minaie
- Department of Computer Science, Utah Valley University, Orem, Utah, USA
| | - M A El-Saidi
- Office of Academic Research, Utah Valley University, Orem, Utah, USA
| | - A A El Ezzi
- Department of Chemistry, Utah Valley University, Orem, Utah, USA
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17
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Bruzzone P. Paid Organ Donation: An Italian Perspective. Transplant Proc 2015; 47:2109-12. [PMID: 26361655 DOI: 10.1016/j.transproceed.2015.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/11/2015] [Accepted: 01/28/2015] [Indexed: 11/30/2022]
Abstract
The only countries that have allowed financial incentives for organ donation are Iran since 1988, and later on, Singapore and Saudi Arabia. In Europe, and of course in Italy, financial incentives for donors are prohibited. The author has completed extensive research via the Internet (PubMed) of worldwide scientific literature on paid organ donation, also researching studies concerning public opinion on organ commercialism and "regulated markets". Italian transplant laws also have been reported and analyzed.
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Affiliation(s)
- P Bruzzone
- Department of General Surgery, Surgical Sciences and Transplantation "Paride Stefanini", Università di Roma "La Sapienza", Rome, Italy.
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18
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A moral dilemma argument against clinical trials of incentives for kidney donation. Transplant Res 2015. [PMID: 26199722 PMCID: PMC4509566 DOI: 10.1186/s13737-015-0025-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Commercial transplant tourism results in significant harm to both kidney donors and recipients. However, proponents of incentives for kidney donation assert that proper oversight of the process prevents these harms and also that transplant numbers can be safely increased so that the moral burden of poor end-stage kidney disease outcomes can be alleviated. In a moral dilemma analysis, the principle of preventing donor harm can be dissociated from the principles of providing benefits to the recipient and to society. It is plausible that an incentivized donor is fundamentally different from an uncompensated donor. Incentivized donors can experience harms unrelated to lack of regulation because their characteristics are determined by the incentive superimposed upon a poverty circumstance. Moreover, creating a system of incentivized donation without established national registries for capturing all long-term donor outcomes would be morally inconsistent, since without prior demonstration that donor outcomes are not income or wealth-dependent, a population of incentivized donors cannot be morally created in a clinical trial. Socioeconomic factors adversely affect outcome in other surgical populations, and interventions on income or wealth in these populations have not been studied. Coercion will be increased in families not affected by kidney disease, where knowledge of a new income source and not of a potential recipient is the incentive. In the case of elective surgery such as kidney donation, donor non-maleficence trumps donor autonomy, recipient beneficence, and beneficence to society when there is a conflict among these principles. Yet, we are still faced with the total moral burden of end-stage kidney disease, which belongs to the society that cannot provide enough donor kidneys. Acting according to one arm of the dilemma to prevent donor harm does not erase obligations towards the other, to provide recipient benefit. To resolve the moral burden, as moral agents, we must rearrange our institutions by increasing available donor organs from other sources. The shortage of donor kidneys creates a moral burden for society, but incentives for donation will only increase the total moral burden of end-stage kidney disease.
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Tong A, Ralph AF, Chapman JR, Wong G, Gill JS, Josephson MA, Craig JC. Focus group study of public opinion about paying living kidney donors in Australia. Clin J Am Soc Nephrol 2015; 10:1217-26. [PMID: 25908793 PMCID: PMC4491296 DOI: 10.2215/cjn.10821014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/26/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Twelve focus groups were conducted with 113 participants recruited from the general public in three Australian states in February 2013. Thematic analysis was used to analyze the transcripts. RESULTS Five themes were identified: creating ethical impasses (commodification of the body, quandary of kidney valuation, pushing moral boundaries), corrupting motivations (exposing the vulnerable, inevitable abuse, supplanting altruism), determining justifiable risk (compromising kidney quality, undue harm, accepting a confined risk, trusting protective mechanisms, right to autonomy), driving access (urgency of organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets), and honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense). Reimbursement and justifiable recompense are considered by the Australian public as a legitimate way of supporting donors and reducing disadvantage. Financial payment beyond reimbursement is regarded as morally reprehensible, with the potential for exploitative commercialism. Some contend that regulated compensation could be a defensible strategy to increased donation rates provided that mechanisms are in place to protect donors. CONCLUSIONS The perceived threat to community values of human dignity, goodwill, and fairness suggests that there could be strong public resistance to any form of financial inducements for living kidney donors. Policy priorities addressing the removal of disincentives may be more acceptable to the public.
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Affiliation(s)
- Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia;
| | - Angelique F Ralph
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Jeremy R Chapman
- The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
| | - John S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; and
| | | | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
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20
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Fisher JS, Butt Z, Friedewald J, Fry-Revere S, Hanneman J, Henderson ML, Ladin K, Mysel H, Preczewski L, Sherman LA, Thiessen C, Gordon EJ. Between Scylla and Charybdis: charting an ethical course for research into financial incentives for living kidney donation. Am J Transplant 2015; 15:1180-6. [PMID: 25833728 DOI: 10.1111/ajt.13234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 12/15/2014] [Accepted: 12/25/2015] [Indexed: 01/25/2023]
Abstract
New approaches to address the kidney scarcity in the United States are urgently needed. The greatest potential source of kidneys is from living donors. Proposals to offer financial incentives to increase living kidney donation rates remain highly controversial. Despite repeated calls for a pilot study to assess the impact of financial compensation on living kidney donation rates, many fear that financial incentives will exploit vulnerable individuals and cast the field of transplantation in a negative public light, ultimately reducing donation rates. This paper provides an ethical justification for conducting a pilot study of a federally regulated approach to providing financial incentives to living kidney donors, with the goal of assessing donors' perceptions.
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Affiliation(s)
- J S Fisher
- Scripps Center for Organ and Cell Transplantation, Scripps Clinic/Green Hospital, La Jolla, CA
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21
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Salomon DR, Langnas AN, Reed AI, Bloom RD, Magee JC, Gaston RS. AST/ASTS workshop on increasing organ donation in the United States: creating an "arc of change" from removing disincentives to testing incentives. Am J Transplant 2015; 15:1173-9. [PMID: 25833653 DOI: 10.1111/ajt.13233] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/16/2015] [Accepted: 01/16/2015] [Indexed: 01/25/2023]
Abstract
The American Society of Transplantation (AST) and American Society of Transplant Surgeons (ASTS) convened a workshop on June 2-3, 2014, to explore increasing both living and deceased organ donation in the United States. Recent articles in the lay press on illegal organ sales and transplant tourism highlight the impact of the current black market in kidneys that accompanies the growing global organ shortage. We believe it important not to conflate the illegal market for organs, which we reject in the strongest possible terms, with the potential in the United States for concerted action to remove all remaining financial disincentives for donors and critically consider testing the impact and acceptability of incentives to increase organ availability in the United States. However, we do not support any trials of direct payments or valuable considerations to donors or families based on a process of market-assigned values of organs. This White Paper represents a summary by the authors of the deliberations of the Incentives Workshop Group and has been approved by both AST and ASTS Boards.
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Affiliation(s)
- D R Salomon
- Department of Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA
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22
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Rodrigue JR, Kazley AS, Mandelbrot DA, Hays R, LaPointe Rudow D, Baliga P. Living Donor Kidney Transplantation: Overcoming Disparities in Live Kidney Donation in the US--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1687-95. [PMID: 25883072 DOI: 10.2215/cjn.00700115] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.
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Affiliation(s)
- James R Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Abby Swanson Kazley
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Didier A Mandelbrot
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; and
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin; and
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina;
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23
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The Rationale for Incentives for Living Donors: An International Perspective? CURRENT TRANSPLANTATION REPORTS 2015. [DOI: 10.1007/s40472-014-0045-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Gordon EJ, Patel CH, Sohn MW, Hippen B, Sherman LA. Does financial compensation for living kidney donation change willingness to donate? Am J Transplant 2015; 15:265-73. [PMID: 25425398 DOI: 10.1111/ajt.13004] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 01/25/2023]
Abstract
The potential use of financial compensation to increase living kidney donation rates remains controversial in potentially introducing undue inducement of vulnerable populations to donate. This cross-sectional study assessed amounts of financial compensation that would generate motivation and an undue inducement to donate to family/friends or strangers. Individuals leaving six Departments of Motor Vehicles were surveyed. Of the 210 participants who provided verbal consent (94% participation rate), respondents' willingness to donate would not change (70%), or would increase (29%) with compensation. Median lowest amounts of financial compensation for which participants would begin to consider donating a kidney were $5000 for family/friends, and $10,000 for strangers; respondents reporting $0 for family/friends (52%) or strangers (26%) were excluded from analysis. Median lowest amounts of financial compensation for which participants could no longer decline (perceive an undue inducement) were $50,000 for family/friends, and $100,000 for strangers; respondents reporting $0 for family/friends (44%) or strangers (23%) were excluded from analysis. The two most preferred forms of compensation included: direct payment of money (61%) and paid leave (21%). The two most preferred uses of compensation included: paying off debt (38%) and paying nonmedical expenses associated with the transplant (29%). Findings suggest tolerance for, but little practical impact of, financial compensation. Certain compensation amounts could motivate the public to donate without being perceived as an undue inducement.
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Affiliation(s)
- E J Gordon
- Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL; Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, IL
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25
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Gazibara T, Kovacevic N, Nurkovic S, Kurtagic I, Maric G, Kisic-Tepavcevic D, Pekmezovic T. To be or not to be an organ donor: differences in attitudes between freshmen and senior medical students. Cell Tissue Bank 2014; 16:457-65. [DOI: 10.1007/s10561-014-9491-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 12/12/2014] [Indexed: 11/29/2022]
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26
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Tong A, Chapman JR, Wong G, Craig JC. Perspectives of Transplant Physicians and Surgeons on Reimbursement, Compensation, and Incentives for Living Kidney Donors. Am J Kidney Dis 2014; 64:622-32. [DOI: 10.1053/j.ajkd.2014.02.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 02/20/2014] [Indexed: 12/19/2022]
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Caulfield T, Nelson E, Goldfeldt B, Klarenbach S. Incentives and organ donation: what's (really) legal in Canada? Can J Kidney Health Dis 2014; 1:7. [PMID: 25780602 PMCID: PMC4349723 DOI: 10.1186/2054-3581-1-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 05/09/2014] [Indexed: 11/12/2022] Open
Abstract
Purpose of review To date, there has been little analysis of the degree to which emerging incentive initiatives are permissible under Canadian law. The purpose of this review is to examine the relevant law – including legislation and case law – in order to clarify the legality of existing proposed incentive schemes. Sources of information Legislation and case law. Findings Organ donation is governed by provincial legislation that, in general, bans the exchange of any “benefit” or any form of “valuable consideration” in return for an organ. As such, these laws are tremendously restrictive and could have significant implications for emerging and proposed procurement policy. Implications Given the need for innovative, ethically appropriate policies to increase donation rates, we suggest that the time is right to rethink the potentially restrictive nature of Canada’s organ donation laws.
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Affiliation(s)
- Timothy Caulfield
- Faculty of Law and School of Public Health, Health Law Institute, University of Alberta, 116 St and 85 Avenue, Edmonton, AB T6G 2R3 Canada ; School of Public Health, 3-300 Edmonton Clinic Health Academy, University of Alberta, 11405 - 87 Avenue, Edmonton, AB T6G 1C9 Canada
| | - Erin Nelson
- Faculty of Law and School of Public Health, Health Law Institute, University of Alberta, 116 St and 85 Avenue, Edmonton, AB T6G 2R3 Canada
| | - Brice Goldfeldt
- Faculty of Law and School of Public Health, Health Law Institute, University of Alberta, 116 St and 85 Avenue, Edmonton, AB T6G 2R3 Canada
| | - Scott Klarenbach
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 116 St and 85 Avenue, Edmonton, AB T6G 2R3 Canada
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Hippen B. All the more reason: why Julian Koplin should support a trial of incentives for organ donation. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2014; 14:31-33. [PMID: 25229579 DOI: 10.1080/15265161.2014.947047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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29
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Fortin MC. Is the Canadian Legal Framework Too Restrictive and Based on False Premises? Can J Kidney Health Dis 2014; 1:8. [PMID: 25780603 PMCID: PMC4349664 DOI: 10.1186/2054-3581-1-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Accepted: 05/16/2014] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal (CHUM), Montreal, Canada
- Bioethics Program, Department of Social and Preventive Medicine, École de santé publique de l'Université de Montréal, Montreal, Canada
- Nephrology and Transplantation Division, Centre hospitalier de l'Université de Montréal (CHUM), 1560 Sherbrooke Street East, Montreal, Quebec H2L 4M1, Canada
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30
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Gill JS, Klarenbach S, Barnieh L, Caulfield T, Knoll G, Levin A, Cole EH. Financial Incentives to Increase Canadian Organ Donation: Quick Fix or Fallacy? Am J Kidney Dis 2014; 63:133-40. [DOI: 10.1053/j.ajkd.2013.08.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 08/05/2013] [Indexed: 11/11/2022]
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Barnieh L, Gill JS, Klarenbach S, Manns BJ. The cost-effectiveness of using payment to increase living donor kidneys for transplantation. Clin J Am Soc Nephrol 2013; 8:2165-73. [PMID: 24158797 DOI: 10.2215/cjn.03350313] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND OBJECTIVES For eligible candidates, transplantation is considered the optimal treatment compared with dialysis for patients with ESRD. The growing number of patients with ESRD requires new strategies to increase the pool of potential donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using decision analysis modeling, this study compared a strategy of paying living kidney donors to waitlisted recipients on dialysis with the current organ donation system. In the base case estimate, this study assumed that the number of donors would increase by 5% with a payment of $10,000. Quality of life estimates, resource use, and costs (2010 Canadian dollars) were based on the best available published data. RESULTS Compared with the current organ donation system, a strategy of increasing the number of kidneys for transplantation by 5% by paying living donors $10,000 has an incremental cost-savings of $340 and a gain of 0.11 quality-adjusted life years. Increasing the number of kidneys for transplantation by 10% and 20% would translate into incremental cost-savings of $1640 and $4030 and incremental quality-adjusted life years gain of 0.21 and 0.39, respectively. CONCLUSION Although the impact is uncertain, this model suggests that a strategy of paying living donors to increase the number of kidneys available for transplantation could be cost-effective, even with a transplant rate increase of only 5%. Future work needs to examine the feasibility, legal policy, ethics, and public perception of a strategy to pay living donors.
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Affiliation(s)
- Lianne Barnieh
- Departments of Medicine and, ‖Community Health Sciences, University of Calgary, Calgary, Alberta, Canada;, †Department of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada;, ‡Department of Medicine, University of Alberta, Edmonton, Alberta, Canada, §Alberta Kidney Disease Network, Calgary, Alberta, Canada
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Andersen MJ, Friedman AN. The coming fiscal crisis: nephrology in the line of fire. Clin J Am Soc Nephrol 2013; 8:1252-7. [PMID: 23704301 DOI: 10.2215/cjn.00790113] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nephrologists in the United States face a very uncertain economic future. The astronomical federal debt and unfunded liability burden of Medicare combined with the aging population will place unprecedented strain on the health care sector. To address these fundamental problems, it is conceivable that the federal government will ultimately institute rationing and other budget-cutting measures to rein in costs of ESRD care, which is generously funded relative to other chronic illnesses. Therefore, nephrologists should expect implementation of cost-cutting measures, such age-based rationing, mandated delayed dialysis and home therapies, compensated organ donation, and a shift in research priorities from the dialysis to the predialysis patient population. Nephrologists also need to recognize that these changes, which are geared toward the population level, may make it more difficult to advocate effectively for the needs of individual patients.
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Affiliation(s)
- Martin J Andersen
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
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Wiseman AC. Removing financial disincentives to organ donation: an acceptable next step? Clin J Am Soc Nephrol 2012; 7:1917-9. [PMID: 23160262 DOI: 10.2215/cjn.11021012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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