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 Researchers examined survey data from 796 living kidney donors on
how much they spent for out-of-pocket medical costs as well as
indirect expenses such as lost income or travel bills associated
with donation.
Overall, 78 percent of the donors shouldered some costs themselves,
and 21 percent of them reported more than $500 in out-of-pocket
medical bills and other expenses, the study found.
“While the need for kidney transplants continues to rise, I do think
that costs deter donors,” said lead study author Jennifer Wiseman, a
living donor social worker at the University of Minnesota Medical
Center in Minneapolis.
“I do not advocate that we begin paying living kidney donors to
donate,” Wiseman added by email. “Rather, I am for financial
neutrality – I think that living kidney donation should not cost
donors anything.”
In the study, donors were 44 years old on average and 53 percent of
them were blood relatives of their organ's recipient. The majority
of donors were female, and nearly all of them were white.
At the time of the donation, 83 percent of the donors had jobs and
84 percent had health insurance.
While 72 percent of the donors reported no out-of-pocket medical
expenses, 27 percent did pay for some of their care themselves and 6
percent spent more than $500, researchers report in the journal
Transplantation.
By contrast, 75 percent of donors reported nonmedical expenses.
Usually these bills were related to travel to and from the
transplant center, and for 18 percent of donors, non-medical
expenses exceeded $500.
Even when donors reported no out-of-pocket costs, 23 percent still
said they had at least moderate financial burden as a result of this
experience, likely due to things like lost wages.
To meet out-of-pocket costs, 35 percent of donors dipped into
savings, 14 percent borrowed from friends or family, 7 percent had a
fundraiser and 4 percent borrowed from a bank or credit union.
All told, 22 percent of the donors received grant money from a local
foundation or from the National Living Donor Assistance Center to
defray costs. But 51 percent of these grant recipients still
reported moderate to high financial burden.
One limitation of the study is that the degree of burden is somewhat
subjective and depends on a variety of factors like how easily
donors can keep up with other daily expenses, the authors note.
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Still, the study adds to a growing body of evidence that living
kidney donors face financial burdens that can discourage donations,
said Dr. Peter Reese, a chair of the United Network for Organ
Sharing (UNOS) ethics committee and a researcher at the University
of Pennsylvania in Philadelphia.
“Every person discouraged from donating means another person with
kidney disease suffering and dying prematurely from end-stage kidney
disease,” Reese, who wasn’t involved in the study, said by email.
Even though organ donation is an altruistic act that shouldn’t be
motivated by money, it also doesn’t make ethical sense for organ
donors to shoulder huge costs, said Dr. Neil Wenger, director of the
University of California Los Angeles Health Ethics Center.
“Removing a financial disincentive is not the same as providing an
incentive and could serve to permit potential donors to find it
feasible to be able to act altruistically,” Wenger, who wasn’t
involved in the study, said by email.
In the long run, paying for donors' costs may mean better outcomes
for less money than letting transplant recipients remain on
dialysis, often the only treatment alternative for people awaiting
transplants, said Dr. Robert Truog, director of the Center for
Bioethics at Harvard Medical School in Boston.
“Organ transplantation has consistently been shown to be
substantially more cost effective than treatment with dialysis, and
with a much improved quality of life,” Truog, who wasn’t involved in
the study, said by email. “Why aren’t we doing everything we can to
remove the substantial disincentives for those who would consider
being a living donor?”
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