Remove Kidney Donation Barriers, Specialists Say Marcia Frellick October 13, 2014 Interviews with 110 transplant nephrologists and surgeons from 12 countries found strong support for reimbursing living kidney donors for medical bills, lodging, transportation, and childcare costs linked with their donations, according to authors of a new study published in the October issue of the American Journal of Kidney Diseases. Allison Tong, PhD, from the Centre for Kidney Research, the Childrens Hospital at Westmead in Sydney, Australia, and colleagues also found that compensating lost income and inconvenience was widely agreeable, as long as the donor was not profiting from the donation. Most specialists interviewed said direct financial incentives to living donors, even in a regulated market, were not justified, based on moral arguments and feasibility issues. Among the concerns was whether paid donations would incentivize donors to cover up health issues, and thus lower the quality of donated kidneys. Some said paying for donations was a form of coercion, as it might force people to take risks they otherwise might not. The study sought opinions from kidney transplant physicians on incentives and reimbursement for donations, given the increasing shortage of donors worldwide. This study clearly shows that transplant professionals are frustrated with the waiting period patients endure for organs, especially for kidneys, Thomas Manley, director of scientific activities at the National Kidney Foundation, said in a news release. But the underlying theme is one that we have been advocating for many years — we need to reduce the disincentives associated with living donation, not only in the United States, but around the world. Currently, in the United States, more than 100,000 people are awaiting kidney transplants, according to the news release. In 2013, 16,896 kidney transplants took place in the United States, 5733 of which came from living donors. The authors acknowledge that the survey was done in only English-speaking, wealthier Western countries, and therefore the results may not be globally representative. Participants, selected to represent a wide spectrum of ages, experience, and locations, were interviewed in person and were asked to nominate others with differing or important opinions for additional interviews. Editorial: Incentives Could Include Life Insurance In an accompanying editorial, Puneet Sood, MD, and Sundaram Hariharan, MD, both from the University of Pittsburgh Medical Center in Pennsylvania, agree that basic barriers should be removed, including (for living donors) coverage of lost wages, travel, medical, and out-of-pocket expenses, but they acknowledge this would improve donations only marginally. Among their suggestions for bigger changes are well-regulated, noncash incentives. If incentives are given, they should be given to both directed and nondirected donations, they said, and they should not come from recipients or family members, as that would disadvantage those in lower economic brackets. Instead, the source should be a central organization, such as a private insurance carrier or governmental agency, with strict oversight, they write. Rather than cash, which would undermine altruism and cause many countries hardship, the incentive could be additional life insurance for a certain number of years after donation; health insurance covering physical exams, imaging, and treatment of illnesses; supplemental health insurance; or tax incentives. This approach eases financial concerns because the insurer would be insuring healthy people, they say. They suggest oversight from the government through agencies such as the Centers for Medicare & Medicaid Services to eliminate bias and enforce regulation. This approach is sensible, but would have to pass all regulatory barriers and will increase the cost of kidney transplantation. However, increasing donation, and thus transplantation, will lead to an overall reduction in cost and greater benefit to patients with chronic kidney failure, the authors write. Dr Tong is supported by the National Health and Medical Research Council. The other authors and the editorialists have disclosed no relevant financial relationships. Am J Kidney Dis. Article full text, Editorial full text Medscape Medical News © 2014 WebMD, LLC
Posted on: Mon, 13 Oct 2014 16:06:11 +0000
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