Economic Consequences of Adult Living Kidney Donation: A Systematic Review

doi:10.1016/j.jval.2020.10.005

Value in Health

Volume 24, Issue 4, April 2021, Pages 592-601

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Highlights

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Adult living kidney donors incur both direct and indirect costs as a result of donation. Direct costs include out-of-pocket payments for travel expenses, accommodation, healthcare, and other incidental fees, while indirect costs comprise lost income, dependent care, housework, and other items.
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The average donation-related costs range from $900 to $19 900 over the period of predonation evaluation to the end of the first postoperative year.
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Most donors do not seek financial assistance and incur financial loss due to donation.
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Indirect cost items, not previously reported, include caregiver income loss, the cost associated with obstacles to health and life insurance coverage, and temporary exercise impairment.
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Long-distance donation and poor household economic status were associated with greater donation-related financial burden.
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The next step in compensating living kidney donors needs to focus on predonation evaluation, long-distance donations, and lifetime insurance protection.

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.

Keywords

organ donation

financial neutrality

donor compensation

kidney transplantation