Economic Consequences of Adult Living Kidney Donation: A Systematic Review
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.
CET Conclusion
| Reviewer: | Dr Liset Pengel, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | The narrative systematic review aimed to assess the donor costs for adult living kidney donors. A comprehensive search identified 16 studies mostly published since 2005 that came from North America. Two reviewers independently selected studies for inclusion and extracted data. One reviewer assessed the risk of bias using the appraisal checklists from the Joanna Briggs Institute and found that most (13/16) studies had low risks of bias. The review included pre-, peri- and post-donation costs incurred by the donor and their caregivers. The average donor would incur a cost between $900 and $19,900 from pre-donation evaluation to the first posttransplant year. Eleven out of 16 studies presented direct, out-of-pocket expenses related to travel, accommodation and health services. All studies reported indirect costs, such as lost income, lost home productivity and new costs including lost income for the donor caregiver and insurance difficulties. Most costs were uncompensated. Donor-perceived financial burden was higher among donors from lower-income households and those who travelled greater distances. |
Study Details
| Aims: | This study aimed to evaluate the magnitude and type of cost that adult living kidney donors have to incur. |
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| Interventions: | A literature search was conducted using the UK National Institute for Health Research Economic Evaluation Database, MEDLINE, PubMed, Scopus, Research Papers in Economics, and EconLit. Study selection and data extraction were performed by two reveiwers. The methodological quality of the included studies was assessed by one reviewer, using the the Joanna Briggs Institute appraisal checklists. |
| Participants: | 16 studies were included in the review. |
| Outcomes: | The primary outcome was total donor-borne costs. The secondary outcomes were types of costs and donation-related financial correlates. |
| Follow Up: | N/A |
Metadata
| Funding: | No funding was received for this study |
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| Publication type: | Systematic Review |
| Organ: | Kidney |
| Language: | English |
| Author email: | rui.fu@mail.utoronto.ca |
| MeSH terms: | Adult; Health Care Costs; Humans; Kidney; Kidney Transplantation; Living Donors; Middle Aged; Socioeconomic Factors; Tissue and Organ Procurement |