Kidney donors pay the price

People who donate a kidney to help someone else often suffer financially to do so, according to a study done in part by the University of Alberta in Edmonton, Canada.

While expenses for medical evaluation, surgery and hospital care are generally covered through public or private insurance, donors often foot the bill for other costs associated with the donation process, said Dr. Scott Klarenbach, a co-author on the study who is a nephrologist and health economist at the University of Alberta in Canada. The results of the review appear in the July issue of Nephrology Dialysis Transplantation.

"We found that living organ donors, through their altruistic act to improve the health of others, may experience substantial economic losses in a variety of cost categories," Klarenbach said.

Klarenbach and fellow researchers from the University of Western Ontario and McMaster University reviewed 35 relevant studies from 12 countries about costs incurred by people who donated kidneys between 1964 and 2003. It is the first such review to assemble and analyze quantitative data on the direct and indirect costs incurred by living kidney donors. The research revealed that while no one study had a complete tally of expenses, many types of costs attributable to kidney donation were incurred.

Due to the nature of the existing literature, a composite tally was not possible. However, costs incurred by donors were common. For example, a U.S. study reported average costs of $837 per donor, and ranged from zero to $28,900. Travel and/or accommodation costs were incurred by nine to 99 per cent of the donors and were higher in countries with a larger land mass, such as Canada. The study also showed that 14 to 30 per cent of donors incurred costs for lost income, with an average loss of $3,386 in one study from the United Kingdom and $682 in a study from the Netherlands.

Studies from Australia and Germany showed that physical limitations following transplant surgery cost three per cent of donors their jobs by either being fired or resigning. As well, a U.S. study showed that over the long term donors were 37 per cent less likely than non-donors to have growth in household income. Due to the various shortcomings of existing studies, it is very likely that both the frequency and magnitude of the above costs are systematically underestimated, however, even relatively small costs may be a significant burden to those who donate, and may be a disincentive to potential donors, Klarenbach said.

As living organ donation is increasingly relied upon to improve the health of those with kidney failure, it is critical to understand the associated economic risks for donors. "This information is needed to properly inform and protect potential donors and to assist in guiding donor reimbursement policies, which are being considered in several countries," he added.

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The study was supported by the Canadian Institutes of Health Research and the Canadian Council for Donation and Transplantation.


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