How to finance kidney exchange?

In kidney exchange (also called kidney paired donation), potential donors have to be evaluated without knowing what patient, if any, their kidney might go to. So...how should those donor evaluation costs be paid for, since they can't be billed to a particular patient's insurance? (This is particularly so for donors who don't proceed to transplant, e.g. because their costly CT scan reveals an anatomical abnormality: so that's a hard to recover cost.) Below, from Pub Med, is the abstract of a paper proposing a solution like the one reached for deceased donors. (The full paper is still under embargo as it hasn't appeared yet in the print version of the American Journal of Transplantation (but you can see the abstract for free here); I'll post a version when I can...)

Call to Develop a Standard Acquisition Charge Model for Kidney Paired Donation.

Rees MA, Schnitzler MA, Zavala EY, Cutler JA, Roth AE, Irwin FD, Crawford SW, Leichtman AB., Am J Transplant. 2012 Apr 9. doi: 10.1111/j.1600-6143.2012.04034.x. [Epub ahead of print],

Abstract

We propose a Medicare Demonstration Project to develop a standard acquisition charge for kidney paired donation. A new payment strategy is required because Medicare and commercial insurance companies may not directly pay living donor costs intended to lead to transplantation of a beneficiary of a different insurance provider. Until the 1970s, when organ procurement organizations were empowered to serve as financial intermediaries to pay the upfront recovery expenses for deceased donor kidneys before knowing the identity of the recipient, there existed similar limitations in the recovery and placement of deceased donor organs. Analogous to the recovery of deceased donor kidneys, kidney paired donation requires the evaluation of living donors before identifying their recipient. Tissue typing, crossmatching and transportation of living donors or their kidneys represent additional financial barriers. Finally, the administrative expenses of the organizations that identify and coordinate kidney paired donation transplantation require reimbursement akin to that necessary for organ procurement organizations. To expand access to kidney paired donation for more patients, we propose a model to reimburse paired donation expenses analogous to the proven strategy used for over 30 years to pay for deceased donor solid organ transplantation in America.
© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.