Sunday, December 18, 2016

Removing financial disincentives to kidney donation in the U.S.

A forthcoming article in the American Journal of Transplantation, by authors who are firmly opposed to creating incentives for donation, show increasing acceptance of reimbursing donor expenses...but there is as yet too little action towards making that happen.

Providing coverage for the unique life-long health care needs of living kidney donors within the framework of financial neutrality
John S. Gill, Francis Delmonico, Scott Klarenbach and Alexander Morgan Capron
Accepted manuscript online: 26 NOV 2016
Organ donation should neither enrich nor impose financial burdens on donors. We describe the scope of health care required for all living kidney donors that reflects contemporary understanding of long-term donor health outcomes, propose an approach to identify donor health conditions which should be covered within the framework of financial neutrality, and propose strategies to pay for this care. Despite the Affordable Care Act in the United States, donors continue to have inadequate coverage for important health conditions that are either donation related or may compromise post-donation kidney function. Amendment of Medicare regulations is needed to clarify that surveillance and treatment of conditions that may compromise post-donation kidney function following donor nephrectomy will be covered without expense to the donor. In other countries lacking health insurance for all residents, sufficient data exist to allow creation of a compensation fund or donor insurance policies to ensure appropriate care. Providing coverage for donation-related sequelae as well as care to preserve post-donation kidney function ensures protection against the financial burdens of health care encountered by donors throughout their lifetime. Providing coverage for this care should thus be cost-effective even without considering the health care cost savings that occur in living donor transplant recipients. T 
It is now widely accepted that to remove economic barriers to donation and achieve a fair and successful program of living organ donation, the gift of an organ must be “financially neutral” for the donor. Financial neutrality requires that donors be protected against health care costs arising from post-surgical events, and medical complications that manifest in the weeks or months after the donation, as well as the long-term care of conditions that may compromise residual kidney function.
Strategies to provide for the particular lifelong health care needs of living donors will vary among countries. Limiting coverage to the costs arising from the donation and its potential sequelae including loss of post donation kidney function will avoid creating an inducement to donate—and the consequent violation of financial neutrality—that would arise were countries to offer living donors comprehensive medical insurance as a means of covering donors’ future health-care costs.

and here's an earlier related paper...

Am J Transplant. 2015 May;15(5):1187-91. doi: 10.1111/ajt.13232. Epub 2015 Mar 31.
Living and deceased organ donation should be financially neutral acts.
The supply of organs—particularly kidneys—donated by living and deceased donors falls short of the number of patients added annually to transplant waiting lists in the United States. To remedy this problem, a number of prominent physicians, ethicists, economists and others have mounted a campaign to suspend the prohibitions in the National Organ Transplant Act of 1984 (NOTA) on the buying and selling of organs. The argument that providing financial benefits would incentivize enough people to part with a kidney (or a portion of a liver) to clear the waiting lists is flawed. This commentary marshals arguments against the claim that the shortage of donor organs would best be overcome by providing financial incentives for donation. We can increase the number of organs available for transplantation by removing all financial disincentives that deter unpaid living or deceased kidney donation. These disincentives include a range of burdens, such as the costs of travel and lodging for medical evaluation and surgery, lost wages, and the expense of dependent care during the period of organ removal and recuperation. Organ donation should remain an act that is financially neutral for donors, neither imposing financial burdens nor enriching them monetarily.

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