Dynamic Challenges Inhibiting Optimal Adoption of Kidney Paired Donation: Findin

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http://onlinelibrary.wiley.com/doi/10.1111/ajt.12140/abstract

Dynamic Challenges Inhibiting Optimal Adoption of Kidney Paired Donation: Findings of a Consensus Conference
M. L. Melcher1, C. D. Blosser2, L. A. Baxter-Lowe3, F. L. Delmonico4,5, S. E. Gentry6, R. Leishman7, G. A. Knoll8, M. S. Leffell9, A. B. Leichtman10, D. A. Mast11, P. W. Nickerson12, E. F. Reed13, M. A. Rees14, J. R. Rodrigue15, D. L. Segev16, D. Serur17, S. G. Tullius18, E. Y. Zavala19, S. Feng3,*
DOI: 10.1111/ajt.12140
American Journal of Transplantation
Volume 13, Issue 4, pages 851–860, April 2013

Abstract

While kidney paired donation (KPD) enables the utilization of living donor kidneys from healthy and willing donors incompatible with their intended recipients, the strategy poses complex challenges that have limited its adoption in United States and Canada. A consensus conference was convened March 29–30, 2012 to address the dynamic challenges and complexities of KPD that inhibit optimal implementation. Stakeholders considered donor evaluation and care, histocompatibility testing, allocation algorithms, financing, geographic challenges and implementation strategies with the goal to safely maximize KPD at every transplant center. Best practices, knowledge gaps and research goals were identified and summarized in this document.

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http://onlinelibrary.wiley.com/doi/10.1111/ajt.12345/full

Response to “Dynamic Challenges Inhibiting Optimal Adoption of Kidney Paired Donation: Findings of a Consensus Conference” by Melcher et al.
A. O. Ojo1,*, R. M. Merion2, D. H. Howard3, P. H. Warren4
DOI: 10.1111/ajt.12345
American Journal of Transplantation
Volume 13, Issue 8, page 2228, August 2013

To the Editor:

We are responding to the Melcher et al. [1] article, which recommends that the National Living Donor Assistance Center (NLDAC) pay for travel and lodging for nondirected donors (NDDs). We commend the work done by this group of stakeholders and believe the publishing of their findings is vital to improving the process of kidney paired donation. We do, however, need to clarify one point in their many important recommendations.

The article recommends “The National Living Donor Assistance Center should provide travel and lodging expenses to the NDD.” It is important to note that there are limits to the NLDAC program that were put in place by the U.S. Congress. NLDAC cannot pay for the travel and lodging expenses for all NDDs. The Organ Donation Recovery and Improvement Act (ODRIA) [2] established the legislative parameters for NLDAC. ODRIA states that individuals may not receive compensation from the grant if these expenses can reasonably be paid by a State or Federal program, an insurance company or the recipient of the organ. ODRIA requires means testing of the recipient's household income.

In practice, this means a recipient must be identified before an application can be filed with NLDAC. Because NDDs do not have a recipient identified before their evaluation trip to transplant center, NLDAC cannot reimburse those expenses. However, after a recipient is identified, a NLDAC application may then be filed. It should be noted that NLDAC received 42 applications between 2008 and 2012 for NDD, of which 32 were approved, providing NDDs with reimbursement of travel expenses through NLDAC.

If the recipient's household income is below the income threshold of 300% of the HHS Poverty Guidelines, NLDAC is allowed to reimburse those donor's expenses for the surgery and medical follow-up trips. If the recipient's income is above the income threshold, NLDAC may reimburse the donor's expenses if financial hardship is proven by the recipient. If the application is not approved, the National Organ Transplant Act (NOTA) [3] allows the recipient to reimburse the donor's expenses.

Lastly, we agree with the article's recommendation that payers should cover donor travel and lodging costs given that, by donating and traveling, the donor is enabling not only the recipient's transplant, but also those of other recipients.

This letter represents the views of the authors and does not necessarily represent the views of the grant funder.

Disclosure
The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.


References
1
Melcher ML, Blosser CD, Baxter-Lowe LA, et al. Dynamic challenges inhibiting optimal adoption of kidney paired donation: Findings of a consensus conference. Am J Transplant 2013; 13: 851–860.
2
Organ Donation and Recovery Improvement Act (ODRIA) of 2004, U.S.C. §274f.
3
National Organ Transplant Act (NOTA) of 1984, U.S.C. §274e.