Reimbursement, Compensation, and Incentives for Living Kidney Donors

[Clark]

http://www.ajkd.org/article/S0272-6386(14)00609-X/fulltext

Perspectives of Transplant Physicians and Surgeons on Reimbursement, Compensation, and Incentives for Living Kidney Donors
Allison Tong, PhDemail, Jeremy R. Chapman, FRCP, Germaine Wong, PhD, Jonathan C. Craig, PhD
American Journal of Kidney Diseases
Volume 64, Issue 4, Pages 622–632, October 2014
DOI: http://dx.doi.org/10.1053/j.ajkd.2014.02.019

Background
The shortage of donors for organ transplantation has stimulated debate on financial incentives for living kidney donors. This study aims to describe the range of attitudes and opinions of transplant physicians on financial reimbursement, compensation, and incentives in living kidney donation.

Study Design
Qualitative study.

Setting & Participants
110 transplant nephrologists and surgeons from 12 countries across 43 transplantation units in Europe, Australasia, and North America.

Methodology
Face-to-face semistructured interviews were conducted.

Analytical Approach
Transcripts were thematically analyzed.

Results
We identified 7 major themes. Prioritizing the removal of disincentives for living kidney donors was largely deemed acceptable. By contrast, provision of financial incentives raised concerns about undermining benevolence, compromising human dignity and value, and traversing market forces. Some contended that financial incentives potentially were legitimate if regulated, arguing that this would maximize utility in transplantation, but most also acknowledged the difficulty and that operational feasibility of a regulated system of financial incentivization may be limited.

Limitations
Participants were English speaking and from Western high-income countries; therefore, the transferability of our findings may be limited.

Conclusions
Transplantation specialists believed that minimizing disincentives would support equity and justice in living kidney donation. Direct financial incentivization for living kidney donors, even in the context of a regulated market, was regarded by most as unjustified because of the potential moral consequences and uncertain feasibility. Removing financial disincentives and safeguarding the intrinsic volunteerism, value, and meaning of donation were viewed to uphold integrity in living kidney donation.