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Thomas AG, Hussain S, Klitenic SB, Sidoti CN, Waldram MM, Chang A, Motter JD, Terlizzi K, Massie AB, Schofield M, Barstow K, Bingaman A, Segev DL, Levan ML. Effectiveness of a Mobile Health System on Compliance With 2-Year Living Kidney Donor Follow-Up in the United States. Clin Transplant 2025; 39:e70139. [PMID: 40145946 DOI: 10.1111/ctr.70139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 02/25/2025] [Accepted: 03/13/2025] [Indexed: 03/28/2025]
Abstract
BACKGROUND Organ Procurement and Transplantation Network (OPTN) policy requires 2 years of follow-up for living kidney donors (LKDs); however, many transplant hospitals struggle to meet this requirement. We developed and tested a mobile health (mHealth) system for LKD follow-up in a pilot randomized-controlled trial (RCT). METHODS LKDs were randomly assigned to either the intervention (mHealth + standard of care) or control arm (standard of care). We assessed OPTN policy-defined completeness and timeliness of 6-month, 1-year, and 2-year follow-ups. Four hundred LKDs were enrolled in the study (June 2018 to February 2021). RESULTS At 6-month follow-up, a higher proportion of the intervention arm participants completed composite visits (97.5% vs. 91.5%, p = 0.01). Both arms had similar compliance rates at 1- and 2-year follow-up (92.0% vs. 89.5%, p = 0.49, and 66.5% vs. 65.0%, p = 0.83). Intervention arm participants completed 6-month follow-up 11 days earlier than their counterparts (p = 0.009). CONCLUSION mHealth technologies improved 6-month follow-up, but did not impact 1- and 2-year LKD follow-up in this single-center RCT. Other strategies, such as providing services beyond data collection, may be necessary to improve donor engagement and support LDK's long-term follow-up.
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Affiliation(s)
- Alvin G Thomas
- Department of Surgery, NYU Langone Health, New York, New York, USA
- Department of Psychiatry, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sarah Hussain
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Carolyn N Sidoti
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | | | - Amy Chang
- Department of Surgery, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Internal Medicine, East Carolina University, Greenville, North Carolina, USA
| | | | - Kelly Terlizzi
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Allan B Massie
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Mary Schofield
- Methodist Hospital Specialty and Transplant, San Antonio, Texas, USA
| | - Karol Barstow
- Methodist Hospital Specialty and Transplant, San Antonio, Texas, USA
| | - Adam Bingaman
- Methodist Hospital Specialty and Transplant, San Antonio, Texas, USA
| | - Dorry L Segev
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Macey L Levan
- Department of Surgery, NYU Langone Health, New York, New York, USA
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2
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Kumar A, Nishio Lucar AG, Doshi MD. Pushing the Boundaries of Living Donation Through Kidney Paired Donation. Am J Kidney Dis 2025; 85:513-519. [PMID: 39706246 DOI: 10.1053/j.ajkd.2024.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 09/24/2024] [Accepted: 10/03/2024] [Indexed: 12/23/2024]
Abstract
Living-donor kidney transplant (LDKT) is the treatment of choice for patients with advanced kidney disease. Kidney paired donation (KPD), originally proposed to overcome immunological barriers, has now evolved to address biological and chronological incompatibilities and reduce financial disincentives. This strategy has allowed the maximization of the number of LDKTs. In 2021, of the 5,971 LDKTs performed, 1,115 (18.6%) were facilitated by KPD. Although KPD programs vary in size and structure, privately owned KPD programs dominate the landscape. Participation in KPD is far from universal: it is not offered in 40% of transplant centers. Across the United States, there are large areas devoid of transplant centers that offer KPD. As a result, some donor and recipient candidates are missing opportunities for a successful LDKT. Some private KPD programs provide financial and legal protections to living donors. Therefore, access to such donor protections is variable and not available to all donors. In this perspective, we review the evolution of KPD programs, explore ways to enhance participation, discuss the need for transparency about living donation options to donor and recipient candidates, and ultimately call for national action for regulatory oversight and to make living kidney donation financially neutral regardless of participation in KPD.
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Affiliation(s)
- Abhishek Kumar
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Angie G Nishio Lucar
- Division of Nephrology, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Mona D Doshi
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
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Dobbs K, Reuvekamp E, Limburg B, Sakpal SV. Unlocking Rural Live-Kidney Donation Through Insights From a Decade-Long Analysis at a Single Center in the Northern Great Plains. Transplant Proc 2025; 57:180-186. [PMID: 39843344 DOI: 10.1016/j.transproceed.2024.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 12/17/2024] [Indexed: 01/24/2025]
Abstract
BACKGROUND Data on barriers to live-kidney donation in the rural United States is limited despite its widespread adoption across the country. METHODS A retrospective review of 1776 self-referrals for live-kidney donation between June 1, 2012, and May 31, 2022, was conducted. Multivariate analyses evaluated independent factors which may have potentially influenced donation at different stages in its process. RESULTS Of the 1776 self-referrals, 398 (22.4%) individuals underwent evaluation and 121 (6.8%) of those became live-kidney donors. Middle-aged people (average age = 43 years), Whites (91.7%), and women (70.2%) were the most likely to donate. One thousand, one hundred, eighteen individuals (63.0%) dropped out after completing the intake form and the primary reasons included lost to follow-up (32.1%) and donor retraction (24.6%). Concerns related to personal health and compatibility were the predominant subjective factors for retraction. Following in-person evaluation, the most common reasons were medical comorbidities (34.9%) and inoperable renal anatomy (26.5%). Of the 1655 people that did not donate, 178 (10.8%) individuals discovered a new diagnosis during their evaluation process. CONCLUSIONS Only a fraction of those who begin the process proceed to donate a kidney, and most withdraw voluntarily before reaching the in-person evaluation phase. Focused approaches aimed at concerns regarding personal health and donor-recipient compatibility in otherwise healthy, motivated candidates in the early phases of donation hold potential for improving retention rates and subsequent donations.
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Affiliation(s)
- Kaleb Dobbs
- University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Els Reuvekamp
- University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Benjamin Limburg
- University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota
| | - Sujit Vijay Sakpal
- Avera McKennan Hospital and University Health Center, Avera Medical Group Transplant & Liver Surgery, Sioux Falls, South Dakota; Department of Surgery, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota; Department of Internal Medicine, University of South Dakota, Sanford School of Medicine, Sioux Falls, South Dakota.
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Massey EK, Rule AD, Matas AJ. Living Kidney Donation: A Narrative Review of Mid- and Long-term Psychosocial Outcomes. Transplantation 2025; 109:259-272. [PMID: 38886889 PMCID: PMC11652709 DOI: 10.1097/tp.0000000000005094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 04/26/2024] [Accepted: 05/02/2024] [Indexed: 06/20/2024]
Abstract
Living kidney donors make a significant contribution to alleviating the organ shortage. The aim of this article is to provide an overview of mid- and long-term (≥12 mo) living donor psychosocial outcomes and highlight areas that have been understudied and should be immediately addressed in both research and clinical practice. We conducted a narrative review by searching 3 databases. A total of 206 articles were included. Living donors can be divided into those who donate to an emotionally or genetically related person, the so-called directed donors, or to an emotionally or genetically unrelated recipient, the so-called nondirected donors. The most commonly investigated (bio)psychosocial outcome after living donation was health-related quality of life. Other generic (bio)psychological outcomes include specific aspects of mental health such as depression, and fatigue and pain. Social outcomes include financial and employment burdens and problems with insurance. Donation-specific psychosocial outcomes include regret, satisfaction, feelings of abandonment and unmet needs, and benefits of living kidney donation. The experience of living donation is complex and multifaceted, reflected in the co-occurrence of both benefits and burden after donation. Noticeably, no interventions have been developed to improve mid- or long-term psychosocial outcomes among living donors. We highlight areas for methodological improvement and identified 3 areas requiring immediate attention from the transplant community in both research and clinical care: (1) recognizing and providing care for the minority of donors who have poorer long-term psychosocial outcomes after donation, (2) minimizing donation-related financial burden, and (3) studying interventions to minimize long-term psychosocial problems.
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Affiliation(s)
- Emma K. Massey
- Erasmus Medical Center Transplant Institute, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam, Zuid Holland, the Netherlands
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Arthur J. Matas
- Department of Surgery, Transplantation Division, University of Minnesota, Minneapolis, MN
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Rossi AP, Katz-Greenberg G, Coscia L, Brady CW, Doligalski C, Irani RA, Matas A, Shah S, Lentine KL. Living Donation and Pregnancy-Related Complications: State of the Evidence and Call To Action for Improved Risk Assessment. Clin J Am Soc Nephrol 2024; 19:1659-1670. [PMID: 39652653 PMCID: PMC11637692 DOI: 10.2215/cjn.0000000593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2024]
Abstract
Living kidney donation and living liver donation significantly increases organ supply to make lifesaving transplants possible, offering survival benefits to the recipients and cost savings to society. Of all living donors, 40% are women of childbearing age. However, limited data exist regarding the effect of donation on future pregnancies and of pregnancy-related complications on postdonation outcomes. In February 2023, the American Society of Transplantation Women's Health Community of Practice held a virtual Controversies Conference on reproductive health, contraception, and pregnancy after transplantation and living donation. Experts in the field presented the available data. Smaller breakout sessions were created to discuss findings, identify knowledge gaps, and develop recommendations. We present the conference findings related to living donation. The evidence reviewed shows that gestational hypertension and gestational diabetes mellitus before kidney donation have been associated with an increased risk of developing postdonation hypertension and diabetes mellitus, respectively, without increasing the risk of developing an eGFR <45 ml/min after donation. The risk of preeclampsia in living kidney donors increases to 4%-10%, and low-dose aspirin may help reduce that risk. Little is known about the financial burden for living donors who become pregnant, their risk of postpartum depression, or the optimal time between donation and conception. The data on living liver donors are even scarcer. The creation of a registry of donor candidates may help answer many of these questions and, in turn, educate prospective donors so that they can make an informed choice.
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Affiliation(s)
| | - Goni Katz-Greenberg
- Division of Nephrology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Lisa Coscia
- Transplant Pregnancy Registry International, Gift of Life, Philadelphia, Pennsylvania
| | - Carla W. Brady
- Division of Gastroenterology, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Christina Doligalski
- Department of Pharmacy, University of North Carolina Hospitals and Clinics, Chapel Hill, North Carolina
| | - Roxanna A. Irani
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, California
| | - Arthur Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Silvi Shah
- Division of Nephrology and Hypertension, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Krista L. Lentine
- SSM Health Saint Louis University Transplant Center, Saint Louis University School of Medicine, St. Louis, Missouri
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6
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Douglas CE, Bradford MC, Engen RM, Ng YH, Wightman A, Mokiao R, Bartosh S, Dick AA, Smith JM. Neighborhood Socioeconomic Deprivation is Associated with Worse Outcomes in Pediatric Kidney Transplant Recipients. Clin J Am Soc Nephrol 2024; 20:01277230-990000000-00492. [PMID: 39480491 PMCID: PMC11835194 DOI: 10.2215/cjn.0000000592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 10/28/2024] [Indexed: 11/02/2024]
Abstract
Key Points This is the largest US cohort study investigating neighborhood socioeconomic deprivation and outcomes among pediatric kidney transplant recipients. High neighborhood deprivation was associated with worse graft survival and lower access to preemptive and living donor transplantation. Findings demonstrate inequities in pediatric kidney transplantation associated with neighborhood-level factors that warrant intervention. Background Social determinants of health shape a child's transplant course. We describe the association between neighborhood socioeconomic deprivation, transplant characteristics, and graft survival in US pediatric kidney transplant recipients. Methods US recipients younger than 18 years at the time of listing transplanted between January 1, 2010, and May 31, 2022 (N =9178) were included from the Scientific Registry of Transplant Recipients. Recipients were stratified into three groups according to Material Community Deprivation Index score, with greater score representing higher neighborhood socioeconomic deprivation. Outcomes were modeled using multivariable logistic regression and Cox proportional hazards models. Results Twenty-four percent (n =110) of recipients from neighborhoods of high socioeconomic deprivation identified as being of Black race, versus 12% (n =383) of recipients from neighborhoods of low socioeconomic deprivation. Neighborhoods of high socioeconomic deprivation had a much greater proportion of recipients identifying as being of Hispanic ethnicity (67%, n =311), versus neighborhoods of low socioeconomic deprivation (17%, n =562). The hazard of graft loss was 55% higher (adjusted hazards ratio [aHR], 1.55; 95% confidence interval [CI], 1.24 to 1.94) for recipients from neighborhoods of high versus low socioeconomic deprivation when adjusted for base covariates, race and ethnicity, and insurance status, with 59% lower odds (adjusted odds ratio [aOR], 0.41; 95% CI, 0.30 to 0.56) of living donor transplantation and, although not statistically significant, 8% lower odds (aOR, 0.92; 95% CI, 0.72 to 1.19) of preemptive transplantation. The hazard of graft loss was 41% higher (aHR, 1.41; 95% CI, 1.25 to 1.60) for recipients from neighborhoods of intermediate versus low socioeconomic deprivation when adjusted for base covariates, race and ethnicity, and insurance status, with 27% lower odds (aOR, 0.73; 95% CI, 0.66 to 0.81) of living donor transplantation and 11% lower odds (aOR, 0.89; 95% CI, 0.80 to 0.99) of preemptive transplantation. Conclusions Children from neighborhoods of high socioeconomic deprivation have worse graft survival and lower utilization of preemptive and living donor transplantation. These findings demonstrate inequities in pediatric kidney transplantation that warrant further intervention.
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Affiliation(s)
- Chloe E. Douglas
- Division of Pediatric Nephrology and Hypertension, Oregon Health & Science University, Portland, Oregon
| | - Miranda C. Bradford
- Core for Biostatistics, Epidemiology, and Analytics in Research, Seattle Children's Research Institute, Seattle, Washington
| | - Rachel M. Engen
- Division of Nephrology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yue-Harn Ng
- Division of Nephrology, University of Washington School of Medicine, Seattle, Washington
| | - Aaron Wightman
- Treuman Katz Center for Bioethics and Palliative Care, Seattle Children's Research Institute, Seattle, Washington
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Reya Mokiao
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington
| | - Sharon Bartosh
- Division of Nephrology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - André A.S. Dick
- Department of Surgery, University of Washington School of Medicine, Seattle, Washington
- Division of Transplant Surgery, Seattle Children's Hospital, Seattle, Washington
| | - Jodi M. Smith
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
- Division of Nephrology, Seattle Children's Hospital, Seattle, Washington
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Kaplan A, Aby ES, Scott S, Sonnenday C, Fox A, Mathur A, Olthoff K, Heimbach J, Ladin K, Emamaullee J. Financial toxicity in living donor liver transplantation: A call to action for financial neutrality. Am J Transplant 2024; 24:1742-1754. [PMID: 38763318 PMCID: PMC11439575 DOI: 10.1016/j.ajt.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/22/2024] [Accepted: 05/14/2024] [Indexed: 05/21/2024]
Abstract
After 2 decades of limited growth, living donor liver transplant (LDLT) has been increasingly accepted as a promising solution to the growing organ shortage in the US. With experience, LDLT offers superior graft and patient survival with low rates of rejection. However, not all waitlisted patients have equal access to LDLT, with financial toxicity representing a substantial barrier. Potential living liver donors face indirect, direct, and opportunity costs associated with donation as well as insurance-based discrimination and variable employer leave policies. There are multiple potential national, local, and patient-centered solutions to address some of the cost-related issues associated with living LDLT. These include standardization of employer leave policies, creation of federal and state-led tax relief programs, optimization of National Living Donor Assistance Center use, engagement of independent living donor advocates, creation of financial toolkits, and encouragement of recipient or donor-led fundraising. In this piece, members of the North American Living Liver Donation Group, a consortium of 37 LDLT programs, explore these financial challenges and discuss solutions to achieve financial neutrality, where individuals can donate free from financial constraints or gains. As a community, it is imperative that we confront factors driving financial toxicity to improve equity and access to LDLT.
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Affiliation(s)
- Alyson Kaplan
- Department of Gastroenterology and Hepatology, Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Elizabeth S Aby
- Department of Gastroenterology and Hepatology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sonia Scott
- Department of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York, USA
| | | | - Alyson Fox
- Department of Gastroenterology and Hepatology, Columbia University Medical Center, New York, New York, USA
| | - Amit Mathur
- Department of Transplant Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | - Kim Olthoff
- Department of Transplant Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Julie Heimbach
- Department of Transplant Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Keren Ladin
- Department of Gastroenterology and Hepatology, Transplant Institute, Tufts University Medical Center, Boston, Massachusetts, USA
| | - Juliet Emamaullee
- Department of Transplant Surgery, University of Southern California, Los Angeles, California, USA.
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Meinders AM, Graviss EA, Nguyen DT, Daw J, Lentine KL, Peipert JD, Gaber AO, Axelrod DA, Weng FL, Waterman AD. Determining Predictors of Actual Living Kidney Donation Based on Potential Donor Characteristics. Clin Transplant 2024; 38:e15439. [PMID: 39190896 DOI: 10.1111/ctr.15439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/06/2024] [Accepted: 08/12/2024] [Indexed: 08/29/2024]
Abstract
BACKGROUND Living donor kidney transplantation is the optimal treatment for end-stage kidney disease; however, few living donor candidates (LDCs) who begin evaluation actually donate. While some LDCs are deemed medically ineligible, others discontinue for potentially modifiable reasons. METHODS At five transplant centers, we conducted a prospective cohort study measuring LDCs' clinical and psychosocial characteristics, educational preparation, readiness to donate, and social determinants of health. We followed LDCs for 12 months after evaluation to determine whether they donated a kidney, opted to discontinue, had modifiable reasons for discontinuing, were medically ineligible, or had other recipient-related reasons for discontinuing. RESULTS Among 2184 LDCs, 18.6% donated, 38.2% opted to or had modifiable reasons for discontinuing, and 43.2% were deemed ineligible due to medical or recipient-related reasons. Multivariable analyses comparing successful LDCs with those who did not complete donation for modifiable reasons (N = 1241) found that LDCs who discussed donation with the recipient before evaluation (OR, 2.31; 95% CI, 1.54-3.46), had completed high school (OR, 2.01; 95% CI, 1.21-3.35), or were a "close relation" to their recipient (OR, 1.89; 95% CI, 1.33-2.69) were more likely to donate. Conversely, LDCs who reported religion as important (OR, 0.55; 95% CI, 0.38-0.80), were Non-White (OR, 0.70; 95% CI, 0.49-1.00), or had overall higher anxiety scores (OR, 0.92; 95% CI, 0.86-0.99) were less likely to donate. CONCLUSION With fewer than a fifth of LDCs donating, developing programs to provide greater emotional support and facilitate open discussions between LDCs and recipients earlier may increase living donation rates.
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Affiliation(s)
- Andrea M Meinders
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Edward A Graviss
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
- Academic Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Duc T Nguyen
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Jonathan Daw
- Department of Sociology and Criminology, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Krista L Lentine
- SSM Health Saint Louis University Transplant Center, St. Louis University, St. Louis, Missouri, USA
| | - John Devin Peipert
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ahmed Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- Academic Institute, Houston Methodist Hospital, Houston, Texas, USA
- J. C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
| | - David A Axelrod
- University of Iowa Organ Transplant Center, University of Iowa, Iowa City, Iowa, USA
| | - Francis L Weng
- Renal and Pancreas Transplant Division, Cooperman Barnabas Medical Center, RWJ Barnabas Health, Livingston, New Jersey, USA
| | - Amy D Waterman
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
- Academic Institute, Houston Methodist Hospital, Houston, Texas, USA
- J. C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, Texas, USA
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Kim E, Sung HC, Kaplow K, Bendersky V, Sidoti C, Muzaale AD, Akhtar J, Levan M, Esayed S, Khan A, Mejia C, Al Ammary F. Donor Perceptions and Preferences of Telemedicine and In-Person Visits for Living Kidney Donor Evaluation. Kidney Int Rep 2024; 9:2453-2461. [PMID: 39156145 PMCID: PMC11328557 DOI: 10.1016/j.ekir.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Living kidney donor evaluation is a lengthy and complex process requiring in-person visits. Access to transplant centers, travel costs, lost wages, and dependent care arrangements are barriers to willing donors initiating evaluation. Telemedicine can help streamline and epedite the evaluation process. We aimed to deeply understand donor experiences and preferences using hybrid telemedicine video/in-person visits to ease access to donor evaluation or counseling. Methods We conducted in-depth, semistructured interviews with donors or donor candidates who completed their evaluation through telemedicine/in-person, or in-person only visits at a tertiary transplant center between November 27, 2019 and March 1, 2021. Enrollment continued until data saturation was reached (interviews with 20 participants) when no new information emerged from additional interviews. Transcripts were analyzed using inductive thematic analysis. Results Eight themes were identified as follows: (i) reducing financial and logistical burdens (minimizing travel time and travel-related expenses), (ii) enhancing flexibility with scheduling (less time off work and child or family caregiver arrangements), (iii) importance of a walkthrough and establishing shared understanding, (iv) supporting information with technology and visual aids, (v) key role of the coordinator, (vi) preferred visit by provider role (meeting donor surgeon in-person to create rapport and engaging primary care provider in donor evaluation/follow-up), (vii) comparing modality differences in human connection, and (viii) opportunity for family and support network engagement (allowing loved ones to be involved in telemedicine visits irrespective of geographic locations and pandemic restrictions). Conclusion Telemedicine/in-person hybrid model can make donor evaluation more accessible and convenient. Our findings help inform about determinants that influence the adoption of telemedicine to initiate donor evaluation to motivate willing donors. In addition, our results call for policy and legislation that support telemedicine services for living donor kidney transplantation across states.
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Affiliation(s)
- Ellie Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hannah C. Sung
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Katya Kaplow
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Victoria Bendersky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Carolyn Sidoti
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jasmine Akhtar
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Macey Levan
- Department of Surgery, NYU Grossman School of Medicine, New York, New York, USA
| | - Suad Esayed
- Department of Medicine, University of California Irvine, California, USA
| | - Amir Khan
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christina Mejia
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Fawaz Al Ammary
- Department of Medicine, University of California Irvine, California, USA
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10
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Smith AR, Mandell RJ, Goodrich NP, Helmuth ME, Wiseman JB, Gifford KA, Fava MA, Ojo AO, Merion RM, Mathur AK. Living Donor Decision-Making and the Complex Interplay of Finances and Other Motivators, Barriers, and Facilitators. Clin Transplant 2024; 38:e15377. [PMID: 38952192 DOI: 10.1111/ctr.15377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/22/2024] [Accepted: 05/30/2024] [Indexed: 07/03/2024]
Abstract
INTRODUCTION The decision to become a living donor requires consideration of a complex, interactive array of factors that could be targeted for clinical, policy, and educational interventions. Our objective was to assess how financial barriers interact with motivators, other barriers, and facilitators during this process. METHODS Data were obtained from a public survey assessing motivators, barriers, and facilitators of living donation. We used multivariable logistic regression and consensus k-means clustering to assess interactions between financial concerns and other considerations in the decision-making process. RESULTS Among 1592 respondents, the average age was 43; 74% were female and 14% and 6% identified as Hispanic and Black, respectively. Among employed respondents (72%), 40% indicated that they would not be able to donate without lost wage reimbursement. Stronger agreement with worries about expenses and dependent care challenges was associated with not being able to donate without lost wage reimbursement (OR = 1.2, 95% CI = 1.0-1.3; OR = 1.2, 95% CI = 1.1-1.3, respectively). Four respondent clusters were identified. Cluster 1 had strong motivators and facilitators with minimal barriers. Cluster 2 had barriers related to health concerns, nervousness, and dependent care. Clusters 3 and 4 had financial barriers. Cluster 3 also had anxiety related to surgery and dependent care. CONCLUSIONS Financial barriers interact primarily with health and dependent care concerns when considering living organ donation. Targeted interventions to reduce financial barriers and improve provider communication regarding donation-related risks are needed.
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Affiliation(s)
- Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- Northwestern University, Chicago, Illinois, USA
| | | | | | - Margaret E Helmuth
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- University of Michigan Ann Arbor, Ann Arbor, Michigan, USA
| | | | | | - Melissa A Fava
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
| | | | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA
- University of Michigan Ann Arbor, Ann Arbor, Michigan, USA
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11
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Crenshaw R, Woods C, Koizumi N, Dave HS, Gentili M, Saleem JJ. Understanding Barriers and Facilitators to Living Kidney Donation Within a Sociotechnical Systems Framework. QUALITATIVE HEALTH RESEARCH 2024; 34:691-702. [PMID: 38229412 DOI: 10.1177/10497323231224706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The objective of this study was to investigate factors influencing one's decision to become a live kidney donor under the framework of sociotechnical systems, by expanding the focus to include larger organizational influences and technological considerations. Semi-structured interviews were conducted with live kidney donors who donated through University of Louisville Health, Trager Transplant Center, a mid-scale transplant program, in the years 2017 through 2019. The interview transcripts were analyzed for barriers and facilitators to live kidney donation within a sociotechnical system. The most salient facilitators included: having an informative, caring, and available care team; the absence of any negative external pressure toward donating; donating to a family or friend; and the ability to take extra time off work for recovery. The most recurrent barriers included: short/medium-term (<1 year) negative health impacts because of donation; the need to make minor lifestyle changes (e.g., less alcohol consumption) after donation; and mental health deterioration stemming from the donation process. The sociotechnical systems framework promotes a balanced system comprised of social, technical, and environmental subsystems. Assessing the facilitators and barriers from the sociotechnical system perspective revealed the importance of and opportunities for developing strategies to promote integration of technical subsystem, such as social media apps and interactive AI platforms, with social and environmental subsystems to enable facilitators and reduce barriers effectively.
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Affiliation(s)
- Rachel Crenshaw
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
- Analytics, Planning, Strategy and Improvement, Brigham and Women's Hospital, Boston, MA, USA
| | - Cary Woods
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Hitarth S Dave
- Division of Nephrology & Hypertension, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Monica Gentili
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
| | - Jason J Saleem
- Department of Industrial Engineering, University of Louisville, Louisville, KY, USA
- Center for Human Systems Engineering, University of Louisville, Louisville, KY, USA
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12
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Min K, Hwang Y. Factors associated with the quality of life of living kidney donors in Korea: A cross-sectional study. Medicine (Baltimore) 2024; 103:e38068. [PMID: 38728517 PMCID: PMC11081590 DOI: 10.1097/md.0000000000038068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
This study investigated the relationship between self-determination, physical health status, and Health related Quality of Life (=HRQoL) among living kidney donors. A descriptive survey was conducted between 2019 and 2020 and included 111 kidney donors. Data were collected using a self-report questionnaire on general and donation-related characteristics, self-determination, and HRQoL. The data also included medical records reflecting the physical health status at the time of the survey. Data were analyzed using a multiple regression model. Factors associated with HRQoL were perceived health recovery after donation (β = 0.42, P < .001), up to 1 year since donation (β = 0.33, P = .008), more than 1 up to 5 years since donation (β = 0.52, P < .001), more than 5 up to 10 years since donation (β = 0.53, P < .001), and competence of self-determination (β = 0.23, P = .033). The explanatory power of these variables was 43.3%. HRQoL of living kidney donors can be affected by subjective and psychological factors. Therefore, health care providers should help living kidney donors have high self-determination during pre and post donation and concentrate on the subjective and psychological factors as well as objective health status.
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Affiliation(s)
- Kyungok Min
- Transplantation Center, Seoul National University Hospital, Seoul, South Korea
| | - Younghui Hwang
- Department of Nursing Science, College of Medicine, Chungbuk National University, Cheongju, South Korea
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13
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Paoletti F, Urciuoli I, Romagnoli J, Bellini MI. Bariatric surgery in prospective obese living kidney donors: scoping review and management decision algorithm. Minerva Surg 2024; 79:197-209. [PMID: 38127433 DOI: 10.23736/s2724-5691.23.10128-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Global chronic kidney disease is now epidemic, with substantial health and economic consequences. While scientific support for living donor renal transplants (LDRT) is strong, donor shortages necessitate consideration of expanded criteria, including obese individuals. Bariatric surgery (BS) may mitigate obesity-related risks, but research on living donor candidates is scarce. Our scoping review aims to compile evidence, identify gaps, and formulate an algorithm to guide healthcare professionals in evaluating BS for obese living donors. EVIDENCE ACQUISITION We did a systematic search of studies on living kidney donors and obesity. We searched the MEDLINE Ovid, Embase Ovid, CENTRAL and Web of Science databases for studies from database inception to March 30, 2023. All English-language articles available in full text have been considered. Excluded are commentaries, editorials, letters, and abstracts. EVIDENCE SYNTHESIS Obesity in LDRT raises long-term ESRD risk. Current high BMI donor admission raises ethical and clinical concerns. Encouraging timely weight loss can make obese candidates suitable donors, reducing risks. Sleeve gastrectomy is the most reported and preferable approach, since it minimizes hyperoxaluria risk. Re-evaluation for donation is possible 6-12 months post-BS, with BMI<35 for three months. Cost-benefit analysis favors BS over nephrectomy in obese donors (cost-benefit ratio: 3.64) when graft survival is equal. CONCLUSIONS BS shows promise with short-term effectiveness and potential long-term outcomes. However, it should not be perceived as a means to expand the donor pool but rather as a personalized approach to address obesity and improve individuals' health.
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Affiliation(s)
- Filippo Paoletti
- Renal Transplant Unit, Department of Medicine and Surgical Sciences A. Gemelli University Polyclinic Foundation IRCCS, Rome, Italy -
| | | | - Jacopo Romagnoli
- Renal Transplant Unit, Department of Medicine and Surgical Sciences A. Gemelli University Polyclinic Foundation IRCCS, Rome, Italy
- Department of Translational Medicine and Surgery, Catholic University of the Sacred Heart, Rome, Italy
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14
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McElroy LM, Schappe T, Mohottige D, Davis L, Peskoe SB, Wang V, Pendergast J, Boulware LE. Racial Equity in Living Donor Kidney Transplant Centers, 2008-2018. JAMA Netw Open 2023; 6:e2347826. [PMID: 38100105 PMCID: PMC10724764 DOI: 10.1001/jamanetworkopen.2023.47826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 12/18/2023] Open
Abstract
Importance It is unclear whether center-level factors are associated with racial equity in living donor kidney transplant (LDKT). Objective To evaluate center-level factors and racial equity in LDKT during an 11-year time period. Design, Setting, and Participants A retrospective cohort longitudinal study was completed in February 2023, of US transplant centers with at least 12 annual LDKTs from January 1, 2008, to December 31, 2018, identified in the Health Resources Services Administration database and linked to the US Renal Data System and the Scientific Registry of Transplant Recipients. Main Outcomes and Measures Observed and model-based estimated Black-White mean LDKT rate ratios (RRs), where an RR of 1 indicates racial equity and values less than 1 indicate a lower rate of LDKT of Black patients compared with White patients. Estimated yearly best-case center-specific LDKT RRs between Black and White individuals, where modifiable center characteristics were set to values that would facilitate access to LDKT. Results The final cohorts of patients included 394 625 waitlisted adults, of whom 33.1% were Black and 66.9% were White, and 57 222 adult LDKT recipients, of whom 14.1% were Black and 85.9% were White. Among 89 transplant centers, estimated yearly center-level RRs between Black and White individuals accounting for center and population characteristics ranged from 0.0557 in 2008 to 0.771 in 2018. The yearly median RRs ranged from 0.216 in 2016 to 0.285 in 2010. Model-based estimations for the hypothetical best-case scenario resulted in little change in the minimum RR (from 0.0557 to 0.0549), but a greater positive shift in the maximum RR from 0.771 to 0.895. Relative to the observed 582 LDKT in Black patients and 3837 in White patients, the 2018 hypothetical model estimated an increase of 423 (a 72.7% increase) LDKTs for Black patients and of 1838 (a 47.9% increase) LDKTs for White patients. Conclusions and Relevance In this cohort study of patients with kidney failure, no substantial improvement occurred over time either in the observed or the covariate-adjusted estimated RRs. Under the best-case hypothetical estimations, modifying centers' participation in the paired exchange and voucher programs and increased access to public insurance may contribute to improved racial equity in LDKT. Additional work is needed to identify center-level and program-specific strategies to improve racial equity in access to LDKT.
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Affiliation(s)
- Lisa M. McElroy
- Department of Surgery, Duke University School of Medicine, Durham, North Carolina
| | - Tyler Schappe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Dinushika Mohottige
- Institute of Health Equity Research and Barbara T. Murphy Division of Nephrology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - LaShara Davis
- Department of Surgery and J. C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas
| | - Sarah B. Peskoe
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Virginia Wang
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina
| | - Jane Pendergast
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - L. Ebony Boulware
- Wake Forest University School of Medicine, Winston Salem, North Carolina
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15
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Vilayur E, van Zwieten A, Chen M, Francis A, Wyld M, Kim S, Cooper T, Wong G. Sex and Gender Disparities in Living Kidney Donation: A Scoping Review. Transplant Direct 2023; 9:e1530. [PMID: 37636486 PMCID: PMC10455160 DOI: 10.1097/txd.0000000000001530] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 06/23/2023] [Accepted: 06/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Women are more likely than men to be living kidney donors. We summarized the evidence concerning the reasons behind sex and gender disparities in living kidney donation (LKD). Methods A scoping review of quantitative and qualitative evidence on reasons for sex and gender disparities in LKD was conducted from inception to March 2023. Results Of 1123 studies screened, 45 were eligible for inclusion. Most studies were from North America, Europe, and Central Asia (n = 33, 73%). A predominance of women as living donors (55%-65%) was observed in 15 out of 18 (83%) studies. Reasons for sex and gender disparities in LKD included socioeconomic, biological, and cognitive or emotional factors. A gendered division of roles within the families was observed in most studies, with men being the primary income earner and women being the main caregiver. Fear of loss of income was a barrier to male donation. Human leukocyte antigen sensitization through pregnancy in female recipients precluded male partner donation, whereas female donation was supported by altruism and a positive attitude toward LKD. Conclusions Sex imbalance in LKD is prevalent, with a predominance of women as living donors. Such disparities are driven by societal and cultural perceptions of gender roles, pregnancy-induced sensitization, and attitudes toward donation and at least some of these factors are modifiable. Donor compensation to support predonation assessments and income loss, implementation of innovative desensitization treatments, promotion of paired kidney exchange program, and targeted educational initiatives to promote equitable living donation may help to close the gender gap in LKD.
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Affiliation(s)
- Eswari Vilayur
- John Hunter Hospital, Hunter New England Health Service, New Lambton, NSW, Australia
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Anita van Zwieten
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Centre for Kidney Research, Westmead Children’s Hospital, Westmead, NSW, Australia
| | - Mingxing Chen
- Centre for Kidney and Transplantation Research, Westmead Hospital, Westmead, NSW, Australia
| | - Anna Francis
- Department of Nephrology, Queensland Children’s Hospital, Brisbane, QLD, Australia
| | - Melanie Wyld
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Centre for Kidney and Transplantation Research, Westmead Hospital, Westmead, NSW, Australia
| | - Siah Kim
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Centre for Kidney Research, Westmead Children’s Hospital, Westmead, NSW, Australia
| | - Tess Cooper
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
| | - Germaine Wong
- Sydney School of Public Health, The University of Sydney, Camperdown, NSW, Australia
- Centre for Kidney Research, Westmead Children’s Hospital, Westmead, NSW, Australia
- Centre for Kidney and Transplantation Research, Westmead Hospital, Westmead, NSW, Australia
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16
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Polireddy K, Crepeau RL, Matar AJ. Eliminating financial disincentives to living kidney donation - a call to action. Front Med (Lausanne) 2023; 10:1061342. [PMID: 37457572 PMCID: PMC10347391 DOI: 10.3389/fmed.2023.1061342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
The incidence of end stage renal disease (ESRD) in the United States (US) is increasing each year. The lone curative treatment for ESRD remains kidney transplantation. Despite the demonstrated medical and economic benefits, living donor kidney transplantation (LDKT) only accounts for a small number of kidney transplantations each year. Direct and indirect costs exist that disincentivize potential living kidney donors from coming forward, such as the cost of travel and lodging, risk of death, potential loss of income due to an extended recovery time, and the inability to donate to a relative in the future if needed. Herein, we advocate for policy changes that make living kidney donation (LKD) a financially neutral process thereby incentivizing increased LDKT and mitigating the kidney donor shortage.
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Affiliation(s)
| | - Rebecca L. Crepeau
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
| | - Abraham J. Matar
- Department of Surgery, Emory University School of Medicine, Atlanta, GA, United States
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17
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Mejia CD, Brennan DC. Many a Slip Twixt the Intake Form and the Living Donation. Transplantation 2023; 107:818-819. [PMID: 36476542 DOI: 10.1097/tp.0000000000004358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Christina D Mejia
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD
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18
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Cholin LK, Schold JD, Arrigain S, Poggio ED, Sedor JR, O'Toole JF, Augustine JJ, Wee AC, Huml AM. Characteristics of Potential and Actual Living Kidney Donors: A Single-center Experience. Transplantation 2023; 107:941-951. [PMID: 36476994 DOI: 10.1097/tp.0000000000004357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND There are limited data and no national capture of barriers associated with initiating and completing the donation process for potential living kidney donors (LKDs). METHODS We performed a retrospective analysis of 3001 intake forms completed by prospective LKDs from 2016 to 2019 at a single transplant center. We analyzed data from all potential donors who completed the intake until they became ineligible or withdrew or donation was complete. We used univariate and multivariate models to evaluate independent factors associated with donation at various stages in the donation process. RESULTS The donation process was deconstructed into 5 steps: intake form, immunologic compatibility testing, clinic evaluation, selection committee review, and donation. The highest percentage of potential donors dropped out after completing the intake form, primarily because of not responding to the follow-up phone call (22.6%). Of 455 potential LKDs that completed immunologic compatibility testing, 36% were ABO or crossmatch incompatible. One-hundred eighty-eight (7.5%) of all LKD applicants reached donation, the majority of whom were White (91.0%) and female (63.8%). CONCLUSIONS A minority of LKD applicants make it to donation. Our ability to track all potential LKDs from the initial touch point to the transplant center will help us develop interventions to address barriers to a successful donation.
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Affiliation(s)
- Liza K Cholin
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Susana Arrigain
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Emilio D Poggio
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH
- Department of Transplantation, Cleveland Clinic, Cleveland, OH
| | - John R Sedor
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH
| | - John F O'Toole
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH
| | - Joshua J Augustine
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH
- Department of Transplantation, Cleveland Clinic, Cleveland, OH
| | - Alvin C Wee
- Department of Transplantation, Cleveland Clinic, Cleveland, OH
| | - Anne M Huml
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH
- Department of Transplantation, Cleveland Clinic, Cleveland, OH
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19
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Horton A, Loban K, Nugus P, Fortin MC, Gunaratnam L, Knoll G, Mucsi I, Chaudhury P, Landsberg D, Paquet M, Cantarovich M, Sandal S. Health System-Level Barriers to Living Donor Kidney Transplantation: Protocol for a Comparative Case Study Analysis. JMIR Res Protoc 2023; 12:e44172. [PMID: 36881454 PMCID: PMC10031444 DOI: 10.2196/44172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences. Identifying these factors can help inform system-level interventions to increase LDKT. OBJECTIVE Our objective is to generate a systemic interpretation of LDKT delivery across provincial health systems with variable performance. We aim to identify the attributes and processes that facilitate the delivery of LDKT to patients, and those that create barriers and compare these across systems with variable performance. These objectives are contextualized within our broader goal of increasing rates of LDKT in Canada, particularly in lower-performing provinces. METHODS This research takes the form of a qualitative comparative case study analysis of 3 provincial health systems in Canada that have high, moderate, and low rates of LDKT performance (the percentage of LDKT to all kidney transplantations performed). Our approach is underpinned by an understanding of health systems as complex adaptive systems that are multilevel and interconnected, and involve nonlinear interactions between people and organizations, operating within a loosely bounded network. Data collection will comprise semistructured interviews, document reviews, and focus groups. Individual case studies will be conducted and analyzed using inductive thematic analysis. Following this, our comparative analysis will operationalize resource-based theory to compare case study data and generate explanations for our research question. RESULTS This project was funded from 2020 to 2023. Individual case studies were carried out between November 2020 and August 2022. The comparative case analysis will begin in December 2022 and is expected to conclude in April 2023. Submission of the publication is projected for June 2023. CONCLUSIONS By investigating health systems as complex adaptive systems and making comparisons across provinces, this study will identify how health systems can improve the delivery of LDKT to patients with kidney failure. Our resource-based theory framework will provide a granular analysis of the attributes and processes that facilitate or create barriers to LDKT delivery across multiple organizations and levels of practice. Our findings will have practice and policy implications and help inform transferrable competencies and system-level interventions conducive to increasing LDKT. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44172.
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Affiliation(s)
- Anna Horton
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Katya Loban
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Peter Nugus
- Department of Family Medicine and the Institute of Health Sciences Education, McGill University, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Lakshman Gunaratnam
- Matthew Mailing Centre for Translational Transplant Studies, Lawson Health Research Institute, London Health Sciences Centre, London, ON, Canada
- Division of Nephrology, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Greg Knoll
- Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Istvan Mucsi
- Ajmera Transplant Center and Division of Nephrology, University Health Network, Toronto, ON, Canada
- Division of Nephrology, University of Toronto, Toronto, ON, Canada
| | - Prosanto Chaudhury
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - David Landsberg
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Michel Paquet
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Shaifali Sandal
- Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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20
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Yoeli D, Feldman AG, Choudhury RA, Moore HB, Sundaram SS, Nydam TL, Wachs ME, Pomfret EA, Adams MA, Jackson WE. Can non-directed living liver donation help improve access to grafts and correct socioeconomic disparities in pediatric liver transplantation? Pediatr Transplant 2023; 27:e14428. [PMID: 36329627 PMCID: PMC10132215 DOI: 10.1111/petr.14428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/10/2022] [Accepted: 05/05/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Each year, children die awaiting LT as the demand for grafts exceeds the available supply. Candidates with public health insurance are significantly less likely to undergo both deceased donor LT and D-LLD LT. ND-LLD is another option to gain access to a graft. The aim of this study was to evaluate if recipient insurance type is associated with likelihood of D-LLD versus ND-LLD LT. METHODS The SRTR/OPTN database was reviewed for pediatric LDLT performed between January 1, 2014 (Medicaid expansion era) and December 31, 2019 at centers that performed ≥1 ND-LLD LDLT during the study period. A multivariable logistic regression was performed to assess relationship between type of living donor (directed vs. non-directed) and recipient insurance. RESULTS Of 299 pediatric LDLT, 46 (15%) were from ND-LLD performed at 18 transplant centers. Fifty-nine percent of ND-LLD recipients had public insurance in comparison to 40% of D-LLD recipients (p = .02). Public insurance was associated with greater odds of ND-LLD in comparison to D-LLD upon multivariable logistic regression (OR 2.37, 95% CI 1.23-4.58, p = .01). CONCLUSIONS ND-LLD allows additional children to receive LTs and may help address some of the socioeconomic disparity in pediatric LDLT, but currently account for only a minority of LDLT and are only performed at a few institutions. Initiatives to improve access to both D-LLD and ND-LLD transplants are needed.
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Affiliation(s)
- Dor Yoeli
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Amy G Feldman
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Rashikh A Choudhury
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Hunter B Moore
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shikha S Sundaram
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatric Medicine, The Digestive Health Institute, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Trevor L Nydam
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael E Wachs
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Elizabeth A Pomfret
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan A Adams
- Division of Transplantation, Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA.,Division of Abdominal Transplant Surgery, Department of Surgery, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Whitney E Jackson
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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21
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Karydis N, Maroulis I. Changing landscape in living kidney donation in Greece. World J Transplant 2023; 13:28-35. [PMID: 36908308 PMCID: PMC9993187 DOI: 10.5500/wjt.v13.i2.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/05/2023] [Accepted: 01/08/2023] [Indexed: 02/16/2023] Open
Abstract
Patients with end-stage renal disease in Greece are facing long waiting times to receive a kidney transplant from a deceased donor. Living kidney donation offers a valuable alternative that provides optimal outcomes and significantly expands the donor pool but still remains relatively underutilised. Developments around the world in the field of kidney transplantation mandate a change in current practice to include additional options for living donation through paired exchange, antibody-incompatible transplantation and other strategies, following careful consideration of the cultural and ethical factors involved in these complex clinical decisions. An increase in living donation rates may be achieved in several ways, including targeted campaigning to overcome potential barriers. Educating clinicians on transplantation will prove as equally important as informing patients and prospective donors but requires training and resources. Adoption of established practices and implementation of new strategies must be tailored to the needs of the Greek donor and recipient population. Local beliefs about donation, perception of associated risk and other social characteristics must be considered in the design of future strategies. Facilitating living donation in a safe environment with appropriate donor and recipient education will form the solid foundation of a new era of kidney transplantation in Greece.
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Affiliation(s)
- Nikolaos Karydis
- Department of General Surgery and Transplantation, University of Patras, Patras 26504, Greece
| | - Ioannis Maroulis
- Department of General Surgery, University of Patras, Patras 26504, Greece
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22
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Horton A, Loban K, Fortin MC, Charbonneau S, Nugus P, Pâquet MR, Chaudhury P, Cantarovich M, Sandal S. Living Donor Kidney Transplantation in Quebec: A Qualitative Case Study of Health System Barriers and Facilitators. Can J Kidney Health Dis 2023; 10:20543581221150675. [PMID: 36704234 PMCID: PMC9871975 DOI: 10.1177/20543581221150675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/05/2022] [Indexed: 01/21/2023] Open
Abstract
Background Patients with kidney failure represent a major public health burden, and living donor kidney transplantation (LDKT) is the best treatment option for these patients. Current work to optimize LDKT delivery to patients has focused on microlevel interventions and has not addressed interdependencies with meso and macro levels of practice. Objective We aimed to learn from a health system with historically low LDKT performance to identify facilitators and barriers to LDKT. Our specific aims were to understand how LDKT delivery is organized through interacting macro, meso, and micro levels of practice and identify what attributes and processes of this health system facilitate the delivery of LDKT to patients with kidney failure and what creates barriers. Design We conducted a qualitative case study, applying a complex adaptive systems approach to LDKT delivery, that recognizes health systems as being made up of dynamic, nested, and interconnected levels, with the patient at its core. Setting The setting for this case study was the province of Quebec, Canada. Participants Thirty-two key stakeholders from all levels of the health system. This included health care professionals, leaders in LDKT governance, living kidney donors, and kidney recipients. Methods Semi-structured interviews with 32 key stakeholders and a document review were undertaken between February 2021 and December 2021. Inductive thematic analysis was used to generate themes. Results Overall, we identified strong links between system attributes and processes and LDKT delivery, and more barriers than facilitators were discerned. Barriers that undermined access to LDKT included fragmented LDKT governance and expertise, disconnected care practices, limited resources, and regional inequities. Some were mitigated to an extent by the intervention of a program launched in 2018 to increase LDKT. Facilitators driven by the program included advocacy for LDKT from individual member(s) of the care team, dedicated resources, increased collaboration, and training opportunities that targeted LDKT delivery at multiple levels of practice. Limitations Delineating the borders of a "case" is a challenge in case study research, and it is possible that some perspectives may have been missed. Participants may have produced socially desirable answers. Conclusions Our study systematically investigated real-world practices as they operate throughout a health system. This novel approach has cross-disciplinary methodological relevance, and our findings have policy implications that can help inform multilevel interventions to improve LDKT.
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Affiliation(s)
- Anna Horton
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada
| | - Katya Loban
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada,Division of Nephrology, Department of
Medicine, Centre hospitalier de l’Université de Montréal, QC, Canada
| | | | - Peter Nugus
- Department of Family Medicine and
Institute of Health Sciences Education, McGill University, Montreal, QC,
Canada
| | - Michel R. Pâquet
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada,Division of Nephrology, Department of
Medicine, Centre hospitalier de l’Université de Montréal, QC, Canada
| | - Prosanto Chaudhury
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Department of Surgery, McGill
University Health Centre, Montreal, QC, Canada
| | - Marcelo Cantarovich
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Shaifali Sandal
- Research Institute of the McGill
University Health Centre, Montreal, QC, Canada,Division of Nephrology, Department of
Medicine, McGill University Health Centre, Montreal, QC, Canada,Shaifali Sandal, Research Institute of the
McGill University Health Centre, Royal Victoria Hospital Glen Site, D05-7176,
1001 boul Decarie, Montreal, QC H4A 3J1, Canada.
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Al Ammary F, Muzaale AD, Tantisattamoa E, Hanna RM, Reddy UG, Bunnapradist S, Kalantar-Zadeh K. Changing landscape of living kidney donation and the role of telemedicine. Curr Opin Nephrol Hypertens 2023; 32:81-88. [PMID: 36444666 PMCID: PMC9713599 DOI: 10.1097/mnh.0000000000000848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW There has been a decline in living kidney donation over the last two decades. Donors from low-income families or racial/ethnic minorities face greater disproportionate geographic, financial, and logistical barriers to completing lengthy and complex evaluations. This has contributed to the decreased proportion of these subgroups. The authors view telemedicine as a potential solution to this problem. RECENT FINDINGS Since the initial decline of donors in 2005, biologically related donors have experienced a lack of growth across race/ethnicity. Conversely, unrelated donors have emerged as the majority of donors in recent years across race/ethnicity, except for unrelated black donors. Disparities in access to living kidney donation persist. Telemedicine using live-video visits can overcome barriers to access transplant centers and facilitate care coordination. In a U.S. survey, nephrologists, surgeons, coordinators, social workers, and psychologists/psychologists across transplant centers are favorably disposed to use telemedicine for donor evaluation/follow-up beyond the coronavirus disease 2019 pandemic. However, with the waning of relaxed telemedicine regulations under the Public Health Emergency, providers perceive payor policy and out-of-state licensing as major factors hindering telemedicine growth prospects. SUMMARY Permanent federal and state policies that support telemedicine services for living kidney donation can enhance access to transplant centers and help overcome barriers to donor evaluation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Abimereki D. Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ramy M. Hanna
- Department of Medicine, University of California Irvine, Orange, California
| | - Uttam G. Reddy
- Department of Medicine, University of California Irvine, Orange, California
| | - Suphamai Bunnapradist
- Department of Medicine, University of California Los Angeles, Los Angeles, California
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Horton A, Loban K, Nugus P, Fortin M, Gunaratnam L, Knoll G, Mucsi I, Chaudhury P, Landsberg D, Paquet M, Cantarovich M, Sandal S. Health System–Level Barriers to Living Donor Kidney Transplantation: Protocol for a Comparative Case Study Analysis (Preprint).. [DOI: 10.2196/preprints.44172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/19/2023]
Abstract
BACKGROUND
Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure and offers significant medical and economic advantages for both patients and health systems. Despite this, rates of LDKT in Canada have stagnated and vary significantly across Canadian provinces, the reasons for which are not well understood. Our prior work has suggested that system-level factors may be contributing to these differences. Identifying these factors can help inform system-level interventions to increase LDKT.
OBJECTIVE
Our objective is to generate a systemic interpretation of LDKT delivery across provincial health systems with variable performance. We aim to identify the attributes and processes that facilitate the delivery of LDKT to patients, and those that create barriers and compare these across systems with variable performance. These objectives are contextualized within our broader goal of increasing rates of LDKT in Canada, particularly in lower-performing provinces.
METHODS
This research takes the form of a qualitative comparative case study analysis of 3 provincial health systems in Canada that have high, moderate, and low rates of LDKT performance (the percentage of LDKT to all kidney transplantations performed). Our approach is underpinned by an understanding of health systems as complex adaptive systems that are multilevel and interconnected, and involve nonlinear interactions between people and organizations, operating within a loosely bounded network. Data collection will comprise semistructured interviews, document reviews, and focus groups. Individual case studies will be conducted and analyzed using inductive thematic analysis. Following this, our comparative analysis will operationalize resource-based theory to compare case study data and generate explanations for our research question.
RESULTS
This project was funded from 2020 to 2023. Individual case studies were carried out between November 2020 and August 2022. The comparative case analysis will begin in December 2022 and is expected to conclude in April 2023. Submission of the publication is projected for June 2023.
CONCLUSIONS
By investigating health systems as complex adaptive systems and making comparisons across provinces, this study will identify how health systems can improve the delivery of LDKT to patients with kidney failure. Our resource-based theory framework will provide a granular analysis of the attributes and processes that facilitate or create barriers to LDKT delivery across multiple organizations and levels of practice. Our findings will have practice and policy implications and help inform transferrable competencies and system-level interventions conducive to increasing LDKT.
INTERNATIONAL REGISTERED REPORT
DERR1-10.2196/44172
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25
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McCormick F, Held PJ, Chertow GM, Peters TG, Roberts JP. Projecting the Economic Impact of Compensating Living Kidney Donors in the United States: Cost-Benefit Analysis Demonstrates Substantial Patient and Societal Gains. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2028-2033. [PMID: 35690519 DOI: 10.1016/j.jval.2022.04.1732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/16/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The aim of this study was to show how the US government could save approximately 47 000 patients with chronic kidney failure each year from suffering on dialysis and premature death by compensating living kidney donors enough to completely end the kidney shortage. METHODS Supply and demand analysis was used to estimate the number of donated kidneys needed to end the kidney shortage and the level of compensation required to encourage this number of donations. These results were then input into a detailed cost-benefit analysis to estimate the economic value of kidney transplantation to (1) the average kidney recipient and their caregiver, (2) taxpayers, and (3) society in general. RESULTS We estimate half of patients diagnosed with kidney failure each year-approximately 62 000 patients-could be saved from suffering on dialysis and premature death if they could receive an average of 1½ kidney transplants. However, currently there are only enough donated kidneys to save approximately 15 000 patients. To encourage sufficient donations to save the other 47 000 patients, the government would have to compensate living kidney donors approximately $77 000 (±50%) per donor. The value of transplantation to an average kidney recipient (and caregiver) would be approximately $1.5 million, and the savings from the recipient not needing expensive dialysis treatments would be approximately $1.2 million. CONCLUSIONS This analysis reveals the huge benefit that compensating living kidney donors would provide to patients with kidney failure and their caregivers and, conversely, the huge cost that is being imposed on these patients and their families by the current legal prohibition against such compensation.
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Affiliation(s)
- Frank McCormick
- U.S. Economic and Financial Research, Bank of America (Retired), Walnut Creek, CA, USA.
| | - Philip J Held
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Glenn M Chertow
- Norman S. Coplon/Satellite Healthcare, Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Thomas G Peters
- Department of Surgery, University of Florida, Jacksonville, FL, USA
| | - John P Roberts
- Department of Surgery, University of California San Francisco, San Francisco, CA, USA
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Managing the Costs of Routine Follow-up Care After Living Kidney Donation: a Review and Survey of Contemporary Experience, Practices, and Challenges. CURRENT TRANSPLANTATION REPORTS 2022; 9:328-335. [PMID: 36187071 PMCID: PMC9510404 DOI: 10.1007/s40472-022-00379-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2022] [Indexed: 11/12/2022]
Abstract
Purpose of Review While living organ donor follow-up is mandated for 2 years in the USA, formal guidance on recovering associated costs of follow-up care is lacking. In this review, we discuss current billing practices of transplant programs for living kidney donor follow-up, and propose future directions for managing follow-up costs and supporting cost neutrality in donor care. Recent Findings Living donors may incur costs and financial risks in the donation process, including travel, lost time from work, and dependent care. In addition, adherence to the Organ Procurement and Transplantation Network (OPTN) mandate for US transplant programs to submit 6-, 12-, and 24-month postdonation follow-up data to the national registry may incur out-of-pocket medical costs for donors. Notably, the Centers for Medicare and Medicaid Services (CMS) has explicitly disallowed transplant programs to bill routine, mandated follow-up costs to the organ acquisition cost center or to the recipient’s Medicare insurance. We conducted a survey of transplant staff in the USA (distributed October 22, 2020–March 15, 2021), which identified that the mechanisms for recovering or covering the costs of mandated routine postdonation follow-up at responding programs commonly include billing recipients’ private insurance (40%), while 41% bill recipients’ Medicare insurance. Many programs reported utilizing institutional allowancing (up to 50%), and some programs billed the organ acquisition cost center (25%). A small percentage (11%) reported billing donors or donors’ insurance. Summary To maintain a high level of adherence to living donor follow-up without financially burdening donors, up-to-date resources are needed on handling routine donor follow-up costs in ways that are policy-compliant and effective for donors and programs. Development of a government-supported national living donor follow-up registry like the Living Donor Collective may provide solutions for aspects of postdonation follow-up, but requires transplant program commitment to register donors and donor candidates as well as donor engagement with follow-up outreach contacts after donation.
Supplementary Information The online version contains supplementary material available at 10.1007/s40472-022-00379-w.
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Identifying Modifiable System-Level Barriers to Living Donor Kidney Transplantation. Kidney Int Rep 2022; 7:2410-2420. [DOI: 10.1016/j.ekir.2022.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
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Al Ammary F, Motter JD, Sung HC, Lentine KL, Sharfuddin A, Kumar V, Yadav A, Doshi MD, Virmani S, Concepcion BP, Grace T, Sidoti CN, Yahya Jan M, Muzaale AD, Wolf J. Telemedicine services for living kidney donation: A US survey of multidisciplinary providers. Am J Transplant 2022; 22:2041-2051. [PMID: 35575439 PMCID: PMC9543040 DOI: 10.1111/ajt.17093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 01/25/2023]
Abstract
Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine can facilitate healthcare access/care coordination. Yet difficulties exist in telemedicine implementation and sustainability. We sought to examine centers' practices and providers' attitudes toward telemedicine to improve services for donors. We surveyed multidisciplinary providers from 194 active adult US living donor kidney transplant centers; 293 providers from 128 unique centers responded to the survey (center representation rate = 66.0%), reflecting 83.9% of practice by donor volume and 91.5% of US states/territories. Most centers (70.3%) plan to continue using telemedicine beyond the pandemic for donor evaluation/follow-up. Video was mostly used by nephrologists, surgeons, and psychiatrists/psychologists. Telephone and video were mostly used by social workers, while video or telephone was equally used by coordinators. Half of respondent nephrologists and surgeons were willing to accept a remote completion of physical exam; 68.3% of respondent psychiatrists/psychologists and social workers were willing to accept a remote completion of mental status exam. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation. However, providers (65.5%) perceived out-of-state licensing as a key policy/regulatory barrier. These findings help inform practice and underscore the instigation of policies to remove barriers using telemedicine to increase living kidney donation.
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Affiliation(s)
- Fawaz Al Ammary
- Department of MedicineJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Hannah C. Sung
- Department of SurgeryJohns Hopkins UniversityBaltimoreMarylandUSA
| | | | - Asif Sharfuddin
- Department of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Vineeta Kumar
- Department of MedicineUniversity of AlabamaBirminghamAlabamaUSA
| | - Anju Yadav
- Department of MedicineThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Mona D. Doshi
- Department of MedicineUniversity of MichiganAnn ArborMichiganUSA
| | - Sarthak Virmani
- Department of MedicineYale UniversityNew HavenConnecticutUSA
| | | | - Terry Grace
- Department of MedicineWake Forest Baptist HealthWinston‐SalemNorth CarolinaUSA
| | | | | | | | - Joshua Wolf
- Piedmont Transplant InstituteAtlantaGeorgiaUSA
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Horton A, Nugus P, Fortin MC, Landsberg D, Cantarovich M, Sandal S. Health system barriers and facilitators to living donor kidney transplantation: a qualitative case study in British Columbia. CMAJ Open 2022; 10:E348-E356. [PMID: 35440483 PMCID: PMC9022938 DOI: 10.9778/cmajo.20210049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In patients with kidney failure, living donor kidney transplantation (LDKT) is the best treatment option; yet, LDKT rates have stagnated in Canada and vary widely across provinces. We aimed to identify barriers and facilitators to LDKT in a high-performing health system. METHODS This study was conducted using a qualitative exploratory case study of British Columbia. Data collection, conducted between October 2020 and January 2021, entailed document review and semistructured interviews with key stakeholders, including provincial leadership, care teams and patients. We recruited participants via purposive sampling and snowballing technique. We generated themes using thematic analysis. RESULTS After analysis of interviews conducted with 22 participants (5 representatives from provincial organizations, 7 health care providers at transplant centres, 8 health care providers from regional units and 2 patients) and document review, we identified the following 5 themes as facilitators to LDKT: a centralized infrastructure, a mandate for timely intervention, an equitable funding model, a commitment to collaboration and cultivating distributed expertise. The relationship between 2 provincial organizations (BC Transplant and BC Renal Agency) was identified as key to enabling the mandate and processes for LDKT. Five barriers were identified that arose from silos between provincial organizations and manifested as inconsistencies in coordinating LDKT along the spectrum of care. These were divided accountability structures, disconnected care processes, missed training opportunities, inequitable access by region and financial burden for donors and recipients. INTERPRETATION We found strong links between provincial infrastructure and the processes that facilitate or impede timely intervention and referral of patients for LDKT. Our findings have implications for policy-makers and provide opportunities for cross-jurisdictional comparative analyses.
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Affiliation(s)
- Anna Horton
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Peter Nugus
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Marie-Chantal Fortin
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - David Landsberg
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Marcelo Cantarovich
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que
| | - Shaifali Sandal
- Research Institute of the McGill University Health Centre (Horton, Cantarovich, Sandal); Department of Family Medicine and Institute of Health Sciences Education (Nugus), McGill University; Division of Nephrology (Fortin), Department of Medicine, Centre hospitalier de l'Université de Montréal; Centre de recherche du Centre hospitalier de l'Université de Montréal (Fortin), Montréal, Que.; Department of Medicine (Landsberg), University of British Columbia, Vancouver, BC; Division of Nephrology (Cantarovich, Sandal), Department of Medicine, McGill University Health Centre, Montréal, Que.
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Asghari M, Nielsen J, Gentili M, Koizumi N, Elmaghraby A. Identifying internet comments related to living kidney donation: A machine-learning classification approach (Preprint). JMIR Med Inform 2022; 10:e37884. [DOI: 10.2196/37884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 08/18/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
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Sandal S, Horton A, Fortin MC. Advancing a Paradigm Shift to Approaching Health Systems in the Field of Living-Donor Kidney Transplantation: An Opinion Piece. Can J Kidney Health Dis 2022; 9:20543581221079486. [PMID: 35237443 PMCID: PMC8882925 DOI: 10.1177/20543581221079486] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/20/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shaifali Sandal
- Division of Nephrology,
Department of Medicine, McGill University Health Centre, Montreal, QC,
Canada
- The Metabolic Disorders and
Complications Program, Research Institute of the McGill University Health
Centre, Montreal, QC, Canada
| | - Anna Horton
- The Metabolic Disorders and
Complications Program, Research Institute of the McGill University Health
Centre, Montreal, QC, Canada
| | - Marie-Chantal Fortin
- Division of Nephrology,
Department of Medicine, Centre hospitalier de l’Université de Montréal, QC,
Canada
- Centre de recherche du Centre
hospitalier de l’Université de Montréal, QC, Canada
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Zazoulina J, Khehra K, Gill J. Motivators and Barriers to Living Donor Kidney Transplant as Perceived by Past and Potential Donors. Can J Kidney Health Dis 2022; 9:20543581221137179. [PMID: 36419528 PMCID: PMC9677302 DOI: 10.1177/20543581221137179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background: For patients with end-stage kidney disease, living donor kidney transplant is
the treatment of choice due to improved patient outcomes, longer graft
survival, and reduced expenses compared with other forms of renal
replacement therapy. However, organ shortage remains a challenge, and living
donation rates have stagnated in recent years, particularly among men. Objective: To understand the motivators and barriers for past and potential living
kidney transplant donors and inform policy and practice changes that support
donors in the future. Methods: Past and potential living donors in British Columbia, Canada in the preceding
2 years were surveyed. Motivators and barriers were examined in 5
categories: family pressures and domestic responsibilities, finances, the
recovery process, complications, and the transplant evaluation process.
Participants ranked statements in each category on a Likert-type scale. Results: A total of 138 responses were collected. In both women and men, policies that
address family and domestic responsibilities and finances were most strongly
identified as motivators to donate. A large proportion of women and men
reported that guaranteed job security (47% women and 38% of men), paid time
off (51% of women and 42% of men), reimbursement of lost wages (49% of women
and 38% of men), and protections to guarantee no impact on future
insurability (62% of women and 52% of men) were significant motivators to
donate. Timely and efficient medical evaluation was considered to be an
important motivator for donation, with 52% of men and 43% of women reporting
support for a “fast-track” option for evaluation to allow for a more rapid
evaluation process. Median barrier and motivator scores were similar between
women and men. Conclusion: Policies to decrease financial burden, ensure job security, improve childcare
support, and offer a fast-track medical evaluation may motivate potential
living kidney donors, irrespective of gender.
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Affiliation(s)
| | - Keesha Khehra
- The University of British Columbia, Vancouver, Canada
| | - Jagbir Gill
- The University of British Columbia, Vancouver, Canada
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Garg N, Waterman AD, Ranasinghe O, Warnke L, Morris J, Cooper M, Mandelbrot DA. Wages, Travel, and Lodging Reimbursement by the National Kidney Registry: An Important Step Toward Financial Neutrality for Living Kidney Donors in the United States. Transplantation 2021; 105:2606-2611. [PMID: 33675322 DOI: 10.1097/tp.0000000000003721] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Since 2007, the National Living Donor Assistance Center has provided the most financial support to US living donors meeting specific income criteria by reimbursing travel, meal, and lodging expenses. In 2019, the National Kidney Registry started providing lost wages, travel, and lodging reimbursement via their Donor Shield program. Donor Shield is automatically provided to donors who participate in kidney paired donation through the National Kidney Registry or who donate at a Donor Shield Direct center, without any income restrictions. METHODS The support donors across the United States received from the Donor Shield program between January 2019 and February 2020 was studied. RESULTS During the study period, 326 (25.9%) of the 1260 donors covered by Donor Shield, from 46 programs received reimbursements amounting to a total of $647 384.45, with $472 389.97 (73.0%) covering lost wages. Median reimbursement per donor was $1813.80 (range, $44.0-$165.63). Eighty-one percent of 108 reimbursed donors who were surveyed reported that the lack of these reimbursements would have posed a financial hardship, and 4% said they would have been unable to donate without this support. CONCLUSIONS Expansion of lost wages reimbursement programs to all donors in the United States would be an important step toward achieving financial neutrality for this unique population and could also help meet the growing demand for transplantable organs by increasing living donation rates.
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Affiliation(s)
- Neetika Garg
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Amy D Waterman
- Division of Nephrology, University of California, Los Angeles, Los Angeles, CA
- Terasaki Institute of Biomedical Innovation, Los Angeles, CA
| | - Omesh Ranasinghe
- Division of Nephrology, University of California, Los Angeles, Los Angeles, CA
| | | | | | | | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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Zhuang J, Guidry A. A Content Analysis of Living Organ Donation Materials from Certified Transplant Centers. HEALTH COMMUNICATION 2021; 36:2002-2009. [PMID: 32847410 DOI: 10.1080/10410236.2020.1813392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Despite the fact that living organ donation has the great potential to reduce the shortage of transplantable organs, it is still surrounded by many misconceptions, ethical concerns, and myths. Research conducted to understand factors contributing to public misconceptions related to living organ donation is rare. This research takes a content analytic approach to uncover how living organ donation is portrayed in materials developed and delivered by transplant centers across 11 regions. A total of 332 unique materials were analyzed. The results revealed that living kidney donation dominated the corpus of data whereas other living organ donations were largely overlooked. Benefits and risks associated with living organ donation were relatively evenly presented; however, social support necessary to donors and recipients and available resources to obtain social support were not sufficiently addressed. Embedded in these materials were 46 personal narrative stories. Analysis of these stories showed a focus on undirected living organ donation and revealed a wide range of emotional experiences. Significant regional differences were found in several themes, such as benefits and risks, and social support. Inconsistent information regarding living organ donation was present. Practical implications are discussed.
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Affiliation(s)
- Jie Zhuang
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University
| | - Ashley Guidry
- Department of Communication Studies, Bob Schieffer College of Communication, Texas Christian University
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Left lateral segment liver volume is not correlated with anthropometric measures. HPB (Oxford) 2021; 23:1830-1836. [PMID: 33980477 DOI: 10.1016/j.hpb.2021.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 04/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver transplantation is definitive therapy for end stage liver disease in pediatric patients. Living donor liver transplantation (LDLT) with the left lateral segment (LLS) is often a feasible option. However, the size of LLS is an important factor in donor suitability - particularly when the recipient weighs less than 10 kg. In the present study, we sought to define a formula for estimating left lateral segment volume (LLSV) in potential LLS donors. METHODS We obtained demographic and anthropometric measurements on 50 patients with Computed Tomography (CT) scans to determine whole liver volume (WLV), right liver volume (RLV), and LLSV. We performed univariable and multivariable linear regression with backwards stepwise variable selection (p < 0.10) to determine final models. RESULTS Our study found that previously reported anthropometric and demographics variables correlated with volume were significantly associated with WLV and RLV. On univariable analysis, no demographic or anthropometric measures were correlated with LLSV. On multivariable analysis, LLSV was poorly predicted by the final model (R2 = 0.10, Coefficient of Variation [CV] = 42.2) relative to WLV (R2 = 0.33, CV = 18.8) and RLV (R2 = 0.41, CV = 15.8). CONCLUSION Potential LLS living donors should not be excluded based on anthropometric data: all potential donors should be evaluated regardless of their size.
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Veale JL, Nassiri N, Capron AM, Danovitch GM, Gritsch HA, Cooper M, Redfield RR, Kennealey PT, Kapur S. Voucher-Based Kidney Donation and Redemption for Future Transplant. JAMA Surg 2021; 156:812-817. [PMID: 34160572 DOI: 10.1001/jamasurg.2021.2375] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Importance Policy makers, transplant professionals, and patient organizations agree that there is a need to increase the number of kidney transplants by facilitating living donation. Vouchers for future transplant provide a means of overcoming the chronological incompatibility that occurs when the ideal time for living donation differs from the time at which the intended recipient actually needs a transplant. However, uncertainty remains regarding the actual change in the number of living kidney donors associated with voucher programs and the capability of voucher redemptions to produce timely transplants. Objective To examine the consequences of voucher-based kidney donation and the capability of voucher redemptions to provide timely kidney allografts. Design, Setting, and Participants This multicenter cohort study of 79 transplant centers across the US used data from the National Kidney Registry from January 1, 2014, to January 31, 2021, to identify all family vouchers and patterns in downstream kidney-paired donations. The analysis included living kidney donors and recipients participating in the National Kidney Registry family voucher program. Exposures A voucher was provided to the intended recipient at the time of donation. Vouchers had no cash value and could not be sold, bartered, or transferred to another person. When a voucher was redeemed, a living donation chain was used to return a kidney to the voucher holder. Main Outcomes and Measures Deidentified demographic and clinical data from each kidney donation were evaluated, including the downstream patterns in kidney-paired donation. Voucher redemptions were separately evaluated and analyzed. Results Between 2014 and 2021, 250 family voucher-based donations were facilitated. Each donation precipitated a transplant chain with a mean (SD) length of 2.3 (1.6) downstream kidney transplants, facilitating 573 total transplants. Of those, 111 transplants (19.4%) were performed in highly sensitized recipients. Among 250 voucher donors, the median age was 46 years (range, 19-78 years), and 157 donors (62.8%) were female, 241 (96.4%) were White, and 104 (41.6%) had blood type O. Over a 7-year period, the waiting time for those in the National Kidney Registry exchange pool decreased by more than 3 months. Six vouchers were redeemed, and 3 of those redemptions were among individuals with blood type O. The time from voucher redemption to kidney transplant ranged from 36 to 155 days. Conclusions and Relevance In this study, the family voucher program appeared to mitigate a major disincentive to living kidney donation, namely the reluctance to donate a kidney in the present that could be redeemed in the future if needed. The program facilitated kidney donations that may not otherwise have occurred. All 6 of the redeemed vouchers produced timely kidney transplants, indicating the capability of the voucher program.
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Affiliation(s)
- Jeffrey L Veale
- Kidney Transplant Exchange Program, UCLA Health, Department of Urology, David Geffen School of Medicine at ULCA, University of California, Los Angeles, Los Angeles
| | - Nima Nassiri
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles
| | - Alexander M Capron
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles.,Gould School of Law, University of Southern California, Los Angeles
| | - Gabriel M Danovitch
- Kidney Transplant Exchange Program, UCLA Health, Department of Urology, David Geffen School of Medicine at ULCA, University of California, Los Angeles, Los Angeles
| | - H Albin Gritsch
- Kidney Transplant Exchange Program, UCLA Health, Department of Urology, David Geffen School of Medicine at ULCA, University of California, Los Angeles, Los Angeles
| | - Matthew Cooper
- Department of Surgery, Georgetown University School of Medicine, Washington, DC.,National Kidney Registry, Babylon, New York
| | - Robert R Redfield
- Department of Surgery, University of Wisconsin School of Medicine, Madison
| | | | - Sandip Kapur
- Department of Surgery, Weill-Cornell School of Medicine, New York, New York
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Park S, Park J, Kang E, Lee JW, Kim Y, Park M, Kim K, Kim HJ, Han M, Cho JH, Lee JP, Lee S, Kim SW, Park SM, Chae DW, Chin HJ, Kim YC, Kim YS, Choi I, Lee H. Economic Impact of Donating a Kidney on Living Donors: A Korean Cohort Study. Am J Kidney Dis 2021; 79:175-184.e1. [PMID: 34419516 DOI: 10.1053/j.ajkd.2021.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/04/2021] [Indexed: 11/11/2022]
Abstract
RATIONALE & OBJECTIVE Although existing studies have reported adverse health outcomes after kidney donation, its socioeconomic impact on living donors requires further study. STUDY DESIGN A retrospective observational cohort study including a matched comparison group. SETTING & PARTICIPANTS 1,285 living kidney donors from 7 tertiary hospitals between 2003 and 2016, and a matched comparison group consisting of the same number of health screening examinees with similar baseline clinical characteristics and socioeconomic status. All participants were receiving Korean national health insurance. EXPOSURE Kidney donation as reflected in the Korean National Health Insurance System (NHIS) database. OUTCOME Changes in household economic status estimated by Korean national health insurance fees and changes in employment status reflected in the NHIS database. ANALYTICAL APPROACH The outcomes of the donor group and matched control group were compared annually using multivariable logistic regression analyses adjusted for clinical and demographic characteristics. RESULTS The median ages of the donors and matched controls were 45 and 46 years, respectively; 44.6% of both groups were male. Compared to the comparison group, living donors were at higher risk of being unemployed or losing employment during the first 2 years after donation (eg, first-year loss of employment: odds ratio (OR), 2.27 [95% CI, 1.55-3.33]); however, this association did not persist. Donors also had a significantly lower odds of improvement in economic status (OR, 0.57 [95% CI, 0.47-0.71]) and a higher odds of deterioration in financial status (OR, 1.54 [95% CI, 1.23-1.93]) in the first year after transplantation and subsequently. LIMITATIONS Unmeasured differences between donors and matched controls creating residual selection bias and confounding. CONCLUSIONS Living kidney donors may suffer loss of employment and poor economic status after their voluntary donation. The socioeconomic impact on these donors should be considered in conjunction with the potential long-term adverse health outcomes after donation.
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Affiliation(s)
- Sehoon Park
- Department of Biomedical Science, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jina Park
- Department of Biostatistics, College of Medicine, Korea University, Seoul, South Korea
| | - Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Jang Wook Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Yaerim Kim
- Department of Internal Medicine, School of Medicine, Keimyung University, Daegu, South Korea
| | - Minsu Park
- Department of Information and Statistics, Chungnam National University, Daejeon, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University, Seoul, South Korea
| | - Hyo Jeong Kim
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Miyeun Han
- Department of Internal Medicine, Pusan National University Hospital, Pusan, South Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University, Daegu, South Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Boramae Medical Center, Seoul National University, Seoul, South Korea
| | - Sik Lee
- Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, South Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Sang Min Park
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, South Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Ho Jun Chin
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yong Chul Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Yon Su Kim
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea
| | - Insun Choi
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, South Korea
| | - Hajeong Lee
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, South Korea; Department of Internal Medicine, Seoul National University Hospital, Seoul National University, Seoul, South Korea.
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Lentine KL, Pastan S, Mohan S, Reese PP, Leichtman A, Delmonico FL, Danovitch GM, Larsen CP, Harshman L, Wiseman A, Kramer HJ, Vassalotti J, Joseph J, Longino K, Cooper M, Axelrod DA. A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation. Am J Kidney Dis 2021; 78:319-332. [PMID: 34330526 DOI: 10.1053/j.ajkd.2021.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023]
Abstract
Over the past 65 years, kidney transplantation has evolved into the optimal treatment for patients with kidney failure, dramatically reducing suffering through improved survival and quality of life. However, access to transplant is still limited by organ supply, opportunities for transplant are inequitably distributed, and lifelong transplant survival remains elusive. To address these persistent needs, the National Kidney Foundation convened an expert panel to define an agenda for future research. The key priorities identified by the panel center on the needs to develop and evaluate strategies to expand living donation, improve waitlist management and transplant readiness, maximize use of available deceased donor organs, and extend allograft longevity. Strategies targeting the critical goal of decreasing organ discard that warrant research investment include educating patients and clinicians about potential benefits of accepting nonstandard organs, use of novel organ assessment technologies and real-time decision support, and approaches to preserve and resuscitate allografts before implantation. The development of personalized strategies to reduce the burden of lifelong immunosuppression and support "one transplant for life" was also identified as a vital priority. The panel noted the specific goal of improving transplant access and graft survival for children with kidney failure. This ambitious agenda will focus research investment to promote greater equity and efficiency in access to transplantation, and help sustain long-term benefits of the gift of life for more patients in need.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St Louis, MO.
| | - Stephen Pastan
- Department of Medicine, Emory Transplant Center, Atlanta, GA
| | - Sumit Mohan
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA
| | - Alan Leichtman
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | | | | | - Lyndsay Harshman
- Department of Pediatrics, University of Iowa Transplant Institute, Iowa City, IA
| | - Alexander Wiseman
- Department of Medicine, Centura Health-Porter Adventist Hospital, Aurora, CO
| | | | - Joseph Vassalotti
- National Kidney Foundation, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Matthew Cooper
- Department of Surgery, Medstar Georgetown Transplant Institute, Washington, DC
| | - David A Axelrod
- Department of Surgery, University of Iowa Transplant Institute, Iowa City, IA
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de Jong RW, Stel VS, Heaf JG, Murphy M, Massy ZA, Jager KJ. Non-medical barriers reported by nephrologists when providing renal replacement therapy or comprehensive conservative management to end-stage kidney disease patients: a systematic review. Nephrol Dial Transplant 2021; 36:848-862. [PMID: 31898742 PMCID: PMC8075372 DOI: 10.1093/ndt/gfz271] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/31/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Large international differences exist in access to renal replacement therapy (RRT) modalities and comprehensive conservative management (CCM) for patients with end-stage kidney disease (ESKD), suggesting that some patients are not receiving the most appropriate treatment. Previous studies mainly focused on barriers reported by patients or medical barriers (e.g. comorbidities) reported by nephrologists. An overview of the non-medical barriers reported by nephrologists when providing the most appropriate form of RRT (other than conventional in-centre haemodialysis) or CCM is lacking. METHODS We searched in EMBASE and PubMed for original articles with a cross-sectional design (surveys, interviews or focus groups) published between January 2010 and September 2018. We included studies in which nephrologists reported barriers when providing RRT or CCM to adult patients with ESKD. We used the barriers and facilitators survey by Peters et al. [Ruimte Voor Verandering? Knelpunten en Mogelijkheden Voor Verbeteringen in de Patiëntenzorg. Nijmegen: Afdeling Kwaliteit van zorg (WOK), 2003] as preliminary framework to create our own model and performed meta-ethnographic analysis of non-medical barriers in text, tables and figures. RESULTS Of the 5973 articles screened, 16 articles were included using surveys (n = 10), interviews (n = 5) and focus groups (n = 1). We categorized the barriers into three levels: patient level (e.g. attitude, role perception, motivation, knowledge and socio-cultural background), level of the healthcare professional (e.g. fears and concerns, working style, communication skills) and level of the healthcare system (e.g. financial barriers, supportive staff and practice organization). CONCLUSIONS Our systematic review has identified a number of modifiable, non-medical barriers that could be targeted by, for example, education and optimizing financing structure to improve access to RRT modalities and CCM.
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Affiliation(s)
- Rianne W de Jong
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Vianda S Stel
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - James G Heaf
- Department of Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Mark Murphy
- The Irish Kidney Association CLG, Dublin, Ireland
| | - Ziad A Massy
- Division of Nephrology, Ambroise Paré University Hospital, APHP, University of Paris Ouest-Versailles-St-Quentin-en-Yvelines (UVSQ), Boulogne-Billancourt/Paris, France
- Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Team 5, CESP UVSQ, University Paris Saclav, Villejuif, France
| | - Kitty J Jager
- ERA-EDTA Registry, Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Fu R, Sekercioglu N, Hishida M, Coyte PC. Economic Consequences of Adult Living Kidney Donation: A Systematic Review. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:592-601. [PMID: 33840438 DOI: 10.1016/j.jval.2020.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/16/2020] [Accepted: 10/03/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Current guidelines mandate organ donation to be financially neutral such that it neither rewards nor exploits donors. This systematic review was conducted to assess the magnitude and type of costs incurred by adult living kidney donors and to identify those at risk of financial hardship. METHODS We searched English-language journal articles and working papers assessing direct and indirect costs incurred by donors on PubMed, MEDLINE, Scopus, the National Institute for Health Research Economic Evaluation Database, Research Papers in Economics, and EconLit in 2005 and thereafter. Estimates of total costs, types of costs, and characteristics of donors who incurred the financial burden were extracted. RESULTS Sixteen studies were identified involving 6158 donors. Average donor-borne costs ranged from US$900 to US$19 900 (2019 values) over the period from predonation evaluation to the end of the first postoperative year. Less than half of donors sought financial assistance and 80% had financial loss. Out-of-pocket payments for travel and health services were the most reported items where lost income accounted for the largest proportion (23.2%-83.7%) of total costs. New indirect cost items were identified to be insurance difficulty, exercise impairment, and caregiver income loss. Donors from lower-income households and those who traveled long distances reported the greatest financial hardship. CONCLUSIONS Most kidney donors are undercompensated. Our findings highlight gaps in donor compensation for predonation evaluation, long-distance donations, and lifetime insurance protection. Additional studies outside of North America are needed to gain a global prospective on how to provide for financial neutrality for kidney donors.
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Affiliation(s)
- Rui Fu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
| | - Nigar Sekercioglu
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Manabu Hishida
- Department of Nephrology, Nagoya University Graduate School of Medicine, Ibaraki, Japan
| | - Peter C Coyte
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
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Pais P, Blydt-Hansen TD, Michael Raj JA, Dello Strologo L, Iyengar A. Low renal transplantation rates in children with end-stage kidney disease: A study of barriers in a low-resource setting. Pediatr Transplant 2021; 25:e13867. [PMID: 33058452 DOI: 10.1111/petr.13867] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 09/02/2020] [Accepted: 09/03/2020] [Indexed: 02/06/2023]
Abstract
After 2 decades as a low-cost transplant centre in India, our rates of kidney transplantation are low compared to the burden of end-stage kidney disease (ESKD). We performed this study to identify possible barriers inhibiting paediatric kidney transplant and to assess the outcomes of paediatric ESKD. A retrospective chart review of ESKD patients (2013 - 2018) at a tertiary paediatric nephrology centre was conducted. Medical/non-medical barriers to transplant were noted. Patient outcomes were classified as "continued treatment," "lost to follow-up (LTFU)" or "died." Of 155 ESKD patients (monthly income 218 USD [146, 365], 94% self-pay), only 30 (19%) were transplanted (28 living donor). Sixty-five (42%) were LTFU, 19 (12%) died, and 71 (46%) continued treatment. LTFU/death was associated with greater travel distance (300 km [60, 400] vs 110 km [20, 250] km, P < .0001) and lower monthly income (145 USD [101, 290] vs 290 USD [159, 681], P < .0001). Among those who continued treatment, 41 proceeded to transplant evaluation of whom 13 had no living donor and remained waitlisted for 27 months (15, 30). The remainder (n = 30) did not proceed to transplant due to unresolved medical issues (n = 10) or a lack of parental interest in pursuing transplant (n = 20). Barriers to transplantation in low-resource setting begin in ESKD. LTFU resulted in withdrawal of care and was associated with low socioeconomic status. Among those who continued treatment, transplant rates were higher but medical challenges and negative attitudes towards transplant and organ donation occurred.
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Affiliation(s)
- Priya Pais
- Department of Pediatric Nephrology, St John's Medical College, St John's National Academy of Health Sciences, Bangalore, India
| | - Tom D Blydt-Hansen
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, Canada
| | - John A Michael Raj
- Department of Biostatistics, St John's Medical College, St John's National Academy of Health Sciences, Bangalore, India
| | - Luca Dello Strologo
- Pediatric Nephrology and Renal Transplant Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy
| | - Arpana Iyengar
- Department of Pediatric Nephrology, St John's Medical College, St John's National Academy of Health Sciences, Bangalore, India
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Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe. Kidney Int 2021; 100:182-195. [PMID: 33359055 DOI: 10.1016/j.kint.2020.12.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/26/2020] [Accepted: 12/07/2020] [Indexed: 02/06/2023]
Abstract
The aims of this study were to determine the frequency of dialysis and kidney transplantation and to estimate the regularity of comprehensive conservative management (CCM) for patients with kidney failure in Europe. This study uses data from the ERA-EDTA Registry. Additionally, our study included supplemental data from Armenia, Germany, Hungary, Ireland, Kosovo, Luxembourg, Malta, Moldova, Montenegro, Slovenia and additional data from Israel, Italy, Slovakia using other information sources. Through an online survey, responding nephrologists estimated the frequency of CCM (i.e. planned holistic care instead of kidney replacement therapy) in 33 countries. In 2016, the overall incidence of replacement therapy for kidney failure was 132 per million population (pmp), varying from 29 (Ukraine) to 251 pmp (Greece). On 31 December 2016, the overall prevalence of kidney replacement therapy was 985 pmp, ranging from 188 (Ukraine) to 1906 pmp (Portugal). The prevalence of peritoneal dialysis (114 pmp) and home hemodialysis (28 pmp) was highest in Cyprus and Denmark respectively. The kidney transplantation rate was nearly zero in some countries and highest in Spain (64 pmp). In 28 countries with five or more responding nephrologists, the median percentage of candidates for kidney replacement therapy who were offered CCM in 2018 varied between none (Slovakia and Slovenia) and 20% (Finland) whereas the median prevalence of CCM varied between none (Slovenia) and 15% (Hungary). Thus, the substantial differences across Europe in the frequency of kidney replacement therapy and CCM indicate the need for improvement in access to various treatment options for patients with kidney failure.
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Habbous S, Barnieh L, Klarenbach S, Manns B, Sarma S, Begen MA, Litchfield K, Lentine KL, Singh S, Garg AX. Evaluating multiple living kidney donor candidates simultaneously is more cost-effective than sequentially. Kidney Int 2020; 98:1578-1588. [DOI: 10.1016/j.kint.2020.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/13/2020] [Accepted: 06/04/2020] [Indexed: 01/11/2023]
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Lee SS, Sielski MW, Charpentier KP. Association Between the Economic Environment and the Living Organ Donation Rate: Evidence and Implications. J Am Coll Surg 2020; 232:187-194.e5. [PMID: 33197569 DOI: 10.1016/j.jamcollsurg.2020.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/15/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We studied the contribution of the economic environment to an individual's decision to donate an organ by examining the relationship between the unemployment rate and the living donation rate. STUDY DESIGN We obtained living organ donation data from the Organ Procurement and Transplant Network (OPTN) containing 134,138 organ donation events from 1990 through 2016. We obtained monthly unemployment rates from the Bureau of Labor Statistics (BLS) from 1990 through 2016, and obtained quarterly real gross domestic product (real GDP) by state from the Bureau of Economic Analysis (BEA) from 2005 through 2016. We conducted graphical and statistical analysis with regression modeling using state and time fixed effects. RESULTS Descriptive graphical plots suggest that unlike the unemployment rate, the donation rate is non-cyclical over time, implying little association between the two factors. This is conferred by a linear regression model using state and calendar month fixed effects, where we found no significant association between the unemployment and donation rates (95% CI [-0.004, 0.008], interpreted as the change in number of donations per 100,000 people associated with 1% change in the unemployment rate). We also did not find any significant association between the real GDP and the donation rates. Subgroup analysis by sex, race, and age also revealed no significant associations. CONCLUSIONS The unemployment rate and the real GDP do not appear to be associated with the living organ donation rate, suggesting that the economic environment may not play a major role in the decision to donate an organ.
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Affiliation(s)
- Sean S Lee
- Warren Alpert Medical School, Brown University, Providence, RI
| | - Michael W Sielski
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Wharton School of Business, University of Pennsylvania, Philadelphia, PA
| | - Kevin P Charpentier
- Department of Surgery, Rhode Island Hospital Providence, RI; Department of Signature Healthcare, Brockton, MA.
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Waterman AD, Gleason J, Lerminiaux L, Wood EH, Berrios A, Meacham LA, Osuji A, Pines R, Peipert JD. Amplifying the Patient Voice: Key Priorities and Opportunities for Improved Transplant and Living Donor Advocacy and Outcomes During COVID-19 and Beyond. CURRENT TRANSPLANTATION REPORTS 2020; 7:301-310. [PMID: 32904875 PMCID: PMC7462355 DOI: 10.1007/s40472-020-00295-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose of Review To define patient advocacy and engagement for modern transplant and living donation care, particularly in light of the COVID-19 pandemic, describe the patient experience when transplant advocacy and engagement are optimized, and recommend opportunities for advocacy within three key areas: (1) including the patient voice in healthcare decisions and drug development, (2) access to the best evidence-based treatments and informed decision-making, and (3) present and future care innovations and policies. Recent Findings There are many avenues for transplant and living donation advocacy and engagement at the patient, provider, family, system, community, and policy levels. Key recommendations include the following: (1) simplifying education to be health literate, written at the appropriate reading level, culturally sensitive, and available in multiple languages and across many delivery platforms, (2) inviting transplant patients and donors to the conversation through advisory panels, consensus conferences, and new mediums like digital storytelling and patient-reported outcomes (PROs), (3) training all members of the health team to understand their role as advocates, and (4) advancing policies and programs that support the financial neutrality of living donation, and support recipients with the cost of immunosuppressive drugs. Key recommendations specific to the COVID-19 pandemic include providing up-to-date, health literate, concise information about preventing COVID-19 and accessing care including telehealth. Summary Enhancing advocacy and engagement for transplant patients and donors along the pre-to-post transplant/donation continuum can improve clinical outcomes and quality of life generally, and more so, in light of the COVID-19 pandemic.
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Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Jim Gleason
- Transplant Recipients International, Beverly, NJ USA
| | - Louise Lerminiaux
- Transplant Diagnostics, Thermo Fisher Scientific, Los Angeles, CA USA
| | - Emily H. Wood
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA USA
| | - Alexander Berrios
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Laurie A. Meacham
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Anne Osuji
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - Rachyl Pines
- Terasaki Institute for Biomedical Innovation, University of California Los Angeles, Los Angeles, CA USA
| | - John D. Peipert
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL USA
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University Transplant Outcomes Research Collaborative, Chicago, IL USA
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Challenges, Innovations, and Next Steps in Achieving Financial Neutrality for Living Donors. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00291-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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The need for a living donor wellness program. Curr Opin Organ Transplant 2020; 25:311-315. [PMID: 32487890 DOI: 10.1097/mot.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Living donation has a tremendous impact in bridging the gap between the shortage of organs and the growing list of transplant candidates but remains underutilized as a percentage of total transplants performed. This review focuses on obesity and social determinants of health as potential barriers to the expansion of living kidney donation. RECENT FINDINGS The growing rate of obesity and associated metabolic syndrome make many potential donors unacceptable as donor candidates because of the future risk for developing chronic health conditions, such as hypertension and diabetes. There is also increasing evidence demonstrating socioeconomic differences and racial disparities potentially limit access to living donation in certain populations. These potentially modifiable factors are not exclusive of each other and together serve as significant contributing factors to lower rates of living donation. SUMMARY Living donors make sacrifices to provide the gift of life to transplant recipients, despite the potential risks to their own health. Studies describing risk factors to living donation call attention to the overall need for more action to prioritize and promote the health and well being of living donors.
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Toufeeq Khan TF, Mirza I, Rashid T, Anwar N. Unrelated donors in kidney transplantation: Myths and the gruesome reality. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:563-567. [PMID: 32394939 DOI: 10.4103/1319-2442.284041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Taqi F Toufeeq Khan
- Department of Nephrology and Transplantation, Rehman Medical Institute, Peshawar, Pakistan
| | - Irfan Mirza
- Department of Nephrology and Transplantation, Rehman Medical Institute, Peshawar, Pakistan
| | - Tahir Rashid
- Department of Nephrology and Transplantation, Rehman Medical Institute, Peshawar, Pakistan
| | - Nisar Anwar
- Department of Nephrology and Transplantation, Rehman Medical Institute, Peshawar, Pakistan
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Sussell J, Silverstein AR, Goutam P, Incerti D, Kee R, Chen CX, Batty DS, Jansen JP, Kasiske BL. The economic burden of kidney graft failure in the United States. Am J Transplant 2020; 20:1323-1333. [PMID: 32020739 DOI: 10.1111/ajt.15750] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 11/13/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
Abstract
Despite improvements in outcomes for kidney transplant recipients in the past decade, graft failure continues to impose substantial burden on patients. However, the population-wide economic burden of graft failure has not been quantified. This study aims to fill that gap by comparing outcomes from a simulation model of kidney transplant patients in which patients are at risk for graft failure with an alternative simulation in which the risk of graft failure is assumed to be zero. Transitions through the model were estimated using Scientific Registry of Transplant Recipients data from 1987 to 2017. We estimated lifetime costs, overall survival, and quality-adjusted life-years (QALYs) for both scenarios and calculated the difference between them to obtain the burden of graft failure. We find that for the average patient, graft failure will impose additional medical costs of $78 079 (95% confidence interval [CI] $41 074, $112 409) and a loss of 1.66 QALYs (95% CI 1.15, 2.18). Given 17 644 kidney transplants in 2017, the total incremental lifetime medical costs associated with graft failure is $1.38B (95% CI $725M, $1.98B) and the total QALY loss is 29 289 (95% CI 20 291, 38 464). Efforts to reduce the incidence of graft failure or to mitigate its impact are urgently needed.
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Affiliation(s)
| | | | | | | | - Rebecca Kee
- Precision Health Economics, Los Angeles, California
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Mathur AK, Stewart Lewis ZA, Warren PH, Walters MC, Gifford KA, Xing J, Goodrich NP, Bennett R, Brownson A, Ellefson J, Felan G, Gray B, Hays RE, Klein-Glover C, Lagreco S, Metzler N, Provencher K, Walz E, Warmke K, Merion RM, Ojo AO. Best practices to optimize utilization of the National Living Donor Assistance Center for the financial assistance of living organ donors. Am J Transplant 2020; 20:25-33. [PMID: 31680449 DOI: 10.1111/ajt.15684] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 01/25/2023]
Abstract
Living organ donors face direct costs when donating an organ, including transportation, lodging, meals, and lost wages. For those most in need, the National Living Donor Assistance Center (NLDAC) provides reimbursement to defray travel and subsistence costs associated with living donor evaluation, surgery, and follow-up. While this program currently supports 9% of all US living donors, there is tremendous variability in its utilization across US transplant centers, which may limit patient access to living donor transplantation. Based on feedback from the transplant community, NLDAC convened a Best Practices Workshop on August 2, 2018, in Arlington, VA, to identify strategies to optimize transplant program utilization of this valuable resource. Attendees included team members from transplant centers that are high NLDAC users; the NLDAC program team; and Advisory Group members. After a robust review of NLDAC data and engagement in group discussions, the workgroup identified concrete best practices for administrative and transplant center leadership involvement; for individuals filing NLDAC applications at transplant centers; and to improve patient education about potential financial barriers to living organ donation. Multiple opportunities were identified for intervention to increase transplant programs' NLDAC utilization and reduce financial burdens inhibiting expansion of living donor transplantation in the United States.
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Affiliation(s)
| | - Zoe A Stewart Lewis
- Transplant Surgery, New York University Langone Medical Center, New York, New York
| | | | | | | | - Jiawei Xing
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | | | - Ada Brownson
- Augusta University Transplant Program, Augusta, Georgia
| | - Jill Ellefson
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | - Gerardo Felan
- University of Texas Health Science Center, San Antonio, Texas
| | | | - Rebecca E Hays
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | | | | | | | | | - Emily Walz
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kara Warmke
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
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