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Nonreimbursed Costs Incurred by Living Kidney Donors

A Case Study From Ontario, Canada

Barnieh, Lianne, PhD1; Klarenbach, Scott, MD2; Arnold, Jennifer, BSc1; Cuerden, Meaghan, MSc1; Knoll, Greg, MD3; Lok, Charmaine, MD4; Sontrop, Jessica M., PhD1; Miller, Matthew, MD5; Ramesh Prasad, G.V., MD6; Przech, Sebastian, MSc1; Garg, Amit X., MD1 for the Donor Nephrectomy Outcomes Research (DONOR) Network

doi: 10.1097/TP.0000000000002685
Original Clinical Science—General
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Background. Living donors may incur out-of-pocket costs during the donation process. While many jurisdictions have programs to reimburse living kidney donors for expenses, few programs have been evaluated.

Methods. The Program for Reimbursing Expenses of Living Organ Donors was launched in the province of Ontario, Canada in 2008 and reimburses travel, parking, accommodation, meals, and loss of income; each category has a limit and the maximum total reimbursement is $5500 CAD. We conducted a case study to compare donors’ incurred costs (out-of-pocket and lost income) with amounts reimbursed by Program for Reimbursing Expenses of Living Organ Donors. Donors with complete or partial cost data from a large prospective cohort study were linked to Ontario’s reimbursement program to determine the gap between incurred and reimbursed costs (n = 159).

Results. The mean gap between costs incurred and costs reimbursed to the donors was $1313 CAD for out-of-pocket costs and $1802 CAD for lost income, representing a mean reimbursement gap of $3115 CAD. Nondirected donors had the highest mean loss for out-of-pocket costs ($2691 CAD) and kidney paired donors had the highest mean loss for lost income ($4084 CAD). There were no significant differences in the mean gap across exploratory subgroups.

Conclusions. Reimbursement programs minimize some of the financial loss for living kidney donors. Opportunities remain to remove the financial burden of living kidney donors.

1 Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, ON, Canada.

2 Department of Medicine, University of Alberta, Edmonton, AB, Canada.

3 Department of Medicine, University of Ottawa, Ottawa, ON, Canada.

4 Department of Medicine, University of Toronto, Toronto, ON, Canada.

5 Division of Nephrology and Transplantation, McMaster University, Hamilton, ON, Canada.

6 Division of Nephrology, St. Michael’s Hospital, Toronto, ON, Canada.

Received 11 December 2018. Revision received 19 January 2019.

Accepted 6 February 2019.

S.K. and A.X.G. contributed equally to the work.

Operating grant support provided by the Canadian Institutes of Health Research (CIHR), which included partnership funding from Astellas in support of the data collection. Dr S.K. was supported by the Kidney Health Research Chair and the Division of Nephrology at the University of Alberta. Dr A.X.G. was supported by the Dr Adam Linton Chair in Kidney Health Analytics and a Canadian Investigator Award from the CIHR.

The authors declare no conflicts of interest.

L.B. participated in the writing of the article and data analysis. S.K. participated in the research design and performance of the research. J.A. participated in the research design and data collection. M.C. participated in the research design, performance of the research, and data analysis.

G.K. participated in the research design and writing of the article. C.L. participated in the research design and writing of the article. J.M.S. participated in the research design, writing of the article, and performance of the research. M.M. participated in the research design and writing of the article. G.V.R.P. participated in the research design and writing of the article. S.P. participated in the research design, performance of the research, and data analysis. A.X.G. participated in the research design, writing of the article, and performance of the research.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Correspondence: Dr Amit X. Garg, Institute for Clinical Evaluative Sciences, Victoria Hospital, 800 Commissioners Rd, Room ELL-215, London, ON N6A 5W9, Canada. (Amit.Garg@lhsc.on.ca).

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