RESUMEN
Deceased donor organs for transplantation are costly. Expenses include donor assessment, pre-operative care of acceptable donors, surgical organ recovery, preservation and transport, and other costs. US Organ Procurement Organizations (OPOs) serve defined geographic areas in which each OPO has exclusive organ recovery responsibilities including detailed reporting of costs. We sought to determine the costs of procuring deceased donor livers by examining reported organ acquisition costs from OPO cost reports. Using 6 years of US OPO cost report data for each OPO (2013-2018), we determined the average cost of recovering a viable (i.e., transplanted) liver for each of the 51 independent US OPOs. We examined predictors of these costs including the number of livers procured, the percent of nonviable livers, direct procurement costs, coordinator salaries, professional education, and local cost of living. A cost curve estimated the relationship between the cost of livers and the number of locally procured livers. The average cost of procured livers by individual OPO-year varied widely from $11 393 to $65 556 (average $31 659) over the six study years. An increase in the overall number of procured livers was associated with lower direct costs, administrative, and procurement overhead costs, but this association differed for imported livers. Cost per local liver decreased linearly for each additional liver, while importing more livers was only cost saving until 200 livers, with imported livers costing more ($39K vs. $31.7K). The largest predictor of variation in cost was the aggregate of direct costs (e.g., hospital costs) to recover the organ (57%). Cost increases were 2.5% per year (+$766/year). This information may be valuable in determining how OPOs might improve service to transplant centers and the patients they serve.
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Trasplante de Hígado , Donantes de Tejidos , Obtención de Tejidos y Órganos , Humanos , Obtención de Tejidos y Órganos/economía , Trasplante de Hígado/economía , Donantes de Tejidos/provisión & distribución , Estados Unidos , Costos de la Atención en Salud/estadística & datos numéricos , Pronóstico , Masculino , Estudios de SeguimientoRESUMEN
BACKGROUND: Solid organ transplantation improves the quality of life for patients but has significant out-of-pocket expenses for donors and recipients in the USA, leading many to utilize crowdfunding for donations to cover expenses. We sought to characterize crowdfunding for transplant patients and to identify ethical and policy issues. METHODS: We obtained newspaper articles that described crowdfunding campaigns for organ transplant patients from Nexis-Uni. Using Nvivo, we identified and analyzed article details, patient characteristics, features of campaigns, additional fundraisers, and policy and ethical issues related to crowdfunding. RESULTS: Most sources were published between 2015 and 2020. Of 231 patients identified, 43% were thoracic organ recipients and 42% were kidney recipients. GoFundMe was the most popular platform. 78% of patients reported at least one intended use of crowdfunding; medical expenses were the most cited reason. Ten percent of articles described at least one ethical or policy consideration related to crowdfunding for organ transplant. Concerns included violations of federal laws prohibiting donors from receiving "valuable consideration" for an organ, taxation of funds, loss of Medicaid or disability benefits, accountability for fund usage, and crowdfunding requirements for organ waiting list placement. In several cases, transplants were delayed due to crowdfunding concerns. CONCLUSIONS: Our findings reveal crowdfunding characteristics and financial barriers present among transplant patients. Furthermore, our study suggests that the ethical and policy implications for crowdfunding in the transplant population are not yet adequately assessed. National regulations and transplant center policies may need to be modified to address issues raised by patient crowdfunding.
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Colaboración de las Masas , Obtención de Fondos , Trasplante de Órganos , Humanos , Obtención de Fondos/ética , Obtención de Fondos/legislación & jurisprudencia , Trasplante de Órganos/ética , Trasplante de Órganos/economía , Trasplante de Órganos/legislación & jurisprudencia , Colaboración de las Masas/ética , Colaboración de las Masas/economía , Colaboración de las Masas/legislación & jurisprudencia , Periódicos como Asunto , Donantes de Tejidos/ética , Donantes de Tejidos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/ética , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Receptores de Trasplantes , Estados Unidos , Política de Salud/legislación & jurisprudenciaRESUMEN
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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Toma de Decisiones , Donadores Vivos , Motivación , Obtención de Tejidos y Órganos , Humanos , Femenino , Masculino , Adulto , Donadores Vivos/psicología , Obtención de Tejidos y Órganos/economía , Persona de Mediana Edad , Encuestas y Cuestionarios , Pronóstico , Estudios de SeguimientoRESUMEN
BACKGROUND: Recent efforts to increase access to kidney transplant (KTx) in the United States include increasing referrals to transplant programs, leading to more pretransplant services. Transplant programs reconcile the costs of these services through the Organ Acquisition Cost Center (OACC). OBJECTIVE: The aim of this study was to determine the costs associated with pretransplant services by applying microeconomic methods to OACC costs reported by transplant hospitals. RESEARCH DESIGN, SUBJECTS, AND MEASURES: For all US adult kidney transplant hospitals from 2013 through 2018 (n=193), we crosslinked the total OACC costs (at the hospital-fiscal year level) to proxy measures of volumes of pretransplant services. We used a multiple-output cost function, regressing total OACC costs against proxy measures for volumes of pretransplant services and adjusting for patient characteristics, to calculate the marginal cost of each pretransplant service. RESULTS: Over 1015 adult hospital-years, median OACC costs attributable to the pretransplant services were $5 million. Marginal costs for the pretransplant services were: initial transplant evaluation, $9k per waitlist addition; waitlist management, $2k per patient-year on the waitlist; deceased donor offer management, $1k per offer; living donor evaluation, procurement and follow-up: $26k per living donor. Longer time on dialysis among patients added to the waitlist was associated with higher OACC costs at the transplant hospital. CONCLUSIONS: To achieve the policy goals of more access to KTx, sufficient funding is needed to support the increase in volume of pretransplant services. Future studies should assess the relative value of each service and explore ways to enhance efficiency.
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Trasplante de Riñón , Listas de Espera , Humanos , Trasplante de Riñón/economía , Trasplante de Riñón/estadística & datos numéricos , Estados Unidos , Masculino , Femenino , Persona de Mediana Edad , Determinación de la Elegibilidad , Adulto , Obtención de Tejidos y Órganos/economía , Costos de la Atención en Salud/estadística & datos numéricosAsunto(s)
Política de Salud , Disparidades en Atención de Salud , Trasplante de Hígado , Obtención de Tejidos y Órganos , Humanos , Política de Salud/economía , Política de Salud/legislación & jurisprudencia , Política de Salud/tendencias , Disparidades en Atención de Salud/etnología , Disparidades en Atención de Salud/legislación & jurisprudencia , Disparidades en Atención de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Trasplante de Hígado/economía , Trasplante de Hígado/legislación & jurisprudencia , Trasplante de Hígado/estadística & datos numéricos , Trasplante de Hígado/tendencias , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/estadística & datos numéricos , Obtención de Tejidos y Órganos/tendencias , Estados Unidos/epidemiologíaRESUMEN
Importance: A new liver allocation policy was implemented by United Network for Organ Sharing (UNOS) in February 2020 with the stated intent of improving access to liver transplant (LT). There are growing concerns nationally regarding the implications this new system may have on LT costs, as well as access to a chance for LT, which have not been captured at a multicenter level. Objective: To characterize LT volume and cost changes across the US and within specific center groups and demographics after the policy implementation. Design, Setting, and Participants: This cross-sectional study collected and reviewed LT volume from multiple centers across the US and cost data with attention to 8 specific center demographics. Two separate 12-month eras were compared, before and after the new UNOS allocation policy: March 4, 2019, to March 4, 2020, and March 5, 2020, to March 5, 2021. Data analysis was performed from May to December 2022. Main Outcomes and Measures: Center volume, changes in cost. Results: A total of 22 of 68 centers responded comparing 1948 LTs before the policy change and 1837 LTs postpolicy, resulting in a 6% volume decrease. Transplants using local donations after brain death decreased 54% (P < .001) while imported donations after brain death increased 133% (P = .003). Imported fly-outs and dry runs increased 163% (median, 19; range, 1-75, vs 50, range, 2-91; P = .009) and 33% (median, 3; range, 0-16, vs 7, range, 0-24; P = .02). Overall hospital costs increased 10.9% to a total of $46â¯360â¯176 (P = .94) for participating centers. There was a 77% fly-out cost increase postpolicy ($10â¯600â¯234; P = .03). On subanalysis, centers with decreased LT volume postpolicy observed higher overall hospital costs ($41â¯720â¯365; P = .048), and specifically, a 122% cost increase for liver imports ($6â¯508â¯480; P = .002). Transplant centers from low-income states showed a significant increase in hospital (12%) and import (94%) costs. Centers serving populations with larger proportions of racial and ethnic minority candidates and specifically Black candidates significantly increased costs by more than 90% for imported livers, fly-outs, and dry runs despite lower LT volume. Similarly, costs increased significantly (>100%) for fly-outs and dry runs in centers from worse-performing health systems. Conclusions and Relevance: Based on this large multicenter effort and contrary to current assumptions, the new liver distribution system appears to place a disproportionate burden on populations of the current LT community who already experience disparities in health care. The continuous allocation policies being promoted by UNOS could make the situation even worse.
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Trasplante de Hígado , Obtención de Tejidos y Órganos , Trasplante de Hígado/economía , Humanos , Estudios Transversales , Estados Unidos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Política de Salud , Masculino , Femenino , Listas de EsperaAsunto(s)
Análisis Costo-Beneficio , Trasplante de Hígado , Trasplante de Hígado/economía , Trasplante de Hígado/métodos , Humanos , Costos de la Atención en Salud/estadística & datos numéricos , Listas de Espera , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/economía , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/métodos , Donantes de Tejidos/provisión & distribuciónRESUMEN
The shortage of organs for transplantations is increasing in Europe as well as globally. Many initiatives to the organ shortage, such as opt-out systems for deceased donation and expanding living donation, have been insufficient to meet the rising demand for organs. In recurrent discussions on how to reduce organ shortage, financial incentives and removal of disincentives, have been proposed to stimulate living organ donation and increase the pool of available donor organs. It is important to understand not only the ethical acceptability of (dis)incentives for organ donation, but also its societal acceptance. In this review, we propose a research agenda to help guide future empirical studies on public preferences in Europe towards the removal of disincentives and introduction of incentives for organ donation. We first present a systematic literature review on public opinions concerning (financial) (dis)incentives for organ donation in European countries. Next, we describe the results of a randomized survey experiment conducted in the United States. This experiment is crucial because it suggests that societal support for incentivizing organ donation depends on the specific features and institutional design of the proposed incentive scheme. We conclude by proposing this experiment's framework as a blueprint for European research on this topic.
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Motivación , Opinión Pública , Obtención de Tejidos y Órganos , Humanos , Obtención de Tejidos y Órganos/economía , Europa (Continente) , Donadores Vivos , Estados Unidos , Donantes de Tejidos/provisión & distribuciónRESUMEN
Donation after circulatory death (DCD) donors now represent over 30% of the deceased donor pool in the United States. Compared to donation after brain death, DCD is less likely to result in transplantation. For each potential donor whose organs cannot be utilized for transplantation (ie, dry run), fees are associated with the attempted donation, which add to the overall costs of organ acquisition. To better characterize the true costs of DCD liver acquisition, we performed a cost comparison of the fees associated with organ acquisition for DCD versus donation after brain death at a single transplant institute that comprises 2 liver transplant centers. Cost, recipient, and transportation data for all cases, including fees associated with liver acquisition from July 1, 2019, to October 31, 2021, were collected. We found that the total cost of DCD liver acquisition per liver transplant was $15,029 more than that for donation after brain death donation, with 18% of the costs of the DCD transplant attributed to dry runs. Overall, the costs associated with DCD transplantation accounted for 34.5% of the total organ acquisition costs; however, DCD transplantation accounted for 30.3% of the transplantation volume. Because the expansion of DCD is essential to increasing the availability of liver grafts for transplantation, strategies need to be implemented to decrease the costs associated with dry runs, including using local recovery, transferring donors to hospitals close to transplant centers, and performing more prerecovery organ analysis. Moreover, these strategies are needed to ensure that financial disincentives to DCD procurement and utilization do not reverse the gains made by expanding the organ donor pool using machine perfusion technologies.
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Muerte Encefálica , Trasplante de Hígado , Donantes de Tejidos , Obtención de Tejidos y Órganos , Humanos , Trasplante de Hígado/economía , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/estadística & datos numéricos , Trasplante de Hígado/métodos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/métodos , Donantes de Tejidos/provisión & distribución , Donantes de Tejidos/estadística & datos numéricos , Estados Unidos , Masculino , Femenino , Persona de Mediana Edad , AdultoRESUMEN
OBJECTIVE: On November 24, 2017, Organ Procurement and Transplantation Network implemented a change to lung allocation replacing donor service area with a 250 nautical mile radius around donor hospitals. We sought to evaluate the experience of a small to medium size center following implementation. METHODS: Patients (47 pre and 54 post) undergoing lung transplantation were identified from institutional database from January 2016 to October 2019. Detailed chart review and analysis of institutional cost data was performed. Univariate analysis was performed to compare eras. RESULTS: Similar short-term mortality and primary graft dysfunction were observed between groups. Decreased local donation (68% vs 6%; P < .001), increased travel distance (145 vs 235 miles; P = .004), travel cost ($8626 vs $14,482; P < .001), and total procurement cost ($60,852 vs $69,052; P = .001) were observed postimplementation. We also document an increase in waitlist mortality postimplementation (6.9 vs 31.6 per 100 patient-years; P < .001). CONCLUSIONS: Following implementation of the new allocation policy in a small to medium size center, several changes were in accordance with policy intention. However, concerning shifts emerged, including increased waitlist mortality and resource utilization. Continued close monitoring of transplant centers stratified by size and location are paramount to maintaining global availability of lung transplantation to all Americans regardless of geographic residence or socioeconomic status.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Enfermedades Pulmonares , Trasplante de Pulmón , Asignación de Recursos , Obtención de Tejidos y Órganos , Listas de Espera/mortalidad , Bases de Datos Factuales/estadística & datos numéricos , Femenino , Rechazo de Injerto/epidemiología , Hospitales de Bajo Volumen/economía , Hospitales de Bajo Volumen/estadística & datos numéricos , Humanos , Enfermedades Pulmonares/clasificación , Enfermedades Pulmonares/mortalidad , Enfermedades Pulmonares/cirugía , Trasplante de Pulmón/métodos , Trasplante de Pulmón/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad , Evaluación de Necesidades , Innovación Organizacional , Asignación de Recursos/métodos , Asignación de Recursos/organización & administración , Asignación de Recursos/tendencias , Donantes de Tejidos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/tendencias , Estados Unidos/epidemiologíaRESUMEN
INTRODUCTION: Several clinical studies have demonstrated the safety, feasibility, and efficacy of machine perfusion in liver transplantation, although its economic outcomes are still underexplored. This review aimed to examine the costs related to machine perfusion and its associated outcomes. METHODS: Expert opinion of several groups representing different machine perfusion modalities. Critical analysis of the published literature reporting the economic outcomes of the most used techniques of machine perfusion in liver transplantation (normothermic and hypothermic ex situ machine perfusion and in situ normothermic regional perfusion). RESULTS: Machine perfusion costs include disposable components of the perfusion device, perfusate components, personnel and facility fees, and depreciation of the perfusion device or device lease fee. The limited current literature suggests that although this upfront cost varies between perfusion modalities, its use is highly likely to be cost-effective. Optimization of the donor liver utilization rate, local conditions of transplant programs (long waiting list times and higher MELD scores), a decreased rate of complications, changes in logistics, and length of hospital stay are potential cost savings points that must highlight the expected benefits of this intervention. An additional unaccounted factor is that machine perfusion optimizing donor organ utilization allows patients to be transplanted earlier, avoiding clinical deterioration while on the waiting list and the costs associated with hospital admissions and other required procedures. CONCLUSION: So far, the clinical benefits have guided machine perfusion implementation in liver transplantation. Albeit there is data suggesting the economic benefit of the technique, further investigation of its costs to healthcare systems and society and associated outcomes is needed.
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Trasplante de Hígado/economía , Perfusión/economía , Análisis Costo-Beneficio , Humanos , Trasplante de Hígado/métodos , Perfusión/métodos , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/métodosRESUMEN
Importance: Acuity circles (AC) liver allocation policy was implemented to eliminate donor service area geographic boundaries from liver allocation and to decrease variability in median Model of End-stage Liver Disease (MELD) score at transplant and wait list mortality. However, the broader sharing of organs was also associated with more flights for organ procurements and higher costs associated with the increase in flights. Objective: To determine whether the costs associated with liver acquisition changed after the implementation of AC allocation. Design, Setting, and Participants: This single-center cost comparison study analyzed fees associated with organ acquisition before and after AC allocation implementation. The cost data were collected from a single transplant institute with 2 liver transplant centers, located 30 miles apart, in different donation service areas. Cost, recipient, and transportation data for all cases that included fees associated with liver acquisition from July 1, 2019, to October 31, 2020, were collected. Exposures: Primary liver offer acceptance with associated organ procurement organization or charter flight fees. Main Outcomes and Measures: Specific fees (organ acquisition, surgeon, import, and charter flight fees) and total fees per donor were collected for all accepted liver donors with at least 1 associated fee during the study period. Results: Of 213 included donors, 171 were used for transplant; 90 of 171 (52.6%) were male, and the median (interquartile range) age of donors was 41.0 (30.0-52.8) years in the pre-AC period and 36.9 (24.0-48.8) years in the post-AC period. There was no significant difference in the post-AC compared with pre-AC period in median (range) MELD score (24 [8-40] vs 25 [6-40]; P = .27) or median (range) match run sequence (15 [1-3951] vs 10 [1-1138]; P = .31), nor in mean (SD) distance traveled (155.83 [157.00] vs 140.54 [144.33] nautical miles; P = .32) or percentage of donors requiring flights (58.5% [69 of 118] vs 56.8% [54 of 95]; P = .82). However, costs increased significantly in the post-AC period: total cost increased 16% per accepted donor (mean [SD] of $52â¯966 [13â¯278] vs $45â¯725 [9300]; P < .001) and 55% per declined donor (mean [SD] of $15â¯865 [3942] vs $10â¯217 [4853]; P < .001). Contributing factors included more than 2-fold increases in the proportions of donors incurring import fees (31.4% [37 of 118] vs 12.6% [12 of 95]; P = .002) and surgeon fees (19.5% [23 of 118] vs 9.5% [9 of 95]; P = .05), increased acquisition fees (10% increase; mean [SD] of $43â¯860 [3266] vs $39â¯980 [2236]; P < .001), and increased flight expenses (43% increase; mean [SD] of $12â¯904 [6066] vs $9049 [5140]; P = .002). Conclusions and Relevance: The unintended consequences of implementing broader sharing without addressing organ acquisition fees to account for increased importation between organ procurement organizations must be remedied to contain costs and ensure viability of transplant programs.
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Enfermedad Hepática en Estado Terminal/cirugía , Honorarios y Precios , Política de Salud/economía , Obtención de Tejidos y Órganos/economía , Adulto , Costos y Análisis de Costo , Enfermedad Hepática en Estado Terminal/economía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Gravedad del Paciente , Selección de Paciente , Listas de Espera , Adulto JovenRESUMEN
BACKGROUND: Evaluation of the joint clinical and economic impacts of lung transplant and associated technologies is crucial for evidence-informed decision-making and wise allocation of scarce healthcare resources. We performed a scoping review to summarize and categorize the available evidence of the costs and cost-effectiveness of lung transplantation. METHODS: A systematic search of MEDLINE, EMBASE, NHS EED, and EconLit was performed to identify studies involving lung transplantation for adults that measured costs, cost-effectiveness, or which described themselves as economic evaluations. A scoping review was performed in adherence to the framework described by Arksey & O'Malley. Risk of bias was assessed in included studies using the ECOBIAS and CHEC-list tools. RESULTS: In total, 324 studies were identified, of which 28 met inclusion criteria. Cost-utility estimates of lung transplant versus waitlist, from the healthcare payer perspective and a time-horizon of at least 10-years ranged between $42,459 and $154,051 per quality-adjusted life year. Common topics of study included lung transplant versus waitlist care, immunosuppression, organ retrieval and allocation, and mechanical life support. CONCLUSIONS: Sources of variation in costs-assessments and economic evaluations included differences in the type of study performed, payer perspective adopted, study time horizon, and variation in clinical practice. The best available cost-utility estimates for lung transplant versus waitlist may represent cost-effectiveness under some circumstances, but high-quality evidence is lacking. Further cost-utility analyses, with sufficient methodologic rigour, are required to overcome the observed variation in results and confirm cost-effectiveness of the current standard of care in lung transplantation.
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Trasplante de Pulmón/economía , Obtención de Tejidos y Órganos/economía , Costos y Análisis de Costo , HumanosAsunto(s)
Prestación Integrada de Atención de Salud , Enfermedad Hepática en Estado Terminal/cirugía , Trasplante de Hígado , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos , Adulto , Anciano , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/organización & administración , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/economía , Enfermedad Hepática en Estado Terminal/epidemiología , Femenino , Costos de la Atención en Salud , Humanos , Cooperación Internacional , Kuwait/epidemiología , Trasplante de Hígado/economía , Donadores Vivos/provisión & distribución , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/organización & administraciónRESUMEN
Kidney failure is a worldwide scourge, made more lethal by the shortage of transplants. We propose a way to organize kidney exchange chains internationally between middle-income countries with financial barriers to transplantation and high-income countries with many hard to match patients and patient-donor pairs facing lengthy dialysis. The proposal involves chains of exchange that begin in the middle-income country and end in the high-income country. We also propose a way of financing such chains using savings to US health care payers.
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Trasplante de Riñón , Donantes de Tejidos , Obtención de Tejidos y Órganos/métodos , Países Desarrollados , Países en Desarrollo , Humanos , Obtención de Tejidos y Órganos/economíaAsunto(s)
Hepatopatías/cirugía , Trasplante de Hígado/tendencias , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/tendencias , Croacia , Selección de Donante/tendencias , Humanos , Trasplante de Hígado/economía , Obtención de Tejidos y Órganos/economía , Resultado del TratamientoAsunto(s)
Trasplante de Riñón , Motivación , Donantes de Tejidos/psicología , Obtención de Tejidos y Órganos , Altruismo , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/legislación & jurisprudencia , Humanos , Trasplante de Riñón/economía , Trasplante de Riñón/legislación & jurisprudencia , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Estados UnidosAsunto(s)
Seguro de Salud/legislación & jurisprudencia , Donadores Vivos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Humanos , Seguro de Salud/economía , Donadores Vivos/provisión & distribución , Obtención de Tejidos y Órganos/economía , Estados UnidosRESUMEN
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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Trasplante de Riñón/economía , Obtención de Tejidos y Órganos/economía , Adulto , Costos de la Atención en Salud , Humanos , Riñón/cirugía , Donadores Vivos , Persona de Mediana Edad , Factores SocioeconómicosRESUMEN
Previous research shows that countries with opt-out consent systems for organ donation conduct significantly more deceased-donor organ transplantations than those with opt-in systems. This paper investigates whether the higher transplantation rates in opt-out systems translate into equally lower death rates among organ patients registered on a waiting list (i.e., organ-patient mortality rates). We show that the difference between consent systems regarding kidney- and liver-patient mortality rates is significantly smaller than the difference in deceased-donor transplantation rates. This is likely due to different incentives between the consent systems. We find empirical evidence that opt-out systems reduce incentives for living donations, which explains our findings for kidneys. The results imply that focusing on deceased-donor transplantation rates alone paints an incomplete picture of opt-out systems' benefits, and that there are important differences between organs in this respect.