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.
| Original language | English (US) |
|---|---|
| Article number | e15377 |
| Journal | Clinical Transplantation |
| Volume | 38 |
| Issue number | 7 |
| DOIs | |
| State | Published - Jul 2024 |
Funding
: This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of two financial assistance awards totaling $9,700,000 and $1,992,684 with 0 percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. Funding Financial disincentives have been partially ameliorated by the National Living Donor Assistance Center (NLDAC), which provides financial assistance to living organ donors meeting recipient income criteria [ 8 ]. Funded by the Health Resources and Services Administration (HRSA), NLDAC has provided reimbursement for travel and subsistence costs related to evaluation and donation since 2007. In Q4 2020, NLDAC began to provide lost wage reimbursement; dependent and elder care costs have been reimbursable since Q1 2021 (Figure 1 ). These added areas of support move further toward financial neutrality in the living donation process for nearly half of US households [ 9, 10 ]. Other programs in the US also address financial disincentives through paired exchange programs, with fees supported by participating transplant centers, and other nonprofit and state programs [ 11, 12 ]. Editorial assistance was provided by Shauna Leighton, an employee at Arbor Research Collaborative for Health, on behalf of the authors and with their permission. This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of two financial assistance awards totaling $9,700,000 and $1,992,684 with 0 percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of two financial assistance awards totaling $9,700,000 and $1,992,684 with 0 percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.Editorial assistance was provided by Shauna Leighton, an employee at Arbor Research Collaborative for Health, on behalf of the authors and with their permission. This program is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of two financial assistance awards totaling $9,700,000 and $1,992,684 with 0 percentage financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.
Keywords
- donor
- living donation
- lost wages
- organ donation
ASJC Scopus subject areas
- Transplantation