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Income of Living Kidney Donors and the Income Difference Between Living Kidney Donors and Their Recipients in the United States.

Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada Tufts-New England Medical Center, Boston, MA Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada Division of Nephrology, University of Calgary, Calgary, Alberta, Canada Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Alberta Kidney Disease Network, Edmonton, Alberta, Canada.
American Journal of Transplantation (Impact Factor: 6.19). 08/2012; DOI: 10.1111/j.1600-6143.2012.04211.x
Source: PubMed

ABSTRACT Disincentives for living kidney donation are common but are poorly understood. We studied 54 483 living donor kidney transplants in the United States between 2000 and 2009, limiting to those with valid zip code data to allow determination of median household income by linkage to the 2000 U.S. Census. We then determined the income and income difference of donors and recipients. The median household income in donors and recipients was $46 334 ±$17 350 and $46 439 ±$17 743, respectively. Donation-related expenses consume ≥ 1 month's income in 76% of donors. The mean ± standard deviation income difference between recipients and donors in transplants involving a wealthier recipient was $22 760 ± 14 792 and in 90% of transplants the difference was <$40 000 dollars. The findings suggest that the capacity for donors to absorb the financial consequences of donation, or of recipients to reimburse allowable expenses, is limited. There were few transplants with a large difference in recipient and donor income, suggesting that the scope and value of any payment between donors and recipients is likely to be small. We conclude that most donors and recipients have similar modest incomes, suggesting that the costs of donation are a significant burden in the majority of living donor transplants.

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    ABSTRACT: The annual number of living kidney donors in the United States peaked at 6647 in 2004. The preceding decade saw a 120% increase in living kidney donation. However, since 2004, living kidney donation has declined in all but 1 year, resulting in a 13% decline in the annual number of living kidney donors from 2004 to 2011. The proportional decline in living kidney donation has been more pronounced among men, blacks, younger adults, siblings, and parents. In this article, we explore several possible explanations for the decline in living kidney donation, including an increase in medical unsuitability, an aging transplant patient population, financial disincentives, public policies, and shifting practice patterns, among others. We conclude that the decline in living donation is not merely reflective of random variation but one that warrants action by the transplant centers, the broader transplant community, and the state and national governments.
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