Living-Donor Kidney Transplantation: Reducing Financial Barriers to Live Kidney Donation--Recommendations from a Consensus Conference.

Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.

Transplant certification and quality assessment: time to take the front line?

In the beginning of the past decade, a series of highly publicized events led the general public to question the ability of the transplant community to effectively police itself. Common to the events was the perception that insufficient regulation of the transplant community allowed both unintentional errors and, rarely, purposeful violations of policy, to affect the safety and justice of organ allocation and transplant practice. The goal of this article is to discuss the resulting regulatory responses to these events and to highlight one transplant center's experience with the current external review process. The potential benefits of using process control charts to prospectively monitoring a center's outcomes, as well as the benefits of implementing procedures that ensure the quality of publically reported data, are described. Specifically, the critical need for each center to understand the components, limitations, and implications of public outcome reporting and to define processes that promote real time self-evaluation and quality improvement are demonstrated.

Healthcare professionals' perceptions of the barriers to living donor kidney transplantation among African Americans.

The number of African Americans participating in living donations continues to remain low. Although researchers have identified multiple barriers to cadaveric donation, relatively little is known about barriers to living kidney donation among this population. We conducted three focus groups of healthcare professionals from a transplant center in South Carolina to determine their perceptions of barriers to living kidney donation among African Americans. An African-American and a Caucasian member of the project team facilitated the groups. Sessions were taped, transcribed and analyzed for key themes. Eighteen transplant professionals participated in the three focus groups, including physicians, transplant coordinators, pharmacists and a data coordinator. Analysis of the transcripts revealed the following perceived barriers to living kidney donation among African Americans: 1) pre-existing medical conditions, 2) financial concerns, 3) reluctance to ask family members and/or friends, 4) distrust of the medical community, 5) fear of surgery, and 6) lack of awareness about living donor kidney transplantation. In addition to previously described barriers to cadaveric donation, this study identified barriers unique to living donation, such as pre-existing medical conditions, financial concerns, reluctance to ask a living donor and fear of surgery.