The decline in living kidney donation over the past several years has been concerning and is poorly understood. A study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN) identifies low income as an important barrier to living donation, and more importantly, implies that this barrier is becoming more difficult to overcome over time. The findings suggest a need to better understand the financial barriers to living donation and to develop more effective strategies to overcome them.
For their study, Jagbir Gill, MD, MPH (University of British Columbia, in Vancouver) and his colleagues divided the US population based on the median household income level of residents' zip codes, and they examined the rates of living donation between 1999 and 2010 in high and low income populations.
The researchers found that lower income populations consistently had lower rates of living donation compared with higher income populations. Most striking, however, was the finding that the difference in living donation rates between lower and higher income populations was much larger in recent years than it was in the past.
"Since 2004, lower income populations experienced a large decline in living donation, while living donation in higher income populations was more stable," said Dr. Gill. "These results suggest that financial barriers to living donation need to be further addressed in order to make it easier for patients to consider and pursue living kidney donation."
Beyond the obvious benefits of improved survival and quality of life for transplant patients, each living kidney donation is estimated to result in a net health care savings of $100,000. There are considerable financial costs to donating a kidney, though, with an average estimated cost of $5000 and some reports citing costs as high as $20,000.