NDT Advance Access originally published online on March 22, 2006
Nephrology Dialysis Transplantation 2006 21(7):1952-1960; doi:10.1093/ndt/gfl069
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
The direct and indirect economic costs incurred by living kidney donors—a systematic review
1 Division of Nephrology, University of Western Ontario, London, 2 Division of Nephrology, University of Alberta, Edmonton, Canada, 3 Institute of Health Economics, Edmonton, 4 Department of Political Science, University of Western Ontario, Ontario, 5 Department of Epidemiology and Biostatistics, University of Western Ontario, London and 6 Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
Correspondence and offprint requests to: Dr Amit Garg, Kidney Clinical Research Unit, Room ELL-101, London Health Sciences Centre, 800 Commissioners Road East, London, Ontario N6A 4G5, Canada. Email: amit.garg{at}lhsc.on.ca
Background. Despite the many benefits of living donor kidney transplantation, economic consequences can result for donors. We reviewed studies which quantified the direct and indirect costs incurred by living kidney donors, in order to understand the strengths and limitations of existing literature.
Methods. We identified relevant studies in MEDLINE, EMBASE and ECONOLIT bibliographic databases, in the Science Citation Index and study reference lists. Any study which reported at least one cost relevant to donors was included. The accuracy of abstracted data was verified by two reviewers and reported in year 2004 US dollars.
Results. Thirty-five studies from 12 countries described costs incurred by individuals who donated between the years 1964 and 2003. No study comprehensively quantified all relevant expenses—the sum of select costs considered in one US study averaged $837 per donor and ranged from $0 to 28 906. Travel and/or accommodation costs were incurred by 9–99% of donors, and were higher in countries with a larger land mass. Post-discharge analgesics were required by 4–24% of donors, but prescription costs were not reported. Between 14 and 30% of donors incurred costs for lost income, with an average loss of $3386 in one study from the UK and $682 in another study from the Netherlands. Costs for dependent care were incurred by 9–44% of donors, while costs for domestic help were incurred by 8% of donors.
Conclusions. Donors incur many types of costs attributable to kidney donation and the total costs are certainly higher than previously reported. To guide informed consent and fair reimbursement policies, further data on all relevant costs, preferably from a detailed prospective multi-centre cohort study, are required.
Keywords: health economics; living kidney donors; reimbursement; systematic review
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