Health insurance for kidney donors: how easy is it to obtain?
TL;DR: Survey of health insurance organizations in the United States indicate that healthy kidney donors should be able to obtain and maintain health insurance at standard rates, and should be reassuring for concerned people who are considering donating a kidney.
Abstract: Because there is a severe shortage of cadaver organs, living donors are a valuable source of kidneys for patients with end-stage renal disease. One area of concern to many potential donors is their ability to obtain health insurance after donation. To investigate this issue, we surveyed 99 health insurance organizations in the United States, including the 10 largest health maintenance organizations, asking for their views and practices regarding living kidney donors; 44% of these organizations responded. The responses were strikingly uniform and indicate that healthy kidney donors should be able to obtain and maintain health insurance at standard rates. This information should be reassuring for concerned people who are considering donating a kidney.
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TL;DR: The person who gives consent to be a live organ donor should be competent, willing to donate, free from coercion, medically and psychosocially suitable, fully informed of the risks and benefits as a donor, and fully informed about the risks, benefits, and alternative treatment available to the recipient.
Abstract: Objective To recommend practice guidelines for transplant physicians, primary care providers, health care planners, and all those who are concerned about the well-being of the live organ donor. Participants An executive group representing the National Kidney Foundation, and the American Societies of Transplantation, Transplant Surgeons, and Nephrology formed a steering committee of 12 members to evaluate current practices of living donor transplantation of the kidney, pancreas, liver, intestine, and lung. The steering committee subsequently assembled more than 100 representatives of the transplant community (physicians, nurses, ethicists, psychologists, lawyers, scientists, social workers, transplant recipients, and living donors) at a national conference held June 1-2, 2000, in Kansas City, Mo. Consensus process Attendees participated in 7 assigned work groups. Three were organ specific (lung, liver, and kidney) and 4 were focused on social and ethical concerns (informed consent, donor source, psychosocial issues, and live organ donor registry). Work groups' deliberations were structured by a series of questions developed by the steering committee. Each work group presented its deliberations to an open plenary session of all attendees. This information was stored and shaped into a statement circulated electronically to all attendees for their comments, and finally approved by the steering committee for publication. The term consensus is not meant to convey universal agreement of the participants. The statement identifies issues of controversy; however, the wording of the entire statement is a consensus by approval of all attendees. Conclusion The person who gives consent to be a live organ donor should be competent, willing to donate, free from coercion, medically and psychosocially suitable, fully informed of the risks and benefits as a donor, and fully informed of the risks, benefits, and alternative treatment available to the recipient. The benefits to both donor and recipient must outweigh the risks associated with the donation and transplantation of the living donor organ.
537 citations
TL;DR: There have been two recent trends in living kidney donation: increased acceptance of living donors and increasedacceptance of laparoscopic nephrectomy (LN).
365 citations
TL;DR: Multivariate analysis was used to identify risk factors for this poor psychosocial outcome and found that relatives other than first degree and donors whose recipient died within 1 year of transplant were more likely to say they would not donate again if it were possible.
Abstract: The University of Minnesota has been a strong advocate of living donor kidney transplants. The benefits for living donor recipients have been well documented. The relative low risk of physical complications during donation has also been well documented. Less well understood is the psychosocial risk to donors. Most published reports have indicated an improved sense of well-being and a boost in self-esteem for living kidney donors. However, there have been some reports of depression and disrupted family relationships after donation, even suicide after a recipient's death. To determine the quality of life of our donors, we sent a questionnaire to 979 who had donated a kidney between August 1, 1984, and December 31, 1996. Of the 60% who responded, the vast majority had an excellent quality of life. As a group, they scored higher than the national norm on the SF-36, a standardized quality of life health questionnaire. However, 4% were dissatisfied and regretted the decision to donate. Further, 4% found the experience extremely stressful and 8% very stressful. We used multivariate analysis to identify risk factors for this poor psychosocial outcome and found that relatives other than first degree (odds ratio=3.5, P=0.06) and donors whose recipient died within 1 year of transplant (odds ratio=3.3, P=0.014) were more likely to say they would not donate again if it were possible. Further, donors who had perioperative complications (odds ratio=3.5, P=0.007) and female donors (odds ratio=1.8, P=0.1) were more likely to find the overall experience more stressful. Overall, the results of this study are overwhelmingly positive and have encouraged us to continue living donor kidney transplants.
302 citations
TL;DR: The authors show that patients who had preemptive transplants or less than 1 year of dialysis have better 5-year graft survival and more frequently return to full-time employment and other major risk factors affecting both short- and long-term outcome.
Abstract: The first successful kidney transplants in humans were from identical twin living donors. 1,2 Although transplanted before the development of chemical immunosuppression, many of these identical twin grafts had long-term survival. With recognition of the immunosuppressive effects of prednisone and azathioprine, the use of nontwin donors became possible. 3,4 Considerable controversy soon followed as to whether it was ethical to use living donors for kidney transplantation. 5–8 Proponents of the use of living donors noted that the short- and long-term patient and graft survival rates were better after living (vs. cadaver) donor transplants. Opponents worried that living donor nephrectomy was a major operation with potential risk to the donor; they believed that these risks did not justify the benefits to the recipient. Our program has always advocated the use of living donors. We recognized the risks to the donor but decided that a fully informed potential donor could choose whether to accept these risks.
In the last decade, as a result of improvements in patient care, optimization of immunosuppressive protocols, and the introduction of new immunosuppressive agents, outcome for both living and cadaver donor recipients has markedly improved. Despite this improvement, for the patient considering a transplant, the single prospective decision that most positively affects long-term outcome continues to be to have a living donor transplant.
We herein describe our entire living donor experience. Between January 1, 1963, and December 31, 1998, we performed 2,540 living donor kidney transplants at the University of Minnesota. Immunosuppressive protocols have evolved over time, and since 1983, our protocols have been cyclosporine-based. Dosing and blood levels have been optimized. We emphasize the improvement in outcome as protocols have evolved, the results that can be expected with cyclosporine- and azathioprine-based immunosuppression, and the risk factors for worse long-term outcome.
206 citations
Cites background from "Health insurance for kidney donors:..."
...37 Kidney donors do not have trouble getting life insurance, and insurance rates are not increased after donation.(38) Although donation carries no physical benefit, studies have shown a psychological benefit: an increase in self-esteem....
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TL;DR: The transplantation of organs from living donors has always involved a balancing of the physical risks and psychological benefits to the donor against the benefits toThe recipient.
Abstract: The transplantation of organs from living donors has always involved a balancing of the physical risks and psychological benefits to the donor against the benefits to the recipient. Early in the hi...
162 citations
References
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TL;DR: It is concluded that perioperative mortality in the USA and Canada after living-donor nephrectomy is low and in long-term follow-up of living donors, there is no evidence of progressive renal deterioration or other serious disorders.
581 citations
TL;DR: In this article, the ability of health care providers to identify donor-eligible patients, approach families about donation, and obtain families' consent to donation was investigated in a 20-month period.
Abstract: . Objective : To determine why Required Request policies, which mandate that hospitals request donation from donor-eligible families, have not resulted in increased organ procurement. . Setting : Stratified sample of 23 acute-care general hospitals in two metropolitan areas. . Design : Chart review identified all eligible donors in study hospitals during a 20-month period. Health care professionals who spoke with the families of eligible donors after death were interviewed to determine families' and health care providers' behaviors after patients' deaths with reference to the donation process. . Participants : All patient deaths (n = 10 681) were reviewed, and 841 donor-eligible cases were chosen for in-depth study ; 1809 health care professionals who provided care to these patients were interviewed. . Measurements : The ability of health care providers to identify donor-eligible patients, approach families about donation, and obtain families' consent to donation. . Results : 83% of health care professionals correctly identified donor-eligible patients. The families of donor-eligible patients were approached about donation in 73.0% of the cases. Families were more likely to be approached about organ (86.6%) donation than either tissue (69.5%) or cornea (67.3%) donation (P < 0.001). The families of organ-eligible patients were less likely to be approached if the patient was female, was on a general medical or surgical floor, or was being cared for by intemists. Only 46.5% of families of eligible donors agreed to donate organs, 34.5% agreed to donate tissues, and 23.5% agreed to donate corneas. . Conclusions : Although health care professionals do request that families donate, families consent to donation less frequently than was previously assumed. Empirically based education campaigns are needed so that health care professionals can improve their communication skills and so that discussion about this important issue can be stimulated among family members.
227 citations
TL;DR: In normal individuals, unilateral nephrectomy does not cause progressive renal dysfunction, but may be associated with a small increase in blood pressure.
225 citations
TL;DR: Donation appeared to stress previously troubled marriages, especially among donors without a religious affiliation, who were pressured to donate by their families, or who borrowed from family members.
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