More efforts needed to reduce financial burdens for living liver donors

Living liver donation is increasingly viewed as a favorable alternative to deceased donor transplantation, leading to efforts to maximize donor well-being. However, little data exists on the impact of donation on liver donors’ lives. To address this gap, researchers used data from the Adult-to-Adult Living Donor Liver Transplant Cohort Study-2 (A2ALL-2) to examine outcomes for living liver donors in the first two years after donation. 271 donors from nine North American transplant centers responded to at least one pre- or post-donation survey assessing social and financial measures.

Social and relationship changes were overall positive, with nearly one-third of donors reporting improved donor family and spousal/partner relationships and more than one-half reporting improved relationships with their recipients. Nearly 42 percent of donors reported they worried about their recipients at three months after donation, but this proportion fell to 25-29 percent by one to two years post-donation.

However, the majority of donors reported cumulative out-of-pocket medical and non-medical expenses, which were judged burdensome by 44 percent of donors. Cumulatively, 24 percent of donors reported that donation costs were more than expected, and 75 percent of donors reported some type of non-medical expense. Contrary to researcher expectations, there was little correlation between financial and relationship outcomes; relationship improvements were not associated with less financial stress, and financial difficulties were not associated with poorer relationships.

Lead author Dr. Andrea DiMartini commented, “It was encouraging to discover the majority of donors experiencing positive relationship changes after donation but distressing that so many donors additionally reported burdensome costs related to donation. I feel these results compel us to identify better ways to offset donation costs.”

Because financial resources may influence the decision to donate, the investigators recommend that financial initiatives should be prioritized to include coverage for expenses beyond donation-related medical costs, particularly for those with lower household incomes. In addition, transplant programs should emphasize the duration of recovery so donors have a realistic appreciation of potential donation-related costs, including lost wages due to missed work.


CITATION:DiMartini A, Dew MA, Liu Q, Simpson MA, Ladner DP, Smith AR, Zee J, Abbey S, Gillespie BW, Weinrieb R, Mandell MS, Fisher RA, Emond JC, Freise CE, Sherker AH, Butt Z. Social and Financial Outcomes of Living Liver Donation: A Prospective Investigation Within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2). Am J Transplant. 2017;17(4):1081-1096.
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