The National Living Donor Assistance Center (NLDAC) produces dramatic federal savings through financial support for lower-income kidney donors

For each American who has kidney failure, the Centers for Medicare & Medicaid Services (CMS) spends more than $80,000 per year for dialysis treatment. This cost drops to only $30,000 when a patient receives a kidney transplant and no longer needs dialysis.

Live kidney donation is healthier for the recipient and relatively low risk for the donor. Unfortunately, U.S. donations have significantly declined since their peak in 2004 and although now rebounding have not returned to previous levels. The recipient’s insurance pays the pair’s medical expenses, but donors pay out-of-pocket for travel and personal needs and may lose wages. Lead author of the study, Dr. Amit Mathur from the Mayo Clinic in Phoenix, Arizona, acknowledges, “Kidney donors, particularly those with lower incomes, face significant financial challenges when it comes to getting their evaluation done or going forward with surgery. The National Living Donor Assistance Center is a valuable resource for them.” Donors agree—more than 75% said that they could not have donated without support.

NLDAC is the only federal program that supports low-income donors, who can receive a maximum of $6,000. Researchers, including Dr. Robert Merion, president of the Arbor Research Collaborative for Health, wanted to know whether NLDAC saves government funds--does it offer a good return on investment (ROI)?

From 2012-2015, NLDAC approved 2,425 applications for assistance, and 1,330 people went on to donate a kidney. The median (middle value) spent was $1,814 per applicant and $2,772 per actual donor. The program granted $6.76 million, only about 3% of the estimated 1-year medical cost of patients’ care.

We estimated that by one year the program had a 5-fold ROI or five dollars saved for every dollar spent. Savings grew to 19-fold at three years and 28.2-fold at five years, a total of more than $256 million in estimated savings. The NLDAC program ROI varied by state, depending on the state’s cost of dialysis and waiting time for a deceased-donor transplant.

Dr. Mathur believes that “the most interesting finding was that not only does the NLDAC program help actual donors with travel and lodging costs, but it results in massive savings for the federal government.” He identifies implications for health policy and funding in that “by off-setting dialysis costs in favor of an earlier live donor transplant, the government saves hundreds of millions of dollars in the long term. There are few health care programs that lead to this type of return on investment when you look at the big picture. Programs that lead to more live donor kidney transplants save payers a lot of money.”

Dr. Mathur sees the obvious benefit in NLDAC’s objectives “We aim to achieve financial neutrality for living donors. NLDAC program expansion could help achieve this goal and still result in significantly reduced dialysis expenditures, massive savings, and long-term survival benefit for the kidney failure population. It’s hard to argue against this.”


CITATION:Mathur AK, Xing J, Dickinson DM, Warren PH, Gifford KA, Hong BA, Ojo A, Merion RM. Return on Investment for Financial Assistance for Living Kidney Donors in the U.S. Clin. Transplant 2018 May:e13277.
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