JENNIFER STEEL (ed.)Living Donor Advocacy2014An Evolving Role Within Transplantation10.1007/978-1-4614-9143-9_20

20. Financial Considerations

Jami Hanneman¹

(1)

Kovler Organ Transplant center, Northwestern Memorial Hospital, 676 N. St. Clair St. Arkes Pavilion No. 1900, 60611 Chicago, IL, USA

Jami Hanneman

Email: jhannema@nmh.org

Abstract

Financial risks are a concern for living kidney donors. Donors want to be able to help their recipients without causing financial hardship for themselves. A proactive and thorough financial assessment can be of great use to minimize risk associated with lost wages, debt, and future issues concerning insurability. If concerns are identified, there are resources available to assist the potential donor. Living donors can be reimbursed for transportation, meals, lodging, and lost wages associated with the donation and recovery. It is possible that a financial hardship may be too great. In efforts to protect the living donor, the transplant professionals may choose to not proceed due to the high financial risk. The informed consent process should continuously educate the patient on potential financial burdens and allow the donor to withdraw from evaluation without prejudice.

Keywords

FinancialValuable considerationLost wagesOrgan donationPaid time offNOTAInsuranceAssistanceRiskContraindication

It has been recognized that there is a potential for financial risks for the living donor . The goal of the independent living donor advocacy team (IDAT) is to ensure that the potential donor is aware of the financial risks. If risks are present, they should be reduced or eliminated so that the donor is not placed in a negative financial position. Financial considerations should be addressed with either the living donor social worker, financial specialist, or with the independent living donor advocate (ILDA) . Patient-specific financial risks are typically assessed during the psychosocial and/or ILDA assessment.

ILDA Kidney donors though they assume all the risks of anesthesia and surgery. In certain familial situations, we cannot deny that there may be a tangible or emotional benefit to donation if the recipient is depended upon as the main financial contributor to the family. Circumstance such as paying for college tuition or a wedding may also put internal pressure on the family to pursue living donation.

A donor should not shy away from having a conversation with the recipient regarding any potential financial strains while the donor is recovering. After all, the donor volunteered a heartfelt gift and should not be left in a negative financial situation. Starting this conversation may be difficult as the topic is somewhat uncomfortable. The assigned ILDA or social worker should be consulted if any assistance with this is needed.

Out-Of-Pocket Costs

Before starting the kidney donor evaluation, it should be explained as part of informed consent, what the donor is and is not financially responsible for. An estimate cost of any out-of-pocket expenses as well as any financial assistance resources should be provided upfront. Certain testing such as age-appropriate cancer screening and follow-up on abnormal testing is the responsibility of the donor. If the person is without health insurance or subject to a high-deductible policy, these unexpected tests may be a financial burden.

Transplant center -specific costs should be considered. This could include parking and other driving expenses. Transplant center-specific billing policies that affect donor evaluation costs and postdonation follow-up need to be specified. This is especially true if the donor resides out of state and plans to do testing or follow-up at a lab or clinic closer to their home. Nonlocal donors will also need to figure in the cost associated with airfare, meals, and lodging.

Assessment of Donor Financial Risk

During the psychosocial assessment, the donor’s financial situation needs to be evaluated. The clinician will use this information to determine the level of financial risk . The donor and/or the IDAT will need to decide if they are comfortable proceeding with this specific information. Employment status, debt, potential loss of income, Family and Medical Leave Act (FMLA) options, short-term disability benefits, and paid time off/sick leave should be evaluated.

Financial risk can fall onto a spectrum. There may be no financial risk if the donor receives 100 % pay while on leave with the FMLA job security option. A moderate risk may occur if only 60 % of wages are earned during recovery. The patient will need to decide if bills can be paid while receiving reduced wages. An example of high financial risk would be no FMLA or short-term disability options with no wage reimbursement. Based on how strenuous the job is, the patient may need at least 6 weeks off work. If the patient goes into debt during this time, there is an obvious financial contraindication . At that point, alternative options for the recipient should be exercised.

If the level of financial risk is unknown or difficult to assess, the donor should be encouraged to make a list of expenses to determine how much is owed while out on recovery. The donor may want to budget conservatively and may assume a return to work in a couple of weeks. However, not all donors are suitable to return to work this quickly and may require a longer recovery. Being optimistically cautious, preparing for the worst but expecting the best will reduce the risks of a future crisis.

The Uninsured Donor

Some transplant centers will not accept potential kidney donors who do not have health insurance . Others will, though specific informed consent must be obtained regarding the future health risk of the donor. The donor may wonder why health insurance is needed if their donor evaluation is covered under the recipient’s insurance. Kidney donors need to plan for their future health, especially after the 2-year marker when transplant centers are no longer required to provide medical follow-up and the recipient’s insurance is no longer financially responsible.

Case Study of an Uninsured Donor¹

Ms. K is a young, healthy 31-year-old lady who flew in from Oklahoma to be evaluated as a kidney donor for her cousin. Ms. K is in between jobs and currently is without health insurance. She qualified for donor assistance to cover her meals, travel, and lodging. Her cousin has offered to cover her utility bills for 2 months. Ms. K has enough money saved to pay her rent for the next several months. The transplant center that evaluated Ms. K informed her of the risks involved in donating without health insurance . She made an educated and informed choice to proceed with donation.

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