Living kidney donors experience adverse economic impact for up to 5 years after donation
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Compared with a group of matched controls, living kidney donors in South Korea had an increased risk for employment loss within 2 years following donation and, in the longer term, were more likely to experience worsening economic status.
The study included 1,285 living kidney donors with national health insurance who did not receive any reimbursement for lost wages or expenses related to donation.
‘Supportive policies’ for living donors
“Although socioeconomic status is known to be an important determinant of kidney transplantation accessibility and prognosis among recipients, there has been limited research on the socioeconomic impact of kidney donation on living donors,” Sehoon Park, MD, of Seoul National University College of Medicine, and colleagues wrote. “Previous studies have focused mostly on the cost of kidney donation for living donors, emphasizing the necessity of a reimbursement system for living donors to remove the financial barriers related to kidney donation. As kidney donation requires hospitalization and surgery — which may cause symptomatic disorders or complications — living donors may have difficulty returning to their regular employment or acquiring new employment after donation. Moreover, this may lead to economic disadvantages among living donors after kidney donation. Investigating this topic would provide important evidence for supportive policies regarding living donors, which may promote living kidney donation.”
For the observational study, living kidney donors were matched to a group of controls based on age, sex, comorbidities and health insurance status.
The median ages of the donor and control group were 45 and 46 years, respectively. Socioeconomic status was assessed annually for 5 years following donation.
“The [Korean National Health Insurance System] NHIS data on socioeconomic status comprise mainly individuals’ ‘economic’ and ‘employment’ status,” Park and colleagues wrote. “In brief, the economic status of an individual’s household is reflected by their health insurance fee, which is determined by household income and financial assets. We collected the annual percentile values of health insurance fees to estimate the economic status of the participants.”
Impact of donation on employment, overall economic status
Researchers observed that, compared with the control group, kidney donors had a greater odds for employment loss in the first year after donation (adjusted OR = 2.27), as well as a lower odds of new employment during the first 2 years after donation (aOR for the first year was 0.48). As this difference in employment status did not persist in the later period of the study, Park and colleagues contended more research is needed to determine why donors may have lower employment status during the first few years.
“Our results indicate that the impact of such acute distress on employment status may be limited to the few years after kidney donation, and that in later periods, kidney donors showed similar employment status as the matched controls,” the researchers wrote. “This suggests that a policy for supporting and maintaining employment, such as securing sufficient sick leave, assisting in finding employment, providing financial aid to cover donation-related expenses, and reimbursing lost wages should be considered in the acute period after kidney donation. Furthermore, efforts to increase positive awareness of kidney donation among the general public may be helpful for donors to maintain their employment status.”
Park and colleagues also observed deteriorations in the economic status of donors in both the short and longer terms. Specifically, in the year following donation, living donors were less likely to experience improvement in their economic status (aOR = 0.57) and were more likely to experience a worsening in their economic status (aOR = 1.54); these differences continued for up to 5 years after donation.
Based on the findings, Park and colleagues recommend that, in addition to long-term health consequences, clinicians should be aware of the potential socioeconomic impact posed by kidney donation.
“Additional research is necessary to investigate whether a reimbursement for lost wages and expenses related to the donation could prevent socioeconomic deprivation among voluntary living donors,” the researchers wrote.
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