L. Tenorio1, S. Khan3, H. Yoo2, H. Han3, Y. Genyk2,3, J. Emamaullee2,3 1Saint Louis University School Of Medicine,St. Louis, MO, USA 2University Of Southern California,Department Of Surgery,Los Angeles, CA, USA 3University Of Southern California,Keck School Of Medicine,Los Angeles, CA, USA
Introduction: Living donor liver transplantation (LDLT) has been developed to increase the availability of liver transplantation, particularly in countries that have limited access to deceased organ donors. LDLT rates vary between nations, including the U.S., due to a myriad of issues for potential living donors: psychosocial and physical contraindications, financial concerns, and impact on employment. There is very little data on how individual countries address these issues with the intent to support patients seeking LDLT. Additionally, there are ethical concerns surrounding financial support and incentivization of potential living donors.
Methods: A comprehensive review of the literature and detailed internet search was carried out to characterize living liver donor reimbursements and incentivization on a global scale, focusing on the top 37 countries performing LDLT per million population in the World Health Organization Transplant Observatory. Categories explored include type of health insurance coverage, reimbursement of lost wages, employment protection, and other incentives designed to promote living liver donation.
Results: Of the 37 countries examined that perform high volume LDLT, 25 have some form of compensation to help ease the financial burden for the living liver donor. These range from childcare, accommodations, meals, and travel reimbursement, to compensation in case of morbidity or mortality related to donation. Nineteen countries provide incentives and/or financial reimbursements, while 22 provide medical compensation or coverage. Fifteen provide reimbursement of lost wages and/or paid time off. There were several unique programs designed to incentivize living donation, including free entry to city museums and observatories, parking and airline discounts, and exemptions on mortgages and medical deductibles.
Conclusion: This study highlights, for the first time, the broad range of incentives, reimbursements, and healthcare support that is utilized to support living liver donation in high volume LDLT countries. The data collected in this study can provide a framework for other nations, including the U.S., to propose and implement ethical reimbursement and incentivizations for living liver donors.