Decline in living kidney donors led by men

By Gene Emery

(Reuters Health) - The number of kidney transplants using organs from living donors has declined in the U.S. since 2005, and only high-income women are becoming kidney donors at a greater rate than they were more than a decade ago, the authors of a new study have found.

Women traditionally outpace men in their willingness to donate one of their kidneys. The new analysis suggests the reason may be tied to income, specifically the fact that working donors typically lose two months of wages for their trouble. The decline in donations was greatest among lower-income men.

"We typically recommend that donors take eight weeks off work, and that doesn't include additional days off for evaluation" prior to the surgery to give up a kidney, chief author Dr. Jagbir Gill told Reuters Health in a telephone interview.

"The prospect of a male donor losing his job may more frequently result in loss of health insurance for him and his dependents," which could affect a man's decision to donate, the researchers said.

Most people can safely give up one kidney because the remaining one is more than capable of filtering waste from their blood. However, a donation carries the risks of major surgery and doctors like to keep tabs on donors to avoid any future health problems.

Such transplants offer a huge benefit over conventional dialysis therapy for people with end-stage kidney disease. Furthermore, there are long waiting lists for kidneys from deceased donors, whereas transplantation of a kidney from a living donor can be done relatively promptly.

In addition, the annual savings to the healthcare system is enormous -- anywhere from $30,000 to $85,000 beginning the first year after the transplant, said Gill.

Although most recipients are male, women represented 63% of all living donations in 2016.

The new study of 52,690 donors in the Journal of the American Society of Nephrology found that donation rates declined from 2005 to 2015.

Since 2005, donation among men declined 25 percent, going from about 22 per million people in 2005 to about 17 per million in 2015. The drop wasn't significant - just 5 percent - among women, where the donation rate was just under 30 per million in 2015.

Income was a major factor. Among people making over $61,902 per year, donation rates declined a mere 4 percent among men and actually increased 11 percent in women.

But for people in the lowest income quartile - those making less than $39,287 - the decline was 27 percent among women and 41 percent among men.

"Since a larger proportion of men are the primary household income earner in the U.S. and are likely to earn higher wages compared to women, it follows that the potential for lost wages may disproportionately impact donations from men,” the researchers wrote. “With the exception of selected private charities and paired exchange registries, most current expense reimbursement programs for living donors do not cover lost wages."

The researchers said the findings, combined with previous research, "highlight the need for broad based policies to ensure donation is financially neutral for living donors. This includes reimbursement for out of pocket expenses at the time of donation, and for long-term health insurance coverage for donation-related complications as well as for health care required to preserve post donation kidney function."

"Living donors are heroes; they undergo a major operation, with associated risks and of no medical benefit," said Drs. Arthur Matax of the University of Minnesota and Rebecca Hays of the University of Wisconsin in an editorial in the journal. "Donors should not also have to pay donation-related costs."

They said, "Many countries have enacted policies to ensure that all living donation-related costs are reimbursed or directly covered, and that donors’ jobs and a living wage are protected during recovery. The United States could and should build from those models."

Gill, a transplant nephrologist at the University of British Columbia, said such proposals are under discussion, including the idea of providing donors free health coverage for life, an expense easily covered by the savings of getting a person off dialysis.

But doctors don't want people selling their organs as a way to make money.

"There needs to be serious discussion around how do we protect people who have donated and protect their health in the long term without creating a scenario where we're paying people off. That sweet spot needs to be determined," Gill said.

He predicts the sweet spot will be found.

"We're going to deal with lost wages. We're going to insure that donors get healthcare protections as well," he said. "I'm optimistic we'll get there."

SOURCE: and Journal of the American Society of Nephrology, online March 8, 2018.

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