Associations of Lack of Insurance and Other Sociodemographic Traits With Follow-up After Living Kidney Donation

Lam, Ngan N.; Muiru, Anthony N.; Tietjen, Andrea L.; Hays, Rebecca; Xiao, Huiling; Garg, Amit X.; McNatt, Gwen; Howey, Robert; Thomas, Christie P.; Sarabu, Nagaraju; Wooley, Cody; Kasiske, Bertram L.; Lentine, Krista L.

doi:10.1053/j.ajkd.2022.01.427

Cited by 3 publications

(3 citation statements)

References 8 publications

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“…Further, there are variations in demographic characteristics and clinical outcomes among donors [11][12][13][14][15][16]. Uninsured donors and those who reside out-of-state relative to the transplant center have lower odds of medical follow-up, which can predispose them to poor outcomes [17][18][19].…”

Section: Changing Landscape In Living Kidney Donationmentioning

confidence: 99%

Changing landscape of living kidney donation and the role of telemedicine

Ammary¹,

Muzaale

Tantisattamoa

et al. 2022

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of review There has been a decline in living kidney donation over the last two decades. Donors from low-income families or racial/ethnic minorities face greater disproportionate geographic, financial, and logistical barriers to completing lengthy and complex evaluations. This has contributed to the decreased proportion of these subgroups. The authors view telemedicine as a potential solution to this problem. Recent findings Since the initial decline of donors in 2005, biologically related donors have experienced a lack of growth across race/ethnicity. Conversely, unrelated donors have emerged as the majority of donors in recent years across race/ethnicity, except for unrelated black donors. Disparities in access to living kidney donation persist. Telemedicine using live-video visits can overcome barriers to access transplant centers and facilitate care coordination. In a U.S. survey, nephrologists, surgeons, coordinators, social workers, and psychologists/psychologists across transplant centers are favorably disposed to use telemedicine for donor evaluation/follow-up beyond the coronavirus disease 2019 pandemic. However, with the waning of relaxed telemedicine regulations under the Public Health Emergency, providers perceive payor policy and out-of-state licensing as major factors hindering telemedicine growth prospects. Summary Permanent federal and state policies that support telemedicine services for living kidney donation can enhance access to transplant centers and help overcome barriers to donor evaluation.

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Section: Changing Landscape In Living Kidney Donationmentioning

confidence: 99%

Changing landscape of living kidney donation and the role of telemedicine

Ammary¹,

Muzaale

Tantisattamoa

et al. 2022

Current Opinion in Nephrology &Amp; Hypertension

View full text Add to dashboard Cite

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“…As such, there is a rationale to include living donor follow-up care as a covered benefit under OACC. Uniform access to follow-up care is especially important in the USA, where there are significant disparities in access to healthcare and living donor outcomes based on social determinants of health and other factors [ 14 ]. Provision of donor follow-up care may also reduce financial burdens on donors, and provide early warning systems for donors at increased risk of long-term complications [ 38 ].…”

Section: Future Directions For Managing Living Donor Follow-up Costsmentioning

confidence: 99%

“…In 2013, the OPTN defined minimum transplant center-level follow-up thresholds as at least 80% and 70% for clinical and laboratory data, respectively [ 13 ]. Two decades later, postdonation follow-up remains a challenge, especially for vulnerable groups like uninsured donors [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Managing the Costs of Routine Follow-up Care After Living Kidney Donation: a Review and Survey of Contemporary Experience, Practices, and Challenges

et al. 2022

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Purpose of Review While living organ donor follow-up is mandated for 2 years in the USA, formal guidance on recovering associated costs of follow-up care is lacking. In this review, we discuss current billing practices of transplant programs for living kidney donor follow-up, and propose future directions for managing follow-up costs and supporting cost neutrality in donor care. Recent Findings Living donors may incur costs and financial risks in the donation process, including travel, lost time from work, and dependent care. In addition, adherence to the Organ Procurement and Transplantation Network (OPTN) mandate for US transplant programs to submit 6-, 12-, and 24-month postdonation follow-up data to the national registry may incur out-of-pocket medical costs for donors. Notably, the Centers for Medicare and Medicaid Services (CMS) has explicitly disallowed transplant programs to bill routine, mandated follow-up costs to the organ acquisition cost center or to the recipient’s Medicare insurance. We conducted a survey of transplant staff in the USA (distributed October 22, 2020–March 15, 2021), which identified that the mechanisms for recovering or covering the costs of mandated routine postdonation follow-up at responding programs commonly include billing recipients’ private insurance (40%), while 41% bill recipients’ Medicare insurance. Many programs reported utilizing institutional allowancing (up to 50%), and some programs billed the organ acquisition cost center (25%). A small percentage (11%) reported billing donors or donors’ insurance. Summary To maintain a high level of adherence to living donor follow-up without financially burdening donors, up-to-date resources are needed on handling routine donor follow-up costs in ways that are policy-compliant and effective for donors and programs. Development of a government-supported national living donor follow-up registry like the Living Donor Collective may provide solutions for aspects of postdonation follow-up, but requires transplant program commitment to register donors and donor candidates as well as donor engagement with follow-up outreach contacts after donation.

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