Non-reimbursed costs incurred by living kidney donors: A case study from Ontario, Canada.

BACKGROUND: Living donors may incur out-of-pocket costs during the donation process. While many jurisdictions have programs to reimburse living kidney donors for expenses, few programs have been evaluated.

METHODS: The Program for Reimbursing Expenses of Living Organ Donors (PRELOD) was launched in the province of Ontario, Canada in 2008 and reimburses travel, parking, accommodation, meals, and loss of income; each category has a limit and the maximum total reimbursement is $5,500 CAD. We conducted a case study to compare donors' incurred costs (out-of-pocket and lost income) with amounts reimbursed by PRELOD. Donors with complete or partial cost data from a large prospective cohort study were linked to Ontario's reimbursement program to determine the gap between incurred and reimbursed costs (n=159).

RESULTS: The mean gap between costs incurred and costs reimbursed to the donors was $1,313 CAD for out-of-pocket costs and $1,802 CAD for lost income, representing a mean reimbursement gap of $3,115 CAD. Non-directed donors had the highest mean loss for out-of-pocket costs ($2,691) and kidney paired donors had the highest mean loss for lost income ($4,084). There were no significant differences in the mean gap across exploratory subgroups.

CONCLUSIONS: Reimbursement programs minimize some of the financial loss for living kidney donors. Opportunities remain to remove the financial burden of living kidney donors.