Xing, Jiawei

AbstractBackgroundPrevious studies indicate there may be psychological consequences of being unable to serve as a living donor, but these have not been explored in a large national cohort of low‐income individuals who initiated living donor evaluation in US transplant centers.MethodsUsing data from 6574 National Living Donor Assistance Center (NLDAC) participants (November 1, 2007‐December 31, 2018), we utilized a cross‐sectional study design to evaluate short‐term depressive symptoms and satisfaction with life in living donors and non‐donors (those who were declined or withdrew from evaluation) using the Satisfaction with Life Scale (SWLS) and the PHQ‐8, with and without risk adjustment using linear regression.ResultsNational Living Donor Assistance Center participants originated from 207 US transplant centers. 52% of NLDAC participants responded to the survey (n = 3423; donors = 2848 (58.6% of all donors), non‐donors = 575 (33.5% of all non‐donors); ncenters = 201)). Respondents were significantly older, more likely to be female, white, non‐Hispanic, married, more educated, more full‐time employed, and more likely to be unrelated to the recipient vs non‐respondents (all, P < .001). Among survey respondents, donors were significantly younger, more likely to be non‐Hispanic, employed, and related to the recipient compared to non‐donors (all, P < .05). Higher PHQ‐8 scores were correlated with lower SWL scores (r = −.32, P < .001). Both groups displayed high SWLS (donors vs non‐donors: 27.1 vs 26.3, P = .002). Both groups had low levels of depressive symptoms overall, but donors had more symptoms than non‐donors (3.5 vs 2.4, P < .001). After risk adjustment, non‐donors had significantly less depressive symptoms by PHQ‐8 (28% lower, P < .001), but had lower life satisfaction (1.2 points lower, P < .001).ConclusionsDonors and non‐donors have high global levels of overall life satisfaction and low levels of depressive symptoms at 8 weeks after donation or denial. While small effect sizes were observed between groups in these outcomes, being a non‐donor was an independent risk factor for lower life satisfaction, which warrants further evaluation.

AbstractBackgroundThe National Living Donor Assistance Center (NLDAC) enables living donor kidney transplants through financial assistance of living donors, but its return on investment (ROI) through savings on dialysis costs remains unknown.MethodsWe retrospectively reviewed 2012‐2015 data from NLDAC, the United States Renal Data System, and the Scientific Registry of Transplant Recipients to construct 1‐, 3‐, and 5‐year ROI models based on NLDAC applications and national dialysis and transplant cost data. ROI was defined as state‐specific federal dialysis cost minus (NLDAC program costs plus state‐specific transplant cost), adjusted for median waiting time (WT).ResultsA total of 2425 NLDAC applications were approved, and NLDAC costs were USD $6.76 million. Median donor age was 41 years, 66.1% were female, and median income was $33 759; 43.6% were evaluated at centers with WT >72 months. Median dialysis cost/patient‐year was $81 485 (IQR $74 489‐$89 802). Median kidney transplant cost/patient‐year was $30 101 (IQR $26 832‐$33 916). Overall, ROI varied from 5.1‐fold (1‐year) to 28.2‐fold (5‐year), resulting in $256 million in savings. Higher ROI was significantly associated with high WT, larger dialysis and transplant costs differences, and more NLDAC applicants completing the donation process.ConclusionsFinancial support for donor out‐of‐pocket expenses produces dramatic federal savings through incremental living donor kidney transplants.