Allison Tong1, Angelique F Ralph2, Jeremy R Chapman3, Germaine Wong4, John S Gill5, Michelle A Josephson6, Jonathan C Craig2. 1. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; allison.tong@sydney.edu.au. 2. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; 3. The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; 4. Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; The Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia; Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia; 5. Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada; and. 6. Department of Medicine, University of Chicago, Chicago, Illinois.
Abstract
BACKGROUND AND OBJECTIVES: The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Twelve focus groups were conducted with 113 participants recruited from the general public in three Australian states in February 2013. Thematic analysis was used to analyze the transcripts. RESULTS: Five themes were identified: creating ethical impasses (commodification of the body, quandary of kidney valuation, pushing moral boundaries), corrupting motivations (exposing the vulnerable, inevitable abuse, supplanting altruism), determining justifiable risk (compromising kidney quality, undue harm, accepting a confined risk, trusting protective mechanisms, right to autonomy), driving access (urgency of organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets), and honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense). Reimbursement and justifiable recompense are considered by the Australian public as a legitimate way of supporting donors and reducing disadvantage. Financial payment beyond reimbursement is regarded as morally reprehensible, with the potential for exploitative commercialism. Some contend that regulated compensation could be a defensible strategy to increased donation rates provided that mechanisms are in place to protect donors. CONCLUSIONS: The perceived threat to community values of human dignity, goodwill, and fairness suggests that there could be strong public resistance to any form of financial inducements for living kidney donors. Policy priorities addressing the removal of disincentives may be more acceptable to the public.
BACKGROUND AND OBJECTIVES: The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may affect public perception and acceptance of living kidney donation. This study aims to describe the range and depth of public opinion on financial reimbursement, compensation, and incentives for living kidney donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Twelve focus groups were conducted with 113 participants recruited from the general public in three Australian states in February 2013. Thematic analysis was used to analyze the transcripts. RESULTS: Five themes were identified: creating ethical impasses (commodification of the body, quandary of kidney valuation, pushing moral boundaries), corrupting motivations (exposing the vulnerable, inevitable abuse, supplanting altruism), determining justifiable risk (compromising kidney quality, undue harm, accepting a confined risk, trusting protective mechanisms, right to autonomy), driving access (urgency of organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets), and honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense). Reimbursement and justifiable recompense are considered by the Australian public as a legitimate way of supporting donors and reducing disadvantage. Financial payment beyond reimbursement is regarded as morally reprehensible, with the potential for exploitative commercialism. Some contend that regulated compensation could be a defensible strategy to increased donation rates provided that mechanisms are in place to protect donors. CONCLUSIONS: The perceived threat to community values of human dignity, goodwill, and fairness suggests that there could be strong public resistance to any form of financial inducements for living kidney donors. Policy priorities addressing the removal of disincentives may be more acceptable to the public.
Authors: Lianne Barnieh; Kevin McLaughlin; Braden J Manns; Scott Klarenbach; Serdar Yilmaz; Brenda R Hemmelgarn Journal: Nephrol Dial Transplant Date: 2010-07-05 Impact factor: 5.992
Authors: L Ebony Boulware; Felicia Hill-Briggs; Edward S Kraus; J Keith Melancon; Mikiko Senga; Kira E Evans; Misty U Troll; Patti Ephraim; Bernard G Jaar; Donna I Myers; Raquel McGuire; Brenda Falcone; Bobbie Bonhage; Neil R Powe Journal: Prog Transplant Date: 2011-06 Impact factor: 1.065