The aim of this study was to examine health insurance trends in living kidney donors (LKDs) in the United States and their association with donor and post-donation characteristics. We queried the UNOS/OPTN database for LKD health insurance status, sociodemographic and health characteristics, relationship to the recipient, geographic region, and presence/absence of post-donation follow-up clinical information. There were 131,693 LKDs between October 1987 and July 2015. Because UNOS/OPTN did not formerly collect donor health insurance status until June 2004, the 63,636 (48.3%) who donated prior to this date were removed. An additional 15,331 (11.6%) were removed because health insurance status was unknown, the donor was <18 yrs old, or the donor did not reside in the US. Of the remaining 53,726 LKDs, 8,308 (15.5%) did not have health insurance at the time of donation. Univariable [chi]² analyses found that younger, male (17.7% vs. 14.0% female), minority (24.4% vs. 11.8% whites), unmarried/unpartnered (24.3% vs. 12.0% married/partnered), unemployed (27.1% vs. 12.7% working), ≤HS education (25.7% vs. 11.1% college educated), normotensive (15.6% vs. 7.2% hypertensive), and current cigarette smoking (27.6% vs. 13.8% non-smokers) LKDs were significantly less likely to have health insurance at donation (all P values <0.001). Also, UNOS regions 4 (23.7%) and 10 (28.4%) had the highest percentage of uninsured LKDs, while regions 1 (6.0%) and 6 (7.4%) had the fewest. Transplant programs were less likely to report clinical information (i.e., creatinine) at 12 month follow-up for uninsured LKDs (14.9% vs. 16.0%, P<0.001). Logistic regression showed that age (P<0.0001), gender (P<0.0001), race (P<0.0001), marital status (P<0.0001), employment status (P<0.0001), education (P<0.0001), hypertension history (P<0.0001), and smoking status (P<0.0001) were all significantly associated with LKD health insurance status ([chi]²=4002.2, P<0.0001). A small but significant percentage of LKDs do not have health insurance at time of donation surgery. While evaluation and treatment of short-term donation-related complications may be covered by the recipient's health insurance, LKDs who remain uninsured following donation may be at risk for higher financial impact if complications occur. Particularly troubling is that lack of insurance is more common in LKDs with known health disparities (e.g., minorities, least educated) and those who have behavioral health risk factors for poor health (e.g., smoking).

CITATION INFORMATION: Rodrigue J, Fleishman A. Health Insurance Trends in United States Living Kidney Donors. Am J Transplant. 2016;16 (suppl 3).

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