Little is known about donation-related out-of-pocket costs incurred by NDD. For NDD, we studied: resources used to cover these costs; level of stress due to costs; and concerns re: health or life insurance. We also asked NDD regarding their attitude about compensation. Stress was ranked on a 5 point Likert scale (not stressful to extremely stressful). We asked about stress related to: 1) total financial burden, 2) medical costs and 3) nonmedical costs (travel, lost wages).

Of 91 NDD, 55 (60%) responded (time from donation ±SD), 6.5±4 yrs. Mean age at donation was 44±11 yrs, 56% female, 98% White. At donation 86% had >high school education and 91% employed. Re: financial resources used during recovery; most common were sick leave (47%); personal savings (40%), vacation leave (35%), short-term disability (18%), and unpaid medical leave (11%). Only 4 (7%) used a donor grant. None borrowed money from family/ bank or held a fundraiser.

Overall financial burden was ranked “moderately” or “very” stressful by 13%. Medical costs were “not at all stressful" for the majority (96%). Nonmedical costs due to donation (i.e. travel, lost wages) were a little stressful for 13%. Concerns re: future health insurance was expressed by 15%; life insurance by 20%. NDD level of burden and stress was lower than our previously reported level seen in directed donors (DD).

Half (53%) NDD agreed donors should be reimbursed for donor specific costs; 33% did not have an opinion and 15% disagreed. Most (76%) NDD did not think donors should be compensated beyond reimbursement for costs, but 15% felt they should; 9% did not have an opinion. Of the 8 affirming payment, tax credits and health insurance were viewed as appropriate vehicles.

We conclude that the majority of NDD use their own financial resources to defray the cost of donation. While overall stress from financial burden was minimal for most, 13% reported greater levels. Stress may be lower in NDD than DD because they choose donation, without any possible obligation or pressure, and can opt to put off donation until financially secure. The fact that NDD (as with any living donor) incur financial burden is disconcerting. The vast majority of NDD endorsed reimbursement for direct expenses like travel, lodging, and meals, yet were willing to absorb this cost. Our data emphasizes the need for a system that minimizes economic stressors associated with donation and at a minimum, make living donation cost neutral.

CITATION INFORMATION: Jacobs C, Wiseman J, Berglund D, Larson D, Garvey C, Vogues M, Rein S, Sanchez O, Radecki Breitkopf C, Ibrahim H, Matas A. Nondirected Kidney Donation – Donating More Than a Kidney. Am J Transplant. 2016;16 (suppl 3).

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