Should We Ever Pay Living Kidney Donors? Focus Group Study of Public Opinion

A. Tong,^1,2 A. Ralph,^1,2 J. Chapman,³ G. Wong,^1,2,3 J. Gill,⁴ M. Josephson,⁵ C. Hanson,^1,2 J. Craig.^1,2

¹School of Public Health, The University of Sydney, Sydney, Australia
²Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia
³Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
⁴Division of Nephrology, University of British Columbia, Vancouver, Canada
⁵Department of Medicine, University of Chicago, Chicago.

Meeting: 2015 American Transplant Congress

Abstract number: A225

Keywords: Donation, Ethics, Kidney transplantation, Public policy

Session Information

Session Name: Poster Session A: Non Organ Specific, Economics, Public Policy, Allocation, Ethics

Session Type: Poster Session

Date: Saturday, May 2, 2015

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Exhibit Hall E

Background: The unmet demand for kidney transplantation has generated intense controversy about introducing incentives for living kidney donors to increase donation rates. Such debates may impact public perception and acceptance of living kidney donation. This study aims to describe public opinion on financial reimbursement, compensation and incentives for living kidney donors.

Methods: 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 or organ shortage, minimizing disadvantage, guaranteeing cost-efficiency, providing impetus, counteracting black markets); and honoring donor deservingness (fairness and reason, reassurance and rewards, merited recompense).

Conclusion: Reimbursement and justifiable recompense are considered by the public as 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. The perceived threat to community values of human dignity, goodwill, and fairness suggest substantial public resistance to financial inducements for living kidney donors and should be limited to removing disincentives. The public are a key stakeholder group who need to be actively and meaningful engaged in policy development and current debates around financial payment for living kidney donors.

To cite this abstract in AMA style:

Tong A, Ralph A, Chapman J, Wong G, Gill J, Josephson M, Hanson C, Craig J. Should We Ever Pay Living Kidney Donors? Focus Group Study of Public Opinion [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/should-we-ever-pay-living-kidney-donors-focus-group-study-of-public-opinion/. Accessed May 30, 2025.

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