Living donor kidney transplantation (LDKT) is the optimal treatment for adults with renal failure. However, living kidney donation has declined in the past decade, particularly among men, younger adults, blacks, and low-income adults. There is evidence that donation-related costs may deter both transplant candidates and potential donors from considering LDKT. Lost wages is a major source of financial loss for some living donors and, unlike travel and lodging expenses, is not reimbursed by financial assistance programs. In this presentation, we will describe the rationale and design – and provide an update – of an NIH-funded, single-center study in which 350 kidney transplant candidates are randomly assigned to one of two parallel arms: (1) possible reimbursement of donor lost wages up to $1,500 or (2) possible reimbursement of donor lost wages up to $3,000, with LDKT occurrence within 12 months of initial transplant evaluation as the primary outcome. The study is testing the impact of offering reimbursement for donor lost wages on the LDKT rate in kidney transplant candidates, examining whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and determining whether higher reimbursement amounts lead to higher LDKT rates. Our central hypotheses are that offering reimbursement for donor lost wages will yield higher LDKT rates overall relative to historical controls, and reduce the disparity between LDKT rates in white and minority patients. In addition, enrolled patients and prospective donors are completing questionnaires to assess financial concerns about transplantation and donation, their relative importance on decision-making, donation ambivalence, and feelings of pressure to donate. We will highlight similarities and differences between our study and the donor lost wages recently funded by the Laura and John Arnold Foundation. Our study is the first such one to be initiated (enrollment underway) and it addresses the transplant community's call to reduce the financial burden of living donation and examine its impact on LDKT rates. Findings have the potential to influence policy, clinical practice, LDKT access, and income and racial disparities in LDKT.

CITATION INFORMATION: Rodrigue J., Pavlakis M., Evenson A., Fleishman A., Carroll M., Mandelbrot D., Baliga P., Howard D., Schold J. The Living Donor Lost Wages Trial: Study Rationale, Protocol, and Update Am J Transplant. 2017;17 (suppl 3).

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