Living kidney donation: Increasing utilization and assessing costs.

摘要

The incidence of end-stage renal disease, a condition requiring renal replacement therapy to sustain life, is increasing. Transplantation is considered the optimal treatment, and living donor kidney transplantation in particular has superior clinical outcomes. However, the number of recipients waiting for a transplant far exceeds the availability of deceased donor kidneys. We undertook a randomized controlled trial (RCT) to determine if an educational intervention would increase the pursuit of living kidney donation in eligible candidates. We initially developed, validated and administered a questionnaire to assess why eligible kidney transplant candidates do not pursue living donation as a treatment option. We found that most candidates do have family or friends who can donate a kidney (66%), but the majority do not know how to ask (71%). Questionnaire results were used to develop the intervention for the RCT, an education session. We randomized 50 patients to the education intervention and 50 to standard care, and found that the education intervention did not increase the likelihood of a potential donor contacting the living donor program. However, patients who received the education session were more likely to change their treatment preference to living donation at study completion.;In summary, given its superior clinical outcomes for recipients and similar costs to deceased kidney donation, effective strategies to increase the pursuit of living donation remain to be determined.;We also undertook a detailed cost analysis of kidney transplantation to determine if there are differences in the cost and resource utilization between recipients who receive a deceased or a living donor kidney. Using administrative data from local and provincial health care databases, transplant-related costs (both recipient and donor) were assessed before transplant and all costs (out- and in-patient care, diagnostic imaging, laboratory tests and transplant medications) were assessed for two years after transplant. We found that there was no significant different in the mean cost of transplantation (which included donor costs), for recipients of living and deceased donors. Predictors of total two-year recipient costs were presence of diabetes, time spent on the waiting list and non-zero panel reactive antibody.