Perspectives of transplant physicians and surgeons on reimbursement, compensation, and incentives for living kidney donors

Am J Kidney Dis. 2014 Oct;64(4):622-32. doi: 10.1053/j.ajkd.2014.02.019. Epub 2014 Apr 3.


Background: The shortage of donors for organ transplantation has stimulated debate on financial incentives for living kidney donors. This study aims to describe the range of attitudes and opinions of transplant physicians on financial reimbursement, compensation, and incentives in living kidney donation.

Study design: Qualitative study.

Setting & participants: 110 transplant nephrologists and surgeons from 12 countries across 43 transplantation units in Europe, Australasia, and North America.

Methodology: Face-to-face semistructured interviews were conducted.

Analytical approach: Transcripts were thematically analyzed.

Results: We identified 7 major themes. Prioritizing the removal of disincentives for living kidney donors was largely deemed acceptable. By contrast, provision of financial incentives raised concerns about undermining benevolence, compromising human dignity and value, and traversing market forces. Some contended that financial incentives potentially were legitimate if regulated, arguing that this would maximize utility in transplantation, but most also acknowledged the difficulty and that operational feasibility of a regulated system of financial incentivization may be limited.

Limitations: Participants were English speaking and from Western high-income countries; therefore, the transferability of our findings may be limited.

Conclusions: Transplantation specialists believed that minimizing disincentives would support equity and justice in living kidney donation. Direct financial incentivization for living kidney donors, even in the context of a regulated market, was regarded by most as unjustified because of the potential moral consequences and uncertain feasibility. Removing financial disincentives and safeguarding the intrinsic volunteerism, value, and meaning of donation were viewed to uphold integrity in living kidney donation.

Keywords: Kidney transplantation; altruism; donor incentives; donor reimbursement; health policy; interviews; kidney donation; living donor; organ shortage; qualitative research; renal transplant.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Altruism
  • Attitude of Health Personnel
  • Australasia
  • Europe
  • Female
  • Health Policy
  • Humans
  • Kidney Failure, Chronic / surgery
  • Kidney Transplantation* / economics
  • Kidney Transplantation* / ethics
  • Kidney Transplantation* / psychology
  • Living Donors* / ethics
  • Living Donors* / psychology
  • Living Donors* / supply & distribution
  • Male
  • Marketing of Health Services / ethics
  • Marketing of Health Services / legislation & jurisprudence
  • Middle Aged
  • Nephrology*
  • North America
  • Qualitative Research
  • Reimbursement, Incentive / organization & administration*
  • Surgeons / ethics
  • Surgeons / psychology*
  • Tissue and Organ Procurement*