A Two-Center Randomized Controlled Trial to Assess Financial Incentives for Compliance With Living Kidney Donor...

The United States Organ Procurement and Transplantation Network mandates collection of 6-month, 1-year, and 2-year post-donation follow-up data on living kidney donors (LKDs), but many centers struggle to meet these requirements. This study investigated whether providing a financial incentive (mailed gift card) could increase patient compliance with LKD follow-up.

A parallel, non-blinded, 1:1 superiority randomized control trial of LKDs was conducted at two centers from March 2017 to February 2021. The control arm received standard of care (SOC): instructions to complete the mandated LKD follow-up consisting of a health questionnaire and laboratory measurements at 6 months, 1 year, and 2 years post-donation. The intervention arm received SOC and was mailed a $25 gift card for each timely completed follow-up. Compliance rates were compared at each timepoint using Poisson regression.

A total of 175 donors consented to participate. The 6-month, 1-year, and 2-year follow-up compliance rates were 65.2%, 63%, and 65.2% in the control arm, and 71.1%, 60.2%, and 53.0% in the intervention arm, respectively. No statistically significant improvement in compliance was observed with the gift card intervention (IRR = _0.891.09_1.34 at 6 months, _0.760.96_1.21 at 1 year, and _0.630.81_1.05 at 2 years). Similarly, no differences were observed in compliance with clinical follow-up, laboratory follow-up, or individual questions or lab values.

Mailed gift cards did not improve patient compliance with LKD follow-up requirements; such interventions may be counterproductive among LKDs. Further research is needed to investigate and address barriers to completing LKD follow-up.

ClinicalTrials.gov identifier: NCT03090646.