Effects of Donor Wage Reimbursement: Findings From the Living Donor Lost Wages Randomized Trial

Lost wages following living donation may deter patients from pursuing living donor kidney transplantation (LDKT) and potential donors from being evaluated.

We randomized patients undergoing transplant evaluation to 1 of 2 donor wage reimbursement groups ($1500 or $3000 maximum) and encouraged them to discuss this reimbursement program with their social network. These patients were compared with matched historical controls (HCs) on the likelihood of LDKT and ≥1 donor evaluation within 1 y of transplant evaluation. Multivariable logistic regression adjusted for demographic and clinical factors known to be associated with LDKT.

Access to any donor wage reimbursement (lost wages $1500 maximum reimbursement and lost wages $3000 maximum reimbursement combined versus HC) was not significantly associated with LDKT occurrence (adjusted odds ratio [aOR], 0.85; 95% confidence interval [CI], 0.39-1.85; P  = 0.68) or with the likelihood of having at least 1 donor evaluated within 1 y of initial evaluation (aOR, 1.07; 95% CI, 0.76-1.50; P  = 0.70) after covariate adjustment. Also, donor wage reimbursement level (lost wages $1500 maximum reimbursement versus lost wages $3000 maximum reimbursement) was not associated with LDKT (aOR, 0.73; 95% CI, 0.22-2.44; P  = 0.61) or with having a donor evaluation initiated (aOR, 0.65; 95% CI, 0.40-1.05; P  = 0.11). In an exploratory analysis extending follow-up to account for COVID-related shutdowns, access to wage reimbursement was associated with higher odds of LDKT compared with HC (aOR, 2.16; 95% CI, 1.12-4.18; P  = 0.02).

Donor wage reimbursement, at the levels tested, did not increase LDKT or living donor evaluation likelihood in primary analyses, although exploratory findings suggest that effects may emerge with longer follow-up. Wage reimbursement alone may be insufficient to meaningfully expand LDKT.