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Kidney Week

Abstract: SA-PO955

Managing the Costs of Kidney Paired Donation: A Survey of Contemporary US Practice and Challenges

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Lentine, Krista L., Saint Louis Univ., St. Louis, Missouri, United States
  • Gheorghian, Geoffrey, Saint Louis Univ., St. Louis, Missouri, United States
  • McNatt, Gwen Elise, Univ. Iowa, Iowa City, Iowa, United States
  • Howey, Robert, Toyon Assoc., Franklin, Tennessee, United States
  • Fleetwood, Vidya, Saint Louis Univ., St. Louis, Missouri, United States
  • Mandelbrot, Didier A., Univ. Wisconsin, Madison, Wisconsin, United States
  • Tabriziani, Hossein, Natera, San Carlos, California, United States
  • Wooley, Cody, Saint Louis Univ., St. Louis, Missouri, United States
  • Al Ammary, Fawaz, UC Irvine, Irvine, California, United States
  • Tietjen, Andrea, St. Barnabas, Livingston, New Jersey, United States
Background

Kidney paired donation (KPD) is increasingly used to provide access to living donor kidney transplantation (LKDT), but concerns related to managing costs pose barriers to transplant center participation. To help inform community discussions of strategies, we surveyed U.S. LDKT program staff on experiences and practices for managing KPD-related costs.

Methods

A survey instrument was designed by a multidisciplinary workgroup of professionals in transplant administration and practice. We distributed the survey to staff at U.S. LDKT transplant programs by email and posting to professional society list-servs in 2024 using the Qualtrics survey platform.

Results

Among 62 programs that participated to date, 95% report KPD participation, with 34% reporting >10 exchanges per year. For external changes, 72% use the National Kidney Registry alone or combined with other programs, and 11% use the Alliance for Paired Donation alone or with other programs. Reported resources for KPD include physician champions (56%), nurse coordinators (35%), financial expertise (47%) and contracting assistance (45%)(Fig A). Heterogenous methods are used to cover database costs (Fig B) and other costs including evaluation, nephrectomy, and organ shipping. 42% of centers report standardized policies and procedures for handling KPD costs, while 21% are uncomfortable discussing methods to cover costs of KPD with administration.

Conclusion

Based on a pilot survey of U.S. LDKT programs, a variety of approaches are used to cover costs of KPD practice, and many centers are uncomfortable discussing resource needs with administration. Up-to-date resources on handling KPD finances will be useful to support programs in expanding KPD practice.