Congressional initiative
Such legislation already is being considered by the U.S. House of Representatives. Rep. Jerrold Nadler (D-NY) and Rep. Michael Burgess (R-TX) in July introduced the Living Donor Protection Act to promote organ donation and protect the rights of living donors. “Organ donation saves Medicare millions of dollars every year,” Nadler noted in a press release.
“It cuts health care costs by as much as two-thirds by reducing the need for dialysis and other expensive medical interventions to treat chronic illnesses. Yet, after taking this heroic step to save a life, living organ donors may unfortunately face discrimination when they try to take medical leave or buy insurance—our bill would address that injustice.”
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Among other provisions, the bill would prohibit life, disability, and long-term care insurance companies from denying or limiting coverage and from change higher premiums for living organ donors. It would clarify that living organ donors may use the Family and Medical Leave Act time to recover from the surgeries and procedures involved in their donation.
To defray from expenses associated with living organ donation, 13 states have enacted laws allowing for $10,000 organ donation tax deductions, according to the American Society of Transplantation website. A few states, such as Idaho, Missouri, and Virginia provide for a paid leave of absence for state employees who become living organ donors.
Studies May Help Quantify Risk of Living Kidney Donation
Amid a decline in living kidney donation (LKD) nationally in the U.S., emerging evidence suggests that LKD may be associated with greater risks than previously thought.
For example, a study led by Hallvard Holdaas, MD, of Oslo University Hospital in Oslo, Norway, found that living kidney donors had an 11.4 times increased risk of end-stage renal disease (ESRD), a 40% increased risk of cardiovascular death, and a 30% increased risk of death from any cause compared with a control group of potentially eligible kidney donors. The median follow-up times for the donors and controls were 15.1 years and 24.9 years, respectively.
“Our findings raise some medical and ethical considerations regarding live-kidney donation,” the authors wrote in Kidney International (2014;86:162-167). “The present study indicates potential increased long-term risks for kidney failure and mortality in kidney donors.”
The researchers noted, however, that this must be put into perspective. Living donor transplantation has been a necessary and essential part of providing ESRD patients with freedom from dialysis and enabling transplant recipients to enjoy a superior quality of life, Dr. Holdaas and his colleagues pointed out. “Most potential living donors are willing to accept a degree of risk when the recipient is a family member of a close friend,” they stated.
A separate study of 96,217 living kidney donors led by Dorry Segev, MD, PhD, an abdominal transplant surgeon at Johns Hopkins University in Baltimore, found that the incidence rate of ESRD was 30.8 per 10,000 among living donors compared with 3.9 per 10,000 among healthy matched controls, but still much lower than individuals in the general population, according to a report published in the Journal of the American Medical Association (JAMA 2014;311:579-586). The median follow-up for donors and controls was 7.6 and 15.0 years, respectively.
Furthermore, contrary to the study by Dr. Holdaas’ team, Dr. Segev’s group found no increased risk of death among living kidney donors in a prior study of 80,247 donors, which also was published in JAMA (2010;303:959-966).
“I definitely think the findings [of these studies] need to be made part of informed consent discussions,” Dr. Segev said, “but I think the findings are actually quite reassuring, given the extremely low risk of ESRD in kidney donors, and I have not found in my own clinical practice that donors are surprised or dissuaded by this information. Rather, they seem to appreciate the careful work that has gone into making sure donating a kidney is safe.”
At the 2014 World Transplant Congress in San Francisco, researchers presented the findings of a study showing that LKD is associated with a modestly increased long-term risk of gout. A team led by Ngan N. Lam, MD, of the London Health Sciences Centre in London, Ontario, studied 1,988 living kidney donors and 19,880 matched healthy non-donors who were followed for a median of 8.4 years.
The median age at the index date of the donors and matched controls was 43 years. Gout developed in significantly more donors than non-donors (3.4% vs. 2.0%), a difference that translated into a 60% increased risk of gout among living donors, according to a poster presentation.
In addition, significantly more donors than non-donors received prescriptions of the gout medicines allopurinol or colchicine (3.8% vs. 1.3%), which translated into a 3.2 times increased likelihood of a gout medication prescription.
