Division of Hepatobiliary and Abdominal Organ Transplant Surgery, University of Southern California, Los Angeles, California, USA.
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Clin Transplant. 2020 Nov;34(11):e14073. doi: 10.1111/ctr.14073. Epub 2020 Sep 27.
Living donor liver transplantation (LDLT) has increased availability of liver transplantation, particularly in countries with limited access to deceased organ donors. It is unclear how individual countries address the financial impact of donation for potential living donors. Herein, living liver donor financial supports were examined, focusing on countries performing ≥10 LDLT per year in the World Health Organization Transplant Observatory. Categories included health insurance coverage, reimbursement of lost wages, employment protection, and other incentives designed to promote living liver donation. Overall, 26 countries have some form of asssistance in removing disincentives to ease the financial burden of living donation, ranging from childcare, accommodations, meals, and travel reimbursement, to coverage of medical complications post-donation. Most countries provide donation-related medical coverage. Fourteen provide reimbursement of lost wages and/or paid time off. Several unique programs were designed to incentivize living donation, including free entry to museums and observatories, parking and airline discounts, and exemptions on mortgages and medical deductibles. This study highlights the broad range of programs designed to support living liver donation in high-volume LDLT countries. The data collected in this study can provide a framework for other nations to propose and implement ethical reimbursement and incentivization for living liver donors.
活体肝移植 (LDLT) 增加了肝移植的可及性，特别是在那些可供使用的已故器官捐献者有限的国家。目前尚不清楚各国如何应对潜在活体供者捐献的经济影响。本文探讨了活体肝供者的经济支持，重点关注世界卫生组织移植观察站中每年进行≥10 例 LDLT 的国家。分类包括医疗保险覆盖范围、工资损失补偿、就业保护以及其他旨在促进活体肝捐献的激励措施。总体而言，26 个国家采取了某种形式的援助措施，以消除对活体捐献的经济负担的抑制因素，范围从儿童保育、住宿、膳食和旅行报销，到捐赠后医疗并发症的覆盖。大多数国家提供与捐赠相关的医疗保障。14 个国家提供工资损失补偿和/或带薪休假。一些独特的项目旨在激励活体捐献，包括免费进入博物馆和观测站、停车和航空公司折扣，以及免除抵押贷款和医疗免赔额。本研究强调了为高容量 LDLT 国家的活体肝捐献者提供支持的广泛计划。本研究中收集的数据可以为其他国家提出和实施活体肝捐献者的伦理补偿和激励措施提供框架。
