Living kidney donors’ financial expenses and mental health

BACKGROUND Living kidney donors incur donation-related expenses but how these expenses impact post-donation mental health is unknown. METHODS In this prospective cohort study, the association between mental health and donor-incurred expenses (both out-of-pocket costs and lost wages) was examined in 821 persons who donated a kidney at one of 12 transplant centres in Canada between 2009 and 2014. Mental health was measured by the RAND Short Form 36 Health Survey along with Beck Anxiety Inventory and Beck Depression Inventory. RESULTS A total of 209 of donors (25%) reported expenses over $5,500 Canadian dollars. Compared to donors who incurred lower expenses, those who incurred higher expenses demonstrated significantly worse mental health-related quality of life 3-months after donation (as demonstrated by lower scores on the Mental Component Summary score of the Short-Form 36), with a trend towards worse anxiety and depression, after controlling for pre-donation mental health-related quality of life and other risk factors for psychological distress. Between-group differences for donors with lower and higher expenses on these measures were no longer significant 12-months after donation. CONCLUSIONS Living kidney donor transplant programs should ensure that adequate psychosocial support is available to all donors who need it, based on known and unknown risk factors. Efforts to minimize donor-incurred expenses and to better support the mental well-being of donors need to continue. Further research is needed to investigate the effect of donor reimbursement programs, which mitigate donor expenses, on post-donation mental health.