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

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