Living Donor Decision-Making and the Complex Interplay of Finances and Other Motivators, Barriers, and Facilitators.

Autor: Smith AR; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.; Northwestern University, Chicago, Illinois, USA., Mandell RJ; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA., Goodrich NP; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA., Helmuth ME; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.; University of Michigan Ann Arbor, Ann Arbor, Michigan, USA., Wiseman JB; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA., Gifford KA; American Society of Transplant Surgeons, Arlington, Virginia, USA., Fava MA; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA., Ojo AO; University of Kansas, Kansas City, Kansas, USA., Merion RM; Arbor Research Collaborative for Health, Ann Arbor, Michigan, USA.; University of Michigan Ann Arbor, Ann Arbor, Michigan, USA., Mathur AK; Mayo Clinic, Phoenix, Arizona, USA.
Jazyk: angličtina
Zdroj: Clinical transplantation [Clin Transplant] 2024 Jul; Vol. 38 (7), pp. e15377.
DOI: 10.1111/ctr.15377
Abstrakt: Introduction: The decision to become a living donor requires consideration of a complex, interactive array of factors that could be targeted for clinical, policy, and educational interventions. Our objective was to assess how financial barriers interact with motivators, other barriers, and facilitators during this process.
Methods: Data were obtained from a public survey assessing motivators, barriers, and facilitators of living donation. We used multivariable logistic regression and consensus k-means clustering to assess interactions between financial concerns and other considerations in the decision-making process.
Results: Among 1592 respondents, the average age was 43; 74% were female and 14% and 6% identified as Hispanic and Black, respectively. Among employed respondents (72%), 40% indicated that they would not be able to donate without lost wage reimbursement. Stronger agreement with worries about expenses and dependent care challenges was associated with not being able to donate without lost wage reimbursement (OR = 1.2, 95% CI = 1.0-1.3; OR = 1.2, 95% CI = 1.1-1.3, respectively). Four respondent clusters were identified. Cluster 1 had strong motivators and facilitators with minimal barriers. Cluster 2 had barriers related to health concerns, nervousness, and dependent care. Clusters 3 and 4 had financial barriers. Cluster 3 also had anxiety related to surgery and dependent care.
Conclusions: Financial barriers interact primarily with health and dependent care concerns when considering living organ donation. Targeted interventions to reduce financial barriers and improve provider communication regarding donation-related risks are needed.
(© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
Databáze: MEDLINE
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