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Ongoing flaws with living donor reimbursement policy — IKA

Passages of the updated Policy on Reimbursement of Expenses for Living Donation remain “unsatisfactory”, despite some improvements, according to the Irish Kidney Association (IKA). Living donor kidney transplants are undertaken at Beaumont Hospital in Dublin, with some transplants facilitated in the UK under a paired exchange programme. Living liver donation usually involves a parent-to-child donation, with these paediatric transplants taking place in the UK.

The policy has an upper limit of reimbursement for loss of earnings (€10,000) and travel/accommodation expenses (€6,000). Childcare costs to €5,000 have been added.

The policy states that “overtime payments, shift allowances or other similar payments will not be eligible for reimbursement, irrespective of whether they comprise a regular portion of the donor’s salary”. According to the IKA, this “adversely affects the most vulnerable lower-paid individuals”.

The policy also says where a donor wishes to extend their stay to remain with the organ recipient, costs associated with this period will not be reimbursed. The IKA stated that “the paired kidney exchange and the living liver donations are mostly with relatives and parents. The donors are often the primary carers of the recipients. A one-week extension or less if the recipient is discharged to go home, probably requiring assistance anyway, is a humane gesture that is not an incentive and more of a necessity.”

According to the IKA, the restrictive terms of the Treatment Abroad Scheme, in respect of recipients, and the living donor policy, can result in costs being borne by the recipients/donors. The IKA has provided financial assistance in a number of cases.

The policy was also criticised by Dr Dominick Natin, an occupational medicine consultant in Dublin who participated in non-directed altruistic kidney donation in Belfast. This is not yet facilitated in Ireland, as the Government has stated legal provisions must be in place. Although the reimbursement policy did not apply to him, Dr Natin said he was “pretty appalled reading it”.

He said it read as though written by an accountant who was giving away their own income. “It reminds me of the phrase ‘they know the price of everything and the value of nothing’,” he added.

There was no reference to altruistic donation being “a good thing to do and that the State appreciated it”.  He added that, aside from the main reason for donation – to ultimately save a person’s life – it also resulted in huge savings for the State, such as in dialysis costs. A good living kidney could efficiently work for 30 years.

Dr Natin also criticised the caps put on wages and expenses reimbursements. “Essentially there will be many people who would consider giving a kidney altruistically and will look at this and say, ‘the Government are certainly discouraging me from doing it and I can’t afford to be out of work for that length of time without receiving vouched expenses in full’.”

See interview, page 10

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