Canadian Stakeholders' Perspectives on Voucher Donation in Kidney Transplantation

Abstract

Introduction: Living donation remains the best therapy for people with end-stage kidney disease. Voucher donation allows donation to take place at the time that is most convenient for the donor. In this type of donation, a voucher is issued that can later be exchanged by a person in need of a kidney transplant. Voucher donation raises numerous issues. The objective of this study was to gather the perspectives of patients and transplant professionals on voucher donation.

Methods: We conducted interviews with 24 patients and 21 transplant professionals between November 2020 and December 2022. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach.

Results: Most participants were open-minded about the possibility of implementing voucher donation because it could increase the number of available organs; however, they raised the following ethical concerns: issues of fairness, risks of undue pressure, informed consent, and risks of commodification. Prioritization among voucher holders, the number of vouchers allowed, the transferability of vouchers, and the verification of voucher holder's identity were the logistical issues raised. Actions suggested before implementing this program included the following: a regulatory framework or guidelines, educational tools, patient engagement, and management by a national program.

Conclusion: This study describes the perspectives of patients and transplant professionals on ethical and logistical issues related to voucher donation. Strategies to address these issues as well to explore the perspectives of marginalized communities and of the general public are needed.

Keywords: living kidney donation; qualitative study; voucher donation.

Graphical abstract

Figure 1

Advanced and voucher donation.

Figure 2

Flowchart for the recruitment process. CHUM, Centre hospitalier de l’Université de Montréal; KTC, kidney transplant candidate; KTR, kidney transplant recipient; LKD, living kidney donor; MUHC, McGill University Health Centre; UHN, University Health Network.