Get access

The financial impact of immunosuppressant expenses on new kidney transplant recipients*


  • *

    An earlier version of this article was presented at the Academy Health Annual Research Meeting, June 4, 2007 and the Chicago Transplant Ethics Consortium Meeting, Dilemmas and Struggles in Transplantation Ethics, Psychosocial Considerations, and Policy, April 4, 2008.

  • This study was approved by Loyola University Medical Center and Albany Medical Center.

Elisa J. Gordon, PhD, MPH, Alden March Bioethics Institute, Albany Medical Center, 47 New Scotland Avenue, MC 153, Albany, NY 12208, USA
Tel.: +1 518 262 3700; fax: +1 518 262 6856;


Abstract: Background:  This study aimed to examine kidney transplant recipients’ ability to afford transplant-related out-of-pocket expenses and the financial impact of these expenses on their lives.

Patients and methods:  This cross-sectional study involved 77 kidney recipients. Variables analyzed were: ability to afford daily necessities; impact of immunosuppressant expenses on patients’ lives; awareness of Medicare support terminating three yr post-transplant; and strategies used to pay for out-of-pocket transplant expenses. The Economic Strain Scale measured financial strain.

Results:  Twenty-nine percent of kidney recipients experienced financial strain. Poor, less educated, and younger patients were more likely to report financial strain. Out-of-pocket expenses relating to kidney transplantation adversely affected patients’ ability to afford leisure activities (35%), a house (27%), and a car (26%). Thirty-one percent reported that immunosuppressant expenses have had somewhat to great (adverse) impact on their lives. Of those on Medicare and not disabled (n = 41), 51% were unaware Medicare coverage will terminate and 71% did not know how long coverage lasts.

Conclusions:  Financial strain presents a considerable risk to kidney recipients’ ability to purchase immunosuppression. Socioeconomic disparities in recipients’ financial strain may be a source of disparities in graft survival. Transplant professionals should better inform transplant candidates about financial consequences of transplantation.