307.3: Do financial incentives improve patient compliance with living donor follow-up? An analysis of a pilot randomized controlled trial.

Background: The Organ Procurement and Transplantation Network (OPTN) requires transplant hospitals to monitor living kidney donors for 2 years post-donation. However, the majority (57%) of transplant hospitals struggle to meet nationally-mandated thresholds.1 Financial incentives have been employed in many realms of healthcare to change health-related behaviors,2 and might be a valuable tool to promote patient engagement with postdonation monitoring efforts without increasing administrative burden. We sought to test the effectiveness of using small financial incentives to increase donor compliance with follow-up care in a randomized controlled trial (RCT). Methods: We are conducting an ongoing, two-arm superiority RCT of donors who undergo nephrectomy at our center. Using block randomization, donors are assigned to the intervention ($25 gift card at time of each follow-up) or control arm (standard of care) upon discharge from their initial hospitalization. Follow-up compliance is tracked over time. We present preliminary 6-month results using Fisher’s exact test to assess the statistical significance of the difference in compliant follow-up between study arms. Results: Among 35 donors who underwent nephrectomy from 3/2017-12/2017, 19 were assigned to the intervention arm and 16 were assigned to the control arm. The majority of donors (N=27) were Caucasian, with a median age of 48.5 (IQR 36.2-59.0) and no differences between study arms (p>0.1). More donors in the intervention arm were compliant with 6-month follow-up (N=15/19; 79%) compared to the control arm (N=10/16; 63%), although these differences did not reach statistical significance (p=0.5). Conclusions: In a preliminary analysis of this ongoing RCT, we detected a tendency towards higher rates of 6-month compliance among donors who received financial incentives compared to those who received standard of care. National Institute of Diabetes and Digestive and Kidney Diseases K01DK114388. National Institute of Diabetes and Digestive and Kidney Diseases K24DK101828. The Living Legacy Foundation of Maryland. National Institute of Diabetes and Digestive and Kidney Diseases K23DK115908. National Institute of Diabetes and Digestive and Kidney Diseases K01DK101677. National Institute of Diabetes and Digestive and Kidney Diseases F32DK105600. National Heart, Lung, and Blood Institute T32HL007055. References: 1. Henderson ML, Thomas AG, Shaffer A, Massie AB, Luo X, Holscher CM, Purnell TS, Lentine KL, Segev DL. The National Landscape of Living Kidney Donor Follow-Up in the United States. American Journal of Transplantation. 2017; 17(12):3131-3140. 2. Sutherland K, Christianson JB, Leatherman S. Impact of targeted financial incentives on personal health behavior: a review of the literature. Medical care research and review. 2008; 65(6 Suppl):36s-78s.