Impact of, Factors for the Success of, and Concerns Regarding Transplant Patients’ Skin Cancer Campaigns: Observational Study
Authors: Mark Erica , Nguyen Joseph , Choudhary Fatima , Lipoff Jules B 
Published: June 2023

Background
Due to rising health care costs, patients have sought alternative ways of addressing medical expenses. In particular, transplant patients have complex and expensive medical needs—including skin cancer surveillance—that may not be fully covered by insurance. One such method of financing medical costs is by crowdsourcing through web-based platforms, most notably GoFundMe.

Objective
Previous work identified factors associated with GoFundMe campaigns’ fundraising success for dermatologic diseases. We sought to characterize these factors in transplant recipients’ campaigns for funds raised for covering skin cancer–related costs. These factors include demographics, campaign traits, and subjective themes.

Methods
From January to April 2022, we analyzed GoFundMe campaigns using the following search terms chosen on the basis of author consensus: “transplant skin cancer,” “transplant basal cell,” “transplant squamous,” “transplant melanoma,” and “dermatologist transplant.” Demographic data were coded from campaign text or subjectively coded based on author consensus. Campaigns were read completely by 2 independent coders and associated with up to 3 different themes. Linear regression was performed to examine the qualities associated with success, which was defined as funds raised when controlling for campaign goals. Logistic regression was used to examine qualities associated with extremely successful campaigns, defined as those raising funds over 1.5 times the IQR.

Results
Across 82 campaigns, we identified several factors that were associated with fundraiser success. Patients who experienced complications during infectious disease treatment, those who received a pancreas transplant, or those who died from their disease raised significantly more money. Patients older than 61 years raised significantly less money. Extremely successful campaigns (>US $20,177) were associated with campaigners who emphasized a disability from their disease, those who were reluctant to ask for help, or those who died due to their disease.

Conclusions
Demographic and thematic factors are associated with transplant patients’ skin cancer–related fundraising success, favoring those who are younger, in more extreme situations, and appear reluctant to ask for help; these findings are consistent with those of previous studies. Additionally, transplant patients have complex and expensive dermatologic needs that may not be fully covered by insurance, as reflected in their GoFundMe campaigns. The most commonly mentioned reasons for fundraising included living expenses or loss of income, inadequate or no insurance, and end-of-life costs. Our findings may inform transplant patients how to maximize the success of their campaigns and highlight gaps in health care coverage for skin cancer–related costs. Limitations include the possibility for misclassification due to the data abstraction process and limiting data collection to fundraisers available on GoFundMe while excluding those on other websites. Further research should investigate the ethical implications of crowdfunding, financial needs of this patient population, and potential ways to improve access to routine skin cancer surveillance among patients receiving transplants.