Characteristics of Potential and Actual Living Kidney Donors: A Single-center Experience.
Journal
Transplantation
ISSN: 1534-6080
Titre abrégé: Transplantation
Pays: United States
ID NLM: 0132144
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
medline:
4
4
2023
pubmed:
9
12
2022
entrez:
8
12
2022
Statut:
ppublish
Résumé
There are limited data and no national capture of barriers associated with initiating and completing the donation process for potential living kidney donors (LKDs). We performed a retrospective analysis of 3001 intake forms completed by prospective LKDs from 2016 to 2019 at a single transplant center. We analyzed data from all potential donors who completed the intake until they became ineligible or withdrew or donation was complete. We used univariate and multivariate models to evaluate independent factors associated with donation at various stages in the donation process. The donation process was deconstructed into 5 steps: intake form, immunologic compatibility testing, clinic evaluation, selection committee review, and donation. The highest percentage of potential donors dropped out after completing the intake form, primarily because of not responding to the follow-up phone call (22.6%). Of 455 potential LKDs that completed immunologic compatibility testing, 36% were ABO or crossmatch incompatible. One-hundred eighty-eight (7.5%) of all LKD applicants reached donation, the majority of whom were White (91.0%) and female (63.8%). A minority of LKD applicants make it to donation. Our ability to track all potential LKDs from the initial touch point to the transplant center will help us develop interventions to address barriers to a successful donation.
Sections du résumé
BACKGROUND
There are limited data and no national capture of barriers associated with initiating and completing the donation process for potential living kidney donors (LKDs).
METHODS
We performed a retrospective analysis of 3001 intake forms completed by prospective LKDs from 2016 to 2019 at a single transplant center. We analyzed data from all potential donors who completed the intake until they became ineligible or withdrew or donation was complete. We used univariate and multivariate models to evaluate independent factors associated with donation at various stages in the donation process.
RESULTS
The donation process was deconstructed into 5 steps: intake form, immunologic compatibility testing, clinic evaluation, selection committee review, and donation. The highest percentage of potential donors dropped out after completing the intake form, primarily because of not responding to the follow-up phone call (22.6%). Of 455 potential LKDs that completed immunologic compatibility testing, 36% were ABO or crossmatch incompatible. One-hundred eighty-eight (7.5%) of all LKD applicants reached donation, the majority of whom were White (91.0%) and female (63.8%).
CONCLUSIONS
A minority of LKD applicants make it to donation. Our ability to track all potential LKDs from the initial touch point to the transplant center will help us develop interventions to address barriers to a successful donation.
Identifiants
pubmed: 36476994
doi: 10.1097/TP.0000000000004357
pii: 00007890-202304000-00028
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
941-951Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors declare no conflicts of interest.
Références
Hart A, Lentine KL, Smith JM, et al. OPTN/SRTR 2019 annual data report: kidney. Am J Transplant. 2021;21(Suppl 2):21–137.
Strigo TS, Ephraim PL, Pounds I, et al. The TALKS study to improve communication, logistical, and financial barriers to live donor kidney transplantation in African Americans: protocol of a randomized clinical trial. BMC Nephrol. 2015;16:160.
Garonzik-Wang JM, Berger JC, Ros RL, et al. Live donor champion: finding live kidney donors by separating the advocate from the patient. Transplantation. 2012;93:1147–1150.
Tushla L, Rudow DL, Milton J, et al.; American Society of Transplantation. Living-donor kidney transplantation: reducing financial barriers to live kidney donation–recommendations from a consensus conference. Clin J Am Soc Nephrol. 2015;10:1696–1702.
Organ Procurement and Transplantation Network. Organ Procurement and Transplantation Network (OPTN) policies. Available at https://optn.transplant.hrsa.gov/media/1200/optn_policies.pdf . Accessed July 27, 2021.
University of Wisconsin School of Medicine and Public Health. 2019 Area Deprivation Index. 2022. Available at https://www.neighborhoodatlas.medicine.wisc.edu/ . Accessed December 20, 2021.
Kind AJH, Buckingham W. Making neighborhood disadvantage metrics accessible: the neighborhood atlas. New England Journal of Medicine. 2018;378:2456–2458.
Bloembergen WE, Port FK, Mauger EA, et al. Gender discrepancies in living related renal transplant donors and recipients. J Am Soc Nephrol. 1996;7:1139–1144.
Gill J, Joffres Y, Rose C, et al. The change in living kidney donation in women and men in the United States (2005-2015): a population-based analysis. J Am Soc Nephrol. 2018;29:1301–1308.
Gill J, Dong J, Rose C, et al. The effect of race and income on living kidney donation in the United States. J Am Soc Nephrol. 2013;24:1872–1879.
Ross LF, Thistlethwaite JR. Gender and race/ethnicity differences in living kidney donor demographics: preference or disparity? Transplant Rev (Orlando). 2021;35:100614.
Matas AJ, Hays RE. Gender disparities and financial barriers to living kidney donation. J Am Soc Nephrol. 2018;29:1081–1083.
Gillespie A, Gardiner HM, Fink EL, et al. Does sex, race, and the size of a kidney transplant candidate’s social network affect the number of living donor requests? A multicenter social network analysis of patients on the kidney transplant waitlist. Transplantation. 2020;104:2632–2641.
Prasad GVR. Understanding the sex disparity in living kidney donation. J Eval Clin Pract. 2018;24:999–1004.
Crimmins EM, Shim H, Zhang YS, et al. Differences between men and women in mortality and the health dimensions of the morbidity process. Clin Chem. 2019;65:135–145.
Glynn SJ. Breadwinning mothers continue to be the U.S. norm. 2019. Center for American Progress. Available at https://www.americanprogress.org/article/breadwinning-mothers-continue-u-s-norm/ . Accessed December 10, 2021.
Purnell TS, Hall YN, Boulware LE. Understanding and overcoming barriers to living kidney donation among racial and ethnic minorities in the United States. Adv Chronic Kidney Dis. 2012;19:244–251.
Hart A, Smith JM, Skeans MA, et al. OPTN/SRTR 2018 annual data report: kidney. Am J Transplant. 2020;20(Suppl s1):20–130.
Mandelbrot DA, Pavlakis M. Living donor practices in the United States. Adv Chronic Kidney Dis. 2012;19:212–219.
Ralph AF, Butow P, Craig JC, et al. Clinicians’ attitudes and approaches to evaluating the potential living kidney donor-recipient relationship: an interview study. Nephrology (Carlton). 2019;24:252–262.
Chipman V, Cooper M, Thomas AG, et al. Motivations and outcomes of compatible living donor-recipient pairs in paired exchange. Am J Transplant. 2022;22:266–273.
Gill JS, Tinckam K, Fortin MC, et al. Reciprocity to increase participation of compatible living donor and recipient pairs in kidney paired donation. Am J Transplant. 2017;17:1723–1728.
Segev DL, Powe NR, Troll MU, et al. Willingness of the United States general public to participate in kidney paired donation. Clin Transplant. 2012;26:714–721.
Waterman AD, Schenk EA, Barrett AC, et al. Incompatible kidney donor candidates’ willingness to participate in donor-exchange and non-directed donation. Am J Transplant. 2006;6:1631–1638.
Rodrigue JR, Leishman R, Vishnevsky T, et al. Concerns of ABO incompatible and crossmatch-positive potential donors and recipients about participating in kidney exchanges. Clin Transplant. 2015;29:233–241.
Garg N, Lentine KL, Inker LA, et al. Metabolic, cardiovascular, and substance use evaluation of living kidney donor candidates: US practices in 2017. Am J Transplant. 2020;20:3390–3400.