Outcomes of Living Kidney Donor Candidate Evaluations in the Living Donor Collective Pilot Registry

Abstract

Background: Gaps in our knowledge of long-term outcomes affect decision making for potential living kidney donors.

Methods: The Scientific Registry of Transplant Recipients was asked to determine the feasibility of a candidate registry.

Results: Ten living kidney donor programs evaluated 2107 consecutive kidney donor candidates; 2099 of 2107 (99.6%) completed evaluations, 1578 of 2099 (75.2%) had a decision, and 790 of 1578 (50.1%) were approved to donate as of March 12, 2020. By logistic regression, candidates most likely to be approved were married or had attended college or technical school; those least likely to be approved had ≥1 of the following characteristics: Black race, history of cigarette smoking, and higher blood pressure, higher triglycerides, or higher urine albumin-to-creatinine ratios. Reasons for 617 candidates not being approved included medical issues other than chronic kidney disease risk (25.3%), chronic kidney disease risk (18.5%), candidate withdrawal (15.2%), recipient reason (13.6%), anatomical risk to the recipient (10.3%), noneconomic psychosocial (10.3%), economic (0.5%), and other reasons (6.4%).

Conclusions: These results suggest that a comprehensive living donor registry is both feasible and necessary to assess long-term outcomes that may inform decision making for future living donor candidates. There may be socioeconomic barriers to donation that require more granular identification so that active measures can address inequities. Some candidates who did not donate may be suitable controls for discerning the appropriateness of acceptance decisions and the long-term outcomes attributable to donation. We anticipate that these issues will be better identified with modifications to the data collection and expansion of the registry to all centers over the next several years.

FIGURE 1.

Living Donor Collective design and definitions. ^aData on potential donors eliminated before being seen by the transplant team are not collected. ^bPotential donors selected to be evaluated are considered to be candidates. ^cCandidates are registered when a participating program enters data on the registration form. ^dRegistration is complete when the form is completed and closed to further data entry. ^eBefore a decision is made, the decision form remains open and pending. ^fSRTR linked candidate registration data to OPTN data to determine when a candidate donated. ^gSRTR will collect long-term follow-up data, which are not reported as part of this pilot project. LDC, Living Donor Collective; OPTN, Organ Procurement and Transplantation Network; SRTR, Scientific Registry of Transplant Recipients.

FIGURE 2.

Number of candidates registered and having decided to donate or not as of March 12, 2020.

FIGURE 3.

Time from registration of donor candidates to the donation decision as of March 12, 2020. Each curve represents a different transplant program.

FIGURE 4.

Time from registration of donor candidates to donation as of March 12, 2020, among the 612 who donated. Each curve represents a different transplant program.