Interventions to Improve Living Kidney Donor Solicitation: A Systematic Review and Meta-analysis.

BACKGROUND

Living donor kidney transplantation provides superior patient and graft outcomes compared with deceased donor transplantation yet remains underutilized globally. A key barrier is recipient discomfort with current care models, which rely heavily on recipient-led donor solicitation. Optimal solicitation models are unknown.

METHODS

This systematic review and meta-analysis followed Cochrane methodology searching 4 databases and gray literature (inception-June 2025) for randomized controlled trials and nonrandomized intervention studies evaluating living donor solicitation strategies.

RESULTS

We included 22 randomized controlled trials (27 082 participants) and 7 nonrandomized interventions (2193 participants) aimed at promoting living donor solicitation. Evidence of very low certainty suggests that education programs increased enquiries (risk ratio [RR]: 1.65, 95% confidence interval [CI]: 1.10-2.46), solicitation (RR: 1.86, 95% CI: 1.02-3.40), and transplants (RR: 4.01, 95% CI: 1.49-10.76) compared with usual care. One-on-one versus group education showed no clear advantage over the other on enquiries (RR: 1.51, 95% CI: 0.91-2.51) and transplants (RR: 1.69, 95% CI: 1.17-2.45). Risk of bias from studies was moderate.

CONCLUSIONS

Interventions to support living donor kidney solicitation-particularly education-based strategies-may improve key outcomes, including donor enquiries, solicitation rates, and transplant completion. However, the overall certainty of evidence remains very low, and the optimal approach to delivering these interventions is unclear. High-quality, well-powered trials are needed to identify effective, equitable, and acceptable models of care that reduce the burden on recipients while increasing living donor transplantation rates.