A Cross-Sectional Social Network Analysis of Decision-Making About Recruiting a Living Donor for Kidney Transplantation.

RATIONALE &

OBJECTIVE

Most living kidney donors are members of the recipient's social network. Our study aims to characterize patient and social network factors associated with recruiting a living kidney donor.

STUDY

DESIGN

A cross-sectional study.

SETTING &

PARTICIPANTS

A total of 106 patients receiving hemodialysis (mean age 60 ± 13 years, 45% female, 75% Black) identified 508 network members (106 who offered to donate and 38 who received a donation request).

PREDICTORS: Demographic and network factors (eg instrumental support, strength of relationships between the patients and members).

OUTCOMES: Whether the member offered to donate and whether the member's offer was accepted. Patients' qualitative reasoning regarding decision-making for recruiting a living kidney donor.

ANALYTIC APPROACH: We performed a mixed-methods egocentric network analysis using multilevel logistic regression models as well as qualitative analysis of open-ended survey questions.

RESULTS

Members who provided instrumental support were more likely to offer to donate (odds ratio 3.54; 95% CI [1.80-7.00]; P < 0.001) and have their offer declined (odds ratio 0.12; 95% CI [0.02-0.74]; P = 0.02). Members with stronger relationships with the patient (9.4 [1] vs 8.4 [2.5], P = 0.02) were more likely to be evaluated at a transplant center. Concern and guilt for the member was the most common reason that patients declined offers (41%) or did not make a living donor request (28%), while members' insistence on donating was a common reason for accepting an offer.

LIMITATIONS: Small sample of only patients receiving hemodialysis.

CONCLUSIONS

For many patients, the barrier to living kidney donation was not a lack of potential donors within their network but reticence to recruit a donor due to concern and guilt for the donor. Future living donor kidney transplantation interventions should engage patients and their networks to facilitate communication, address patient-specific concerns and emphasize donor retention.