Why Donors Do Not Donate: A Living Donation Program Experience.

BACKGROUND

A living donor (LD) kidney transplant is the best therapeutic option for end-stage kidney disease. Potential donors must undergo multiple analyses and the rates of live donation can be as low as 8% to 18%. Here, we report on the live kidney donor program in our unit with emphasis on the reasons why potential donors do not proceed to donation.

METHODS

We performed a single-center retrospective study of all potential kidney donors with a first LD appointment at Centro Hospitalar Universitário do Porto between January 2016 and December 2020.

RESULTS

In our cohort there were 395 potential donors. From the potential donors who finished assessment, 131 were approved for donation and 239 dropped out. After assessment, 104 (28.1%) recipients received a living kidney transplant, 24 of which received a living kidney transplant through the kidney paired exchange program. The individuals who did not proceed to the surgery (n = 239) had a median age of 46.5 years, 64.4% were female, and 34 pairs were ABO-incompatible. The most frequent donor-recipient relationships were spouses, siblings and parents. The 2 most important causes of dropout were due to medical, surgical or psychological contraindications and the donor's voluntary withdrawal. When we evaluated the variables most related to dropout, they were not because of being a spouse and ABO incompatibility.

CONCLUSIONS

When compared to other studies, we showed a relatively higher rate of successful live donations, possibly aided by the presence of cross-over transplantation. Targeted education and support at an earlier stage of the donor assessment process may lead to a better engagement and lower probability of early dropout.