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Drop-out rate during living donor selection
R Trevitt1, C Whittaker, E A Ball
1Transplant Unit, Barts and The London NHS Trust, UK.
Insights
This study analyzed reasons why potential live kidney donors did not proceed to transplant. Key barriers included donor health issues and late-stage crossmatch positivity, prompting improved pre-screening and information for donors.
Area of Science:
- Nephrology
- Transplantation Surgery
- Immunology
Background:
- Live donor kidney transplantation is a critical treatment for end-stage renal disease.
- A significant number of potential live donors do not complete the workup process.
- Understanding donor attrition is essential for optimizing transplant program efficiency.
Purpose of the Study:
- To identify and categorize the reasons for donor workup cancellation in live donor kidney transplantation.
- To analyze the frequency of specific reasons for donor disqualification.
- To inform improvements in donor selection and pre-transplant evaluation protocols.
Main Methods:
- Retrospective audit of 29 live donor kidney transplants performed over a 3-year period.
- Analysis of reasons for cancellation among potential donors who met initial compatibility criteria (tissue type, blood group, crossmatch negative).
- Categorization of disqualifying factors including medical conditions, late-stage immunological issues, and donor-related logistical/personal reasons.
Main Results:
- Common reasons for donor workup cancellation included: failure to attend/change of mind (6 donors), impaired renal function (5 donors), and cardiac/hypertension issues (4 donors).
- Late-stage positive crossmatch occurred in 3 potential donors.
- Other reasons included renovascular disease, cancer, and hepatitis.
Conclusions:
- Donor health issues and logistical/personal factors are significant barriers to live kidney donation.
- Implementing pre-travel screening tests for geographically distant donors and providing comprehensive information leaflets can mitigate some cancellations.
- Continuous audit and process improvement are vital for maximizing live donor kidney transplant rates.
Abstract:
This unit carried out 29 live donor transplants over a 3-year period. Many potential donors did not proceed to transplant. For those who had an acceptable tissue type, were blood group compatible and lymphocytotoxic crossmatch negative, we looked at the reasons for cancelling the donor work up. The reasons were impaired renal function (5 potential donors), cardiac/hypertension (4 potential donors), renovascular (1 potential donor), cancer (1 potential donor), cross-match positive at a late stage (3 potential donors), failure to attend at clinic/change of mind (6 potential donors) and hepatitis (2 potential donors). Improvements carried out following the audit include a list of tests which potential donors living away from this unit--especially those abroad--are asked to do before travelling here. An information leaflet has also been produced for potential donors.