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Evaluation of living kidney donors: variables that affect donation
Deonna R Moore1, Irene D Feurer, Victor Zaydfudim
1Vanderbilt University Medical Center, Nashville, TN, USA.
Abstract:
Approximately 10000 deceased donor organs are available yearly for 85 000 US patients awaiting kidney transplant. Living kidney donation is essential to close this gap and offers better survival rates. However, nationally, 80% of potential donors evaluated fail to donate. Nurse coordinators who perform predonation screening and education need additional insight into the large number of potential donors who fail to complete the donation process. Reasons for nondonation in donor candidates undergoing medical evaluation, and variables affecting nondonation at Vanderbilt University Medical Center between 2004 and 2009 are examined. Multivariable logistic regression models are used to test the effects of age and race on donation status and reasons for nondonation. Summary data are frequencies, percentages, and means (SD). The sample included 706 candidates (63% female, 80% white; mean age, 40 [SD, 12] years). Almost half (46%) received clearance to donate. Undiagnosed hypertension (14%), abnormal glucose tolerance (10%), and protein-urea (9%) were the most prevalent medical reasons for nondonation. About 13% of candidates changed their minds during evaluation. Analyses demonstrated an increased likelihood of older candidates (P < .001) and a decreased likelihood of white candidates (P = .007) being excluded from donation. Within the nondonation group, increased age was associated with undiagnosed hypertension and abnormal glucose tolerance (both race-adjusted, P = .01). Younger candidates (race-adjusted, P = .003) and African Americans (age-adjusted, P = .04) were more likely to decide against donation. The most prevalent medical reasons for nondonation could be identified through enhanced prescreening, and improved preevaluation education could decrease nondonation rates.
Insights
Nearly half of potential living kidney donors fail to donate due to medical reasons like hypertension or glucose issues. Enhancing prescreening and education can improve donor rates.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Living kidney donation is crucial for the 85,000 US patients awaiting transplants, as only 10,000 deceased donor organs are available annually.
- Nationally, 80% of potential living kidney donors do not complete the donation process, highlighting a critical gap in donor availability.
- Nurse coordinators require better insights into the reasons why potential donors are not able to complete the donation process.
Purpose of the Study:
- To examine the reasons for nondonation among living kidney donor candidates.
- To identify variables affecting nondonation at Vanderbilt University Medical Center between 2004 and 2009.
- To analyze the effects of age and race on donation status and reasons for nondonation.
Main Methods:
- A retrospective analysis of 706 living kidney donor candidates evaluated between 2004 and 2009.
- Multivariable logistic regression models were used to assess the impact of age and race on donation status.
- Data included frequencies, percentages, and means (SD) to summarize candidate demographics and reasons for nondonation.
Main Results:
- 46% of candidates were cleared for donation. The most common medical reasons for nondonation were undiagnosed hypertension (14%), abnormal glucose tolerance (10%), and protein-urea (9%).
- Older candidates had an increased likelihood of exclusion (P < .001), while white candidates had a decreased likelihood (P = .007).
- Younger candidates and African Americans were more likely to decide against donation, whereas older candidates were more prone to nondonation due to hypertension and glucose issues.
Conclusions:
- The most prevalent medical reasons for nondonation can be identified through enhanced prescreening protocols.
- Improving pre-evaluation education for potential living kidney donors may decrease nondonation rates.
- Targeted interventions based on age and race could potentially increase the number of successful living kidney donations.
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01:26Kidney Transplant II: Surgical Procedure
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