Why Living Kidney Donors Are Declined: A Swiss Single Center Observation Over 15 Years

Living kidney donation plays a crucial role in addressing organ shortage. Careful and holistic donor assessment is required to minimize donor risks. While acceptance patterns are well documented, donor candidates beyond the threshold remain largely unexamined. This study aims to analyze donor evaluations to identify reasons and trends for donor decline.

In this retrospective observational study, we analyzed prospectively collected data of 275 potential living kidney donor evaluated at our center between 2007 and 2021, assessing demographic and health characteristics, as well as the reasons for donor decline.

Of the 275 donor candidates evaluated, 197 (71.6%) were declined. The primary reasons were medical and surgical issues (32.7%), particularly kidney-related conditions (9.5%), followed by immunological factors (21.1%) and psychosocial concerns (12.7%). Interestingly, there was a trend towards accepting medically more complex donors over the study period, with an increase in mean donor age and lower estimated glomerular filtration rate of accepted donors.

Donor decline is influenced by a range of medical, immunological, and psychosocial factors. These findings highlight the importance of individualized assessments and call for further research into overcoming donation barriers and evaluating long-term outcomes, particularly for medically complex donors, to optimize safe and effective living kidney donation.