A 12-Year Analysis of Equity and Efficiency in Living Kidney Donation at a Rural American Center

In the United States, a severe organ shortage precipitates an extensive transplant waitlist. Living donor kidneys are functionally superior to those from deceased donors and offer an alternative to close the supply-demand gap.

A retrospective review of 2147 patients who self-referred to begin the living kidney donation workup process at our center between June 1, 2012, and October 1, 2023 was conducted with subsequent statistical analysis of gathered data. National Kidney Registry (NKR) affiliation began February 1, 2018, and the pre- and post-NKR periods were compared.

The pre-NKR period saw 894 total referrals (42%) compared to 1253 post-NKR (58%). Post-NKR donors increased to 89 from 47 pre-NKR with similar times between stages except for a significantly shorter referral-to-lab review post-NKR (47.0 vs. 56.5 days, p < 0.01). A notable decrease in referrals from Indigenous Peoples was observed (121 [14%] to 93 [7%], p < 0.01) yet donations increased (2 [4%] to 7 [8%], p = 0.042). Donors originating from South Dakota increased (26-54, p = 0.59) post-NKR, and significantly more patients pursued nondirected referral (25 [3%] vs. 173 [14%], p < 0.01) with similar proportions following through with donation. Reasons for dropout during the process were similar between the periods, yet quantitative distributions differed.

NKR affiliation coincided with encouraging results, in many cases similar to broad national trends, attesting to improved connectivity and impact on focal population groups.