Psychosocial Impact of Being Denied as a Living Kidney Donor

Nationally, nearly 50% of living kidney donor (LKD) candidates are denied the opportunity to donate. We studied the psychosocial impact of denial on LKD candidates and explored potential improvements in the evaluation process. A 21-question survey was developed covering topics related to donation denial including emotional responses, communication experiences, and suggestions for process improvement. Of 193 denied candidates contacted, 64 (33.2%) completed the survey. Respondents reported they were denied due to pre-existing conditions (30%), poor kidney function (25%), anatomic abnormalities (19%), malignancy (8%), and other factors (18%). The most commonly reported emotions were feeling disappointed (50%), sad (34%), content (11%), and frustrated (9%). Seventeen respondents (27%) were significantly impacted by the evaluation outcome, of which 9 (14%) reported a significant positive impact; 8 (13%) reported a significant negative impact. Of the 64 candidates, 46 (72%) felt pride they considered donating and none regretted initiating the process. Notably, 26 (41%) offered suggestions for improving the evaluation process, including enhanced communication and follow-up, with 23% desiring a post-denial follow-up call. This study highlights the significant emotional impact of denial on LKD candidates. We recommend setting clear expectations about approval rates, standardizing communication protocols and offering follow-up support through independent living donor advocates and/or support groups.