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Genetic Evaluation Practices in Living Kidney Donor Candidates
Yasar Caliskan1, Ozgur Akin Oto2, Tarek Alhamad3
1Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Kidney International Reports
|July 20, 2026
Summary
Genetic testing practices for living kidney donor candidates vary globally, with US centers preferring direct donor testing and international centers using recipient-first approaches. Younger donor age is linked to nonacceptance for donation.
Area of Science:
- Nephrology
- Genetics
- Transplantation
Background:
- Genetic testing is increasingly utilized in evaluating living kidney donor (LKD) candidates and recipients.
- Objective data on current genetic testing practices in LKD evaluations are limited.
Purpose of the Study:
- To describe current genetic testing practices in living kidney donor evaluation.
- To analyze regional differences in genetic testing strategies.
- To identify factors associated with donor nonacceptance.
Main Methods:
- A cross-sectional registry (REDCap) collected deidentified data on LKD candidates and genetic test results from 24 international centers.
- Data included candidates who underwent genetic testing, had a family history of genetic kidney disease, or were evaluated for donation to a biologically related recipient with unexplained kidney disease.
- Data were collected between June 2023 and November 2025.
Main Results:
- Genetic testing was performed in 23.4% (295/1259) of LKD evaluations.
- Testing strategies differed significantly by region: US centers favored direct LKD testing (61.5%), while international centers used recipient-first testing (92.1%).
- Younger donor age was independently associated with LKD nonacceptance (aOR: 0.89 per year).
Conclusions:
- Genetic testing practices for LKD candidates exhibit substantial regional variation.
- US centers predominantly perform direct LKD testing, contrasting with international centers' recipient-first approach.
- Younger donor candidate age is a significant independent predictor of nonacceptance for living kidney donation.
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