Factors Leading to Exclusion of Living Kidney Donors: A Single-Center Analysis

Living kidney donation is a critical option to overcome the global organ shortage, yet many potential donors are excluded during evaluation. Understanding the reasons is important for optimizing donor selection, improving candidate outcomes, and increasing the living donor pool. We aimed to identify principal factors for exclusion of potential living kidney donors and compare baseline demographic and clinical characteristics between accepted donors and excluded candidates.

We performed a retrospective analysis of 82 consecutive potential living kidney donors evaluated for 70 recipients with end-stage renal disease between January 2020 and December 2024. Donor evaluations followed clinical practice guidelines of Kidney Disease: Improving Global Outcomes. Exclusion criteria were medical (obesity [body mass index >30], diabetes, impaired renal function, hypertension, and undiagnosed renal structural anomalies), immunological, and uncategorized causes.

Of 82 donor candidates, 36 (43.9%) were excluded. Medical contraindications were the leading cause (26 cases; 72.2% of exclusions). The most frequent medical subcategories were undiagnosed renal structural anomalies (9 cases, 34.6% ), which included 7 vascular anatomic variants (26.9% ), 1 horseshoe kidney (3.8% ), and 1 renal artery stenosis (3.8% ); other exclusions were obesity (5 cases; 19.2% ), diabetes (3; 11.5% ), impaired renal function (2; 7.7% ), and hypertension (1; 3.8% ). Immunological incompatibilities contributed 8 cases (22.2% ); uncategorized reasons accounted for 2 cases (5.5%). No significant sex-based difference in exclusion rates was observed (P = . ⁵⁸ ). Excluded and approved candidates were comparable in age and baseline estimated glomerular filtration rate, indicating rejection was predominantly driven by other factors, particularly comorbidities (P = . ⁰⁴⁶ ) Donor-recipient relationships were predominantly fraternal (45.1% ), parental (34.1%), and spousal (14.6% ).

Medical contraindications constituted the major barriers to living kidney donation. These findings highlight the need for early screening and management of modifiable comorbidities to safely increase donor eligibility and expand the living donor pool in resource-limited settings.