Evaluation and care of international living kidney donor candidates: Strategies for addressing common considerations and challenges

Abstract

End‐stage kidney disease patients in the United States may have family members or friends who are not US citizens or residents but are willing to serve as their living kidney donor in the United States (“international donors”). In July 2017, the American Society for Transplantation (AST) Live Donor Community of Practice (LDCOP) convened a multidisciplinary workgroup of experts in living donation care, including coordinators, social workers, donor advocates, administrators, and physicians, to evaluate educational gaps related to the evaluation and care of international donors. The evaluation of international living donor candidates is a resource‐intensive process that raises key considerations for assessing risk of exploitation/inducement and addressing communication barriers, logistics barriers, and access to care in their home country. Through consensus‐building discussions, we developed recommendations related to: (a) establishing program guidelines for international donor candidate evaluation and selection; (b) initial screening; (c) logistics planning; (d) comprehensive evaluation; and (e) postdonation care and follow‐up. These recommendations are not intended to direct formal policy, but rather as guidance to help programs more efficiently and effectively structure and execute evaluations and care coordination. We also offer recommendations for research and advocacy to optimize the care of this unique group of living donors.

Care of international living kidney donor candidates in the United States: A survey of contemporary experience, practice, and challenges

“…Communication, education, and screening of ILKDs candidates are complex processes that can be facilitated by establishing guidelines addressing key considerations, and training staff members to address challenges in workflows 19,20 . To provide framing for programmatic guidelines, the AST LDCOP workgroup recently developed recommendations for a systematic approach to ILKD candidate evaluations 14 . The workgroup recommended that programs consider developing guidelines for ILKD care, including ethical considerations, eligibility criteria differences, processes for communication, pre‐screening, and visa application assistance, cost considerations, and considerations specific to the ILKD candidate's country of origin.…”

“…It would be difficult for programs to build written donor education materials in all associated languages. Even so, programs evaluating ILKD candidates should seek to provide linguistically attuned, culturally competent basic education during pre‐screening covering all phases of the donation process and associated risks and benefits, so that only very motivated and appropriately healthy candidates undertake the time and expense of travel for donation 14 . Survey respondents described communication via a range of modalities, a marker of team adaptability as well as an acknowledgment of time‐consuming aspects of meeting ILKD learning needs.…”

“…Workgroup objectives included developing and administering a survey of US transplant program staff regarding concerns and challenges. Monthly calls occurred to develop guidance to help programs structure and execute international donor candidate care (reported separately 14 ). Herein we report the results of a national survey of US living kidney donor programs on their experiences, practices, and challenges in the evaluation and care of ILKD candidates and donors, and we discuss the implications of these findings in supporting efficient, appropriate care for this unique candidate group.…”

“…In the current survey, more than 80% of programs reported they did not use or have access to external funding to support the evaluation and care of ILKD candidates. Future advocacy efforts should explore options to assist with funding donation-related care 14. Concerns for access to OPTN-mandated follow-up care and other necessary health care were also common reasons for ILKD evaluation closures or for not considering ILKDs 33.…”

Global Kidney Exchange: opportunity or exploitation? An ELPAT/ESOT appraisal

“…Moreover, even in HIC, low‐income recipients experience higher rates of rejection and graft failure than high‐income recipients [68‐70]. What’s more, it is accepted practice in many countries to accept living kidney donors (usually relatives) who travel from abroad [71]. After their donation, these donors typically return to their country of origin, often without guarantee of postoperative and long‐term follow‐up care.…”