Incompatible Kidney Donor Candidates´ Willingness to Participate in Donor-Exchange and Non-directed Donation

Abstract

Although paired donation, list donation and nondirected donation allow more recipients to receive living donor transplants, policy makers do not know how willing incompatible potential donors are to participate. We surveyed 174 potential donors ruled out for ABO-incompatibility or positive cross-match about their participation willingness. They were more willing to participate in paired donation as compared to list donation where the recipient receives the next deceased donor kidney (63.8% vs. 37.9%, p < 0.001) or non-directed donation (63.8% vs. 12.1%, p < 0.001). Their list donation willingness was greater when their intended recipients moved to the top versus the top 20% of the waiting list (37.9% vs. 19.0%, p < 0.001). Multivariate logistic regression modeling revealed that potential donors' empathy, education level, relationship with their intended recipient and the length of time their intended recipient was on dialysis also affected willingness. For paired donation, close family members of their intended recipient (odds ratio (OR) = 3.01, confidence intervals (CI) = 1.29, 7.02), with high levels of empathy (OR = 2.68, CI = 1.16, 6.21) and less than a college education (OR = 2.67, CI = 1.08, 6.61) were more willing to participate compared to other donors. Extrapolating these levels of willingness nationally, a 1-11% increase in living donation rates yearly (84-711 more transplants) may be possible if donor-exchange programs were available nationwide.

Comparison of Kidney Paired Donation Transplantations with Living Related Donor Kidney Transplantation: Implications for National Kidney Paired Donation Program

“…8 In one study, the incompatible kidney donor candidates showed more willingness for KPD versus list exchanges. 9 Extrapolating these levels of willingness nationally, 1-11% (84-711 more transplants) increase in living donation rates yearly may be possible if donor-exchange programs were available nationwide. 8 It has been estimated that an additional 1000-2000 transplants per year could be accomplished if a national KPD program was implemented in the United States.…”

Organ Donation and Utilization in the United States, 1997–2006

“…Unfortunately, the concept of this exchange of kidneys was felt to possibly assign a value to an organ, which is not allowed under the National Organ Before a nationwide program could be established, several issues with exchanges between patients at different centers need to be settled. These include the level of workup needed before a 'pair' is entered into the database for matching; the logistics (and willingness) of donors and recipients to travel, and of centers to ship kidneys (12); the issue of dealing with levels of comfort on the part of various programs with proceeding with a given transplant; and lastly how to handle the added expense and manpower needed to allow such a complex program to run efficiently. The role of paired donation over list-paired donation schemes is also a controversial point that has an effect not only on the success of paired exchanges, but also on waiting times for deceased donor recipients, especially in blood group O.…”

Facilitators to national kidney paired donation program

“…Sirs, We read with great interest the report by Ferrari P, et al [1] Recent study results are valuable for encouraging participation of kidney paired donation (KPD) pairs and transplant centers in national KPD program [1][2][3][4][5][6][7]. We believe that with some additions scientific value and contribution of the article may result into wider implementation of KPD.…”

“…In one study the incompatible kidney donor candidates' showed more willingness for KPD versus list exchanges [7]. Extrapolating these levels of willingness nationally; 1-11% increase in living donation rates yearly may be possible if donor-exchange programs were available nationwide [7]. Comparatively short waiting time in KPD [1] will save the cost of maintenance dialysis and associated morbidity and mortality.…”

“…The policy makers did not discuss as to how willing incompatible potential donors can participate in donor-exchanges. In one study the incompatible kidney donor candidates' showed more willingness for KPD versus list exchanges [7]. Extrapolating these levels of willingness nationally; 1-11% increase in living donation rates yearly may be possible if donor-exchange programs were available nationwide [7].…”