Motivators and Barriers to Living Donor Kidney Transplant as Perceived by Past and Potential Donors

Abstract

Background: For patients with end-stage kidney disease, living donor kidney transplant is the treatment of choice due to improved patient outcomes, longer graft survival, and reduced expenses compared with other forms of renal replacement therapy. However, organ shortage remains a challenge, and living donation rates have stagnated in recent years, particularly among men. Objective: To understand the motivators and barriers for past and potential living kidney transplant donors and inform policy and practice changes that support donors in the future. Methods: Past and potential living donors in British Columbia, Canada in the preceding 2 years were surveyed. Motivators and barriers were examined in 5 categories: family pressures and domestic responsibilities, finances, the recovery process, complications, and the transplant evaluation process. Participants ranked statements in each category on a Likert-type scale. Results: A total of 138 responses were collected. In both women and men, policies that address family and domestic responsibilities and finances were most strongly identified as motivators to donate. A large proportion of women and men reported that guaranteed job security (47% women and 38% of men), paid time off (51% of women and 42% of men), reimbursement of lost wages (49% of women and 38% of men), and protections to guarantee no impact on future insurability (62% of women and 52% of men) were significant motivators to donate. Timely and efficient medical evaluation was considered to be an important motivator for donation, with 52% of men and 43% of women reporting support for a “fast-track” option for evaluation to allow for a more rapid evaluation process. Median barrier and motivator scores were similar between women and men. Conclusion: Policies to decrease financial burden, ensure job security, improve childcare support, and offer a fast-track medical evaluation may motivate potential living kidney donors, irrespective of gender.

Components of Residential Neighborhood Deprivation and Their Impact on the Likelihood of Live‐Donor and Preemptive Kidney Transplantation

“…Additionally, the elevated risk of comorbidities, allostatic load [59], and inflammation among individuals in deprived neighborhoods may contribute to the observed disparities in the likelihood of both LDKT and preemptive KT [60][61][62][63]. Financial constraints [64], employment issues [65], and food insecurity in such neighborhoods may further pose barriers to transplantation [66,67], along with delayed referral, particularly among racial and ethnic minorities in deprived neighborhoods [68][69][70]. Over time, the impact of residence in deprived neighborhoods may exacerbate disparities in the likelihood of LDKT and preemptive KT, especially for candidates living in high-deprivation neighborhoods.…”