Racial Disparities in Living Kidney Donation: Is There a Lack of Willing Donors or an Excess of Medically Unsuitable Candidates?

Abstract

Determining the reason behind nondonation is a first step towards understanding low rates of live kidney donation. More African American donor referrals are lost to follow-up while rates of other reasons were similar among races. This may indicate that African Americans are not more frequently medically unsuitable, but that the divergence in rates of live kidney donation is caused by a disparity in willingness to donate among African Americans.

Barriers to Living Donor Kidney Transplantation among Black or Older Transplant Candidates

“…Many candidates did not receive LDKTs because their recruited donors lacked further interest in living donation. Potential living donors who are black are more likely to be lost to follow-up and lose interest in living donation (12,13). Thus, efforts to decrease donor "dropout" may especially increase donor conversion and LDKT among black transplant candidates.…”

“…Prior studies could not examine these steps because they examined transplant candidates but lacked data on candidates' potential living donors (2,4,7), examined recipients of LDKTs but lacked data on candidates who did not receive LDKTs (2,7-9,35), or examined potential living donors but lacked data on donors' intended recipients (11)(12)(13)36). Several recent studies have reported reasons for nondonation by recruited, potential living donors (11)(12)(13)36). Although informative, these donor-based studies lacked information about donors' associated transplant candidates, preventing examination of donor recruitment and conversion.…”

“…Unfortunately, decreasing ney donation are appropriately stringent given that donation has short-term (23,24) and possibly long-term (25,26) risks. Obesity, which occurs more commonly among black potential donors (11)(12)(13), has uncertain long-term risks for living donors (27,28). The medical criteria for accepting living donors should not be relaxed given the ethical imperative to protect the welfare of potential and actual donors (29).…”

“…Obesity and possibly hypertension exclude a higher proportion of black, versus non-black, potential donors (11)(12)(13), reflecting the higher prevalence of diabetes, obesity, and hypertension among blacks in general (14,15). However, the lower likelihood of donation by black potential donors does not necessarily demonstrate that the donor conversion step prevents LDKT among black transplant candidates.…”

“…After all, transplant candidates whose initial potential donors fail to donate may later receive LDKTs from subsequent donors. Without information about the transplant candidates, prior studies of potential living donors (11)(12)(13) have been unable to fully characterize the donor conversion step.…”