Recruitment of Live Donors by Candidates for Kidney Transplantation

Abstract

Background: Little is known about efforts that renal transplant candidates make to recruit live donors. It was hypothesized that preference for live donor kidney transplantation and greater knowledge about live donor transplantation are associated with candidates' initiating conversations about donation with potential donors.Design, setting, participants, & measurements: A cross-sectional study of renal transplant candidates was performed at initial transplant evaluation. Candidates completed a questionnaire that specified whether they had initiated conversations about donation with any potential donors. The questionnaire also measured preference for live donor transplantation, knowledge about transplantation, concern about donor harm, willingness to ask for help in coping with kidney disease, and social support.Results: Ninety-six candidates participated. Forty-nine (51%) reported initiating a conversation with at least one potential donor. In multivariable logistic regression, domains associated with initiating a conversation included: preference for live donor transplantation, willingness to ask for help, and female gender. Older age was associated with a lower odds of initiating a conversation. Knowledge, concern about donor harm, social support, and ethnicity were not associated with initiating a conversation with a donor.Conclusions: Attempts at donor recruitment by kidney transplant candidates are common. These findings suggest that interventions that influence preferences about transplantation and willingness to ask others for help are logical targets to enhance access to live donor transplantation.

Sex Differences and Attitudes toward Living Donor Kidney Transplantation among Urban Black Patients on Hemodialysis

“…Whereas our overall percentage of black patients interested in either DDKT or LDKT (72.3%) was almost identical to an earlier study (2), our study diverges from previous studies (2,4,7,(13)(14)(15) in that significantly more black men (82.8%) wanted LDKT compared with women (58.6%). Although there is some evidence that age may affect attitudes toward transplantation (2), younger women were less likely to want LDKT compared with younger men.…”

“…The results are on the basis of a convenience sample of 101 urban-dwelling black patients with ESRD at two hemodialysis clinics affiliated with a university hospital in north Philadelphia that serve a largely minority lowincome patient population (53). Despite their comparatively high rate of transplant referral, our patients are similar to other patients in that many do not complete the workup step toward the waitlist (13,16,48). Although other studies show that patients with private insurance have better access to LDKT (24,25), only two of our patients had private insurance, and neither wanted an LDKT.…”

“…However, LDKT is underused by several disadvantaged groups, including women and blacks. Although Ayanian et al (12) found that women (especially black women) were less likely to want LDKT, recent studies of patients presenting for transplant evaluation have found racial differences but not sex differences in wanting LDKT (2,4,7,(13)(14)(15). It is possible that sex differences in wanting LDKT might be underestimated when only patients presenting for transplant evaluation are studied.…”

Living Kidney Donor Decision Making and Communication

“…with a potential donor (Reese et al, 2008). Research has identified that recipients who are willing to consider living donation as an option perceive a lower risk of complications to the donor, believe that they would live longer following living transplantation, and believe more so than others that it is more appropriate to ask a family member to donate a kidney (Zimmerman, Albert, Llewellyn-Thomas, & Hawker, 2006).…”

Actual and Perceived Knowledge of Kidney Transplantation and the Pursuit of a Live Donor.

“…Social support was measured using The Multidimensional Scale of Perceived Social Support (20) and augmented by asking participants if they usually attended doctors' appointments alone or with someone else. Familiarity with organ donation was determined by asking participants if they were registered as an organ donor, knew someone who had donated an organ, knew anyone who could potentially donate a kidney to them (7), and/or had been offered a kidney previously by a live donor (7). Ability to use technology to gain KT knowledge and to communicate with others regarding organ donation was determined by asking participants if they were comfortable using computers, email, and the internet.…”