The influence of socio-demographic factors, treatment perceptions and attitudes to living donation on willingness to consider living kidney donor among kidney transplant candidates

Abstract

Background. Living donor, compared with cadaveric donor kidney transplantation, is associated with prolonged graft survival and increased life expectancy for patients with end-stage renal disease (ESRD). However, access to living donor transplantation remains variable. Our objective was to further our understanding of the factors associated with the willingness to consider living donor kidney transplant (LDKTx). Methods. All patients from two tertiary care hospitals being assessed for a LDKTx (n ¼ 81), and a random sample of patients on the waiting list for a cadaveric kidney transplant (CDKTx, n ¼ 133) were invited to participate. A mail survey assessed participants' sociodemographic characteristics, and perceptions of dialysis, CDKTx and LDKTx. Multivariable logistic regression was used to assess the influence of these factors on willingness to consider LDKTx. Results. Adjusting for patient age, employment status and number of close relatives, willingness to consider an LDKTx was independently associated with a lower perceived risk of peri-operative complications to the donor (adjusted OR 3.59, P ¼ 0.02), the perception that the recipient would live longer following living donor transplantation (adjusted OR 4.34, P ¼ 0.003) and greater perceived appropriateness of asking a family member to donate a kidney (adjusted OR 5.06, P ¼ 0.007). Conclusion. Among the ESRD patients studied, adjusting for key factors that may be associated with access to LDKTx, perceptions about risks to the donor and benefits to the recipient were independently associated with a willingness to consider LDKTx as a treatment option. Provision of standardized comprehensible information about all treatment options to patients with ESRD may improve acceptance rates for living donor transplantation.

Recruitment of Live Donors by Candidates for Kidney Transplantation

“…One possible explanation is that older candidates are unwilling to ask young donors because of an appreciation that young donors have a long life expectancy during which they might develop medical problems that could be complicated by prior nephrectomy. Our observation corroborates that of Zimmerman et al, who studied transplant candidates undergoing evaluation and patients wait-listed for a deceased donor kidney and found that older age was associated with a lesser willingness to consider live donor transplantation (34).…”

“…Minimal published literature exists on how transplant candidates interact with donors. Although some transplant candidates seek altruistic donors through the media, the majority of donors are recruited through the personal relationships that comprise a candidate's social support network (14,17,34,35). Because these interactions are usually private, transplant professionals interested in donor recruitment need to rely on the self-report of candidates and donors to identify possible methods to increase live donation overall.…”

Non-medical factors influencing access to renal transplantation

“…Difficulties in communication and interaction might result in difficulties in accessing health-care information, decreased demand for appropriate treatment options, and false information about transplantation and its risks that may result in building or reinforcing fears, worries and negative attitudes [35][36][37][38]. Furthermore, language barriers and marginal literacy may also form a barrier towards clarifying complex and difficult processes and may also build barriers to discussing complex or sensitive issues.…”

“…Although living donor transplantation remains an underutilized modality, there has been relatively little research exploring factors associated with potential reservations about and with barriers to living donor transplants both in health-care professionals and in patients and family members [37]. Cadaveric kidney donation rates are substantially lower for racial and ethnic minorities compared with white patients.…”

Socioeconomic, demographic and policy comparisons of living and deceased kidney transplantation rates across 53 countries

“…Previous studies of KTR have focused on the effects that specific, and largely singular, factors play in living or deceased transplant rates. These have included the effects on transplantation rates of religion 6,7 , probabilities of need 8 , demographic factors and attitudes 9 , marital status 10 , gender 11 , geographic variation 12 , presumed consent policies 13 and socioeconomic status 13 . While these studies have provided valuable insight into the potential for single locus variables to influence rates of renal transplantation, few have focused upon more than one country, and, while one 13 has focused on several of the variables included in our study, none has attempted to associate the relationships of so many different factors for both living and deceased KTR during a specific, homogeneous time frame, across such a large number of countries.…”