Outcomes and motivations in Unspecified (non-directed altruistic) Kidney Donation: Results from a UK prospective cohort study.

Abstract

Unspecified kidney donors (UKDs) increase the number of high-quality kidneys available for transplantation. This study aimed to determine whether the practice was acceptable, based on non-inferiority of donor physical and psychosocial outcomes when compared to specified kidney donors (SKDs). A longitudinal, prospective cohort study investigated potential living kidney donors from across all 23 UK adult kidney transplant centres. Participants completed validated questionnaires at four time points (recruitment, 2-4 weeks pre-donation, 3- and 12-months post-donation). Clinical outcome data were collected from NHS Blood and Transplant. 373 (of 837 recruited; 45.7%) went on to donate (November 2016 - January 2021). There were no differences in donation rates (204 SKDs (54.7%) vs 169 UKDs (45.3%); p=0.944). Both groups reported being motivated by the desire to help someone (p=0.157). Tests for non-inferiority indicated that UKDs do no worse than SKDs on psychosocial or clinical outcomes over 12-months, and costs are similar (p>0.05). This is the world's largest prospective observational study comparing SKDs and UKDs. It has demonstrated no differences in primary motivation, donation rates, regret, cost, or psychosocial and physical outcomes. These data should reassure transplant professionals and potential donors and can bolster confidence in the practice around the world.