Willing but Unable - Exploring the Barriers to Living Kidney Donation in a Tertiary Hospital in Southeast Nigeria: A Preliminary Report.

Abstract

Background: Kidney transplantation in Nigeria has witnessed remarkable advancements. Availability of suitable and willing living donors is one of the major factors leading to its success. The aim of this study was to identify and analyze the reasons for exclusion of potential living kidney donors in a transplant program at a tertiary hospital in Southeast Nigeria. This is important in order to improve donor screening, maximize the living donor pool and ensure donor safety.

Methods: This was a retrospective study of kidney transplant register and medical records at the transplant clinic of Federal Medical Center Umuahia, Southeast Nigeria. Relevant clinical data of potential living kidney donors who presented for pre-donation evaluation over a period of 8 years were collated in excel sheet and analyzed using SPSS version 23.0. Tables, charts and graphs were used to illustrate some data.

Results: Pre-donation evaluation records of sixty four potential living donors were retrieved. Median age was 23 (IQR=19-39) years There were 62 males and 2 females with M:F ratio of 31:1. Majority were unskilled workers (83%) and unrelated to prospective recipients (61%). Among those related to the patients (39%), there were more second-degree relatives (22%) than first degree relatives (17%). Out of the 64 potential kidney donors, 13 (20%) eventually donated while 51(80%) did not. Factors that prevented eventual kidney donation included immunological incompatibility (32.8%), albuminuria (11%), hypertension (9%), financial motivation (9%), nephrolithiasis (4.7%), donor withdrawal from donation process (4.7%), Hepatitis B infection (3%), prediabetes (3%) and abnormal cardiac function (1.5%).

Conclusion: The potential living donors evaluated were mostly young males that were unrelated to their potential recipients. Immunologic incompatibility was the leading cause of failure to donate a kidney; mainly from donor-recipient significant HLA mismatches.