Medical Suitability and Willingness for Living Kidney Donation Among Older Adults.

Rationale & objective: The benefits of kidney transplantation compared with treatment with dialysis, including in older adults, are primarily limited by the number of donated kidneys. We studied the potential to expand the use of older living kidney donors.

Study design: Secondary analysis of the Berlin Initiative Study, a population-based cohort.

Setting & participants: 2,069 adults aged≥70 years in Germany.

Exposure: Age and sex.

Outcome: Suitability for living donation assessed by the absence of kidney-related exclusions for donation including albuminuria and low estimated glomerular filtration rate (eGFR) as well as absence of other medical exclusions. Willingness for living and deceased kidney donation assessed by participant survey.

Analytical approach: Descriptive analysis.

Results: Among the 2,069 participants (median age 80 years, 53% women, median eGFR 63mL/min/1.73m²), 93% had≥1 medical contraindication for living donation at study entry unrelated to eGFR or albuminuria. Using 2 published eGFR and albuminuria thresholds for donor acceptance, 38% to 54% of participants had kidney-related exclusions for donation. Among the 5% to 6% of participants with neither medical nor kidney-related exclusions for living donation at baseline, 11% to 12% remained suitable for donation during 8 years of follow-up. Willingness for living or deceased donation was high (73% and 60%, respectively).

Limitations: GFR was not measured, and medical exclusions unrelated to eGFR and albuminuria were assessed using a cohort database complemented by claims data.

Conclusions: One in 20 older adults were potentially suitable for living kidney donation, and willingness for living donation was high. Further studies are warranted to define the feasibility of expanding living kidney donation among older adults.

Plain-language summary: Although potentially beneficial, kidney transplantation remains infrequent among older adults aged≥70 years with kidney failure. Study evaluated the potential to increase living kidney donation among older adults, including their medical suitability as well as willingness to donate. Among 2,069 community-dwelling older adults (median age 80 years), 5% to 6% had no exclusion to donation. Among these individuals, 11% to 12% remained suitable for donation during 8 years of follow-up. Most exclusions were not related to eGFR and albuminuria. Willingness to living donation was high (73%). These findings highlight the potential benefits from expanding the pool of transplantable kidneys through the use of living donation in older adults.