Unlocking Rural Live-Kidney Donation Through Insights From a Decade-Long Analysis at a Single Center in the Northern Great Plains

Background

Data on barriers to live-kidney donation in the rural United States is limited despite its widespread adoption across the country.

Methods

A retrospective review of 1776 self-referrals for live-kidney donation between June 1, 2012, and May 31, 2022, was conducted. Multivariate analyses evaluated independent factors which may have potentially influenced donation at different stages in its process.

Results

Of the 1776 self-referrals, 398 (22.4%) individuals underwent evaluation and 121 (6.8%) of those became live-kidney donors. Middle-aged people (average age = 43 years), Whites (91.7%), and women (70.2%) were the most likely to donate. One thousand, one hundred, eighteen individuals (63.0%) dropped out after completing the intake form and the primary reasons included lost to follow-up (32.1%) and donor retraction (24.6%). Concerns related to personal health and compatibility were the predominant subjective factors for retraction. Following in-person evaluation, the most common reasons were medical comorbidities (34.9%) and inoperable renal anatomy (26.5%). Of the 1655 people that did not donate, 178 (10.8%) individuals discovered a new diagnosis during their evaluation process.

Conclusions

Only a fraction of those who begin the process proceed to donate a kidney, and most withdraw voluntarily before reaching the in-person evaluation phase. Focused approaches aimed at concerns regarding personal health and donor-recipient compatibility in otherwise healthy, motivated candidates in the early phases of donation hold potential for improving retention rates and subsequent donations.