Strategic Innovations to Reduce Disincentives and Increase Living Kidney Donation.

Background: While up to 59% of the U.S. population report willingness to donate a kidney, only about 6,000 living kidney donations occur annually. This study described the use and impact of National Kidney Registry (NKR) programs designed to eliminate disincentives to living kidney donation.

Methods: This was a retrospective cohort analysis utilizing administrative data records from the NKR, a national database capturing information on potential living kidney donors at 103 transplant centers across the continental US. Descriptive statistics were used to summarize donor characteristics, program participation, and outcome measures. An interrupted time series was used to analyze changes in registration conversion rates before and after program implementation.

Results: Following the implementation of Donor Connect, the registration conversion rate increased from 8.4% immediately preceding implementation to 18.4% by the end of follow-up. At the time of intervention, a statistically significant 8% increase in registration conversion rate was observed (p<0.001), with an additional 0.3% increase per quarter thereafter (p=0.017). Remote donors were significantly more likely to live > 150 miles from the recipient's transplant center (84% vs 21%); the Remote Donor Program reduced travel burden by 597 [205,1196] miles. Referral conversion rates were significantly higher for donors living within 50 miles (8.3%) compared to those 51-150 miles (6.5%, p<0.001) and >150 miles (5.3%, p<0.003), corresponding to an increased donation odds of 1.31 and 1.62, respectively). Fifty-one percent of donors received cost reimbursement through the Donor Shield program. Donors who participated were more racially diverse and were more likely to reside further from the transplant center.

Conclusions: This analysis indicates that the outcomes from NKR's programs support the efficacy of disincentive-targeted innovations as a way to increase donation rates by supporting donors and streamlining the donation process. These innovations represent a modern, donor-centered approach to living kidney donation. By addressing known barriers, these programs have the potential to expand the donor pool, improve the efficiency in donor evaluation, and improve the overall donor experience.