Characteristics and Evaluation of Geographically Distant vs Geographically Nearby Living Kidney Donors

Abstract

Background Living donor kidney transplant (LDKT) can be impeded by multiple barriers. One possible barrier to LDKT is a large physical distance between the living donor's home residence and the procuring transplant center. Methods We performed a retrospective, single-center study of U.S. living kidney donors who were geographically distant (residing ≥150 miles) from our transplant center. Each distant donor was matched to four geographically nearby donors (<150 miles from our center) as controls. Results From 2007-2010, of 429 live kidney donors, 55 (12.8%) were geographically distant. Blacks comprised a higher proportion of geographically distant vs. nearby donors (34.6% vs. 15.5%), while Hispanics and Asians comprised a lower proportion (P=0.001). Distant vs. nearby donors had similar median times from donor referral to actual donation (165 vs. 161 days, P=0.81). The geographically distant donors lived a median of 703 miles (25%-75% range 244-1072) from our center and 21.2 miles (25%-75% range, 9.8-49.7) from the nearest kidney transplant center. The proportion of geographically distant donors who had their physician evaluation (21.6%), psychosocial evaluation (21.6%), or CT angiogram (29.4%) performed close to home, rather than at our center, was low. Conclusions Many geographically distant donors live close to transplant centers other than the procuring transplant center, but few of these donors perform parts of their donor evaluation at these closer centers. Blacks comprise a large proportion of geographically distant donors. The evaluation of geographically distant donors, especially among minorities, warrants further study.

Racial differences in completion of the living kidney donor evaluation process

“…In addition, our study adjusted for donor candidate distance to transplant center given that time and distance of travel to the center may be a contributing factor to the rate of progression through the living donor evaluation process . Unlike previous literature, we were able to demonstrate that a substantial proportion of AA donor candidates lived within 50 miles of our transplant facility . Thus, delays may be a manifestation of the transplant candidate's social network; drawn predominantly from biological relatives, persons living in close proximity, and from persons who are likely to be deemed medically ineligible for live kidney donation.…”

“…27 Unlike previous literature, we were able to demonstrate that a substantial proportion of AA donor candidates lived within 50 miles of our transplant facility. 28 Among those who did not make it to the next step, the median time from referral to medical screening was 3.4 mo (2.6 mo AA vs 3.7 mo non-AA), from medical screening to evaluation was 3.9 mo (5.3 mo AA vs 3.4 mo non-AA), from evaluation to clearance was 2.9 mo (4.5 mo AA vs 2.7 mo non-AA), and from clearance to transplant was 3.3 mo (3.0 mo AA vs 3.7 mo non-AA)…”

Factors associated with perceived donation-related financial burden among living kidney donors

“…Living kidney donors (LKDs) currently provide nearly one third of the organs for kidney transplants in the United States, but the number of living kidney donations has been decreasing since 2004. 1 Studies have identified multiple potential barriers to living kidney donation, including completing the evaluation process, 2 concern about health risks, [3][4][5][6][7] geographic distance from the transplant center, 8 and donation-related financial concerns. [9][10][11][12] Donation-related financial concerns have received increased attention, given the potential for intervention, with a 2015 consensus statement from the American Society of Transplantation calling for the reduction of financial barriers to living donor kidney transplantation (LDKT) and the achievement of financial neutrality for LKDs.…”

The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review

“…Common evaluation times included the time until approval to donate, donation, or rejection, although the definition of the starting point varied (Table 3 ). 35 , 47 , 48 , 65 , 72 The time until donation ranged from 4 to 14 months across studies and transplant programs. One report described a single recipient who received a kidney from her father (before) and her mother (after) the living donor evaluation process was redesigned to be completed in 1 day.…”