The General Public's Concerns about Clinical Risk in Live Kidney Donation

Abstract

Difficulty in attracting live kidney donors may be related to fears regarding both the surgical procedure for kidney harvesting and future failure of the remaining kidney. We conducted a cross-sectional study of households in Maryland to identify public disincentives to living related kidney donation. In multivariate analyses, we assessed the independent effects of several factors on willingness to donate a kidney to a sibling. We also assessed thresholds for factors above which persons would not donate a kidney. Of 385 participants, 66% were extremely willing to donate to a sibling. After adjustment, those who considered the length of a hospital stay, out-of-pocket expenses, size and appearance of a scar, the time it takes to get to the transplant center, and the donor risk of developing kidney failure very important had 50-60% less odds of being extremely willing to donate. Median acceptable levels for risk of complications, hospital stay, compensated and uncompensated time from work, time requiring pain medications, and out-of-pocket expenses were greater than levels from clinical evidence regarding both laparoscopic and open nephrectomy. Unrealistic concerns among the general public regarding live donation may serve as potential disincentives to donation. Efforts to educate the public regarding live donation might help assuage fears and attract those who may not otherwise donate.

Rapid Progression of Native Renal Artery Fibromuscular Dysplasia Following Kidney Donation

“…In potential living donors, FMD is the second commonest anatomical abnormality apart from multiple renal arteries and is observed in 2.0-6.6% of the potential donors by angiography (2,6,12). FMD is diagnosed most often in young and middle-aged women, who currently constitute a large part of potential live donors.…”

“…Nonetheless, the disadvantages of live donation includes a perioperative mortality of 0.03%, morbidity of 0.2%, minor complications of <10% and the unknown risk of renal failure from solitary kidney in the long term. Even though the long-term follow-up did not show significant increase in risk for renal failure (2)(3)(4), this degree of safety can only be achieved by very cautious donor selection. It is likely that rapid increase in live kidney donation may lead to relaxation in acceptance criteria, and introduction of less invasive and more cost-effective means of evaluation of the potential donors.…”

Reduced Racial Disparity in Kidney Transplant Outcomes in the United States from 1990 to 2012

“…4,11 Our findings of significant improvements in transplant outcomes for black recipients may help to alleviate unmet concerns that might impede black patients' willingness to pursue transplantation. 13,[17][18][19] Standardized transplant education, which incorporates the latest research findings, might also help to improve transplant knowledge and communication among black patients, their families, and health-care providers not directly involved in the transplant process (e.g., primary care providers and general nephrologists). 15,19,28 Our study was limited by the variables captured in SRTR, including provider-reported race, which has the potential for misclassification bias.…”

“…Suboptimal KT education and provider communication might engender unmet concerns about KTand facilitate less willingness to pursue KT among black patients. 14,[17][18][19] In general, patient and graft survival after KT have dramatically improved in the United States, 4 reflecting advances in transplant care in recent years. We hypothesized that advances in immunosuppression and post-transplant management might differentially benefit black KT recipients (who were disproportionately burdened by immunologic barriers) and contribute to reduced racial disparities in KT outcomes.…”

Perioperative and Long-Term Safety of Living Kidney Donors

“…The general public's concerns of living kidney donation is the length of a hospital stay, out-of-pocket expenses, size and appearance of a scar, and the donor risk of developing kidney failure (Boulware LE, et al 2002 ). In this respect, it is quite important process to inform prospective donor of these issues.…”