Kidney Transplant Candidate Acceptance Of Live Donor Esrd Risk

Abstract

Background: We recently found that potential living kidney donors (LKDs) are willing to accept high levels of end stage renal disease (ESRD) to donate. Since receipt of a living donor kidney is also contingent recipient attitudes, we sought to explore potential recipients’ acceptance of risks to potential LKDs and their attitudes on risk acceptance. Methods: We conducted a mixed methods prospective study of ESRD patients undergoing evaluation to receive a kidney transplant. Using a novel 10,000 dot diagram, participants indicated the highest chance of a LKD getting ESRD they were willing to accept. Participants also completed demographic, risk taking, and health surveys. Ordinal logistic regression assessed factors associated with willingness to accept living donor ESRD risk. Qualitative analysis sought to understand rationale and justification of risk acceptance. Results: 57 potential kidney transplant recipients participated in the study. A third of transplant candidates accepted a maximum risk below the current level of 0.9%. In unadjusted analysis, having an interested potential LKD was associated with willingness to assume a higher chance of donor ESRD (OR 5.74, p=0.002). Adjusting for covariates, having a potential donor remained significantly associated with increased willingness to accept donor ESRD risk (OR 5.88, p=0.008). Qualitative analyses identified four main reasons for willingness to accept higher risk, and four main reasons for willingness to limit donor risk. Discussion: We found that two thirds of potential recipients accept at least the current level of ESRD risk for potential LKDs. Future work should explore why potential recipients are willing to accept greater risks if they have a potential LKD. The use of the visual aid was described as helpful and could be developed into an educational tool to explain risks associated with living donation. The visual aid may also help transplant candidates start the conversation and ask someone to consider being a living donor. Understanding recipient attitudes about risks to LKDs will enhance informed consent and facilitate dialogue between potential donors and recipients