A Comparison of Close Family Members and Other Relationships in Live Kidney Donor Evaluation

Background: While initially live kidney donations (LKD) were largely restricted to biological relatives, there is currently more variety in the types of donor-recipient relationships. We examined the LKD evaluation process to compare behaviors and characteristics of close family members (CFM) versus other relationships. Methods: Single institution retrospective chart review of referrals for LKD between 1/2009-12/2022. Referrals were identified using the Organ Transplant Tracking Record database and cross referenced with billing data. Elimination at each stage of evaluation was compared between CFM (spouses, parents, siblings, and children) and non-CFM using Chi square test. Results: In sum, 1861 referrals were reviewed, including 477 (25.6%) CFM and 1384 (74.4%) non-CFM, resulting in 146 approvals and 125 donations. CFM were more likely to complete medical (med) and psychosocial (psych) workup (WU). Among those who completed WU, CFM were less likely to have med and psych contraindications (CI). Overall, CFM were more likely to be approved and to donate. However, once approved, there was no difference in donation between the 2 groups (p = 0.61). The top med CI for both was obesity, eliminating 60/124 (48.3%) CFM and 203/399 (50.9%) non-CFM, followed by hypertension (HTN) and malignancy concerns for CFM; nephrolithiasis and HTN for non-CFM. The top psych CI was substance use disorder (SUD) for CFM; young donor age for non-CFM. Conclusion: We saw a high proportion of non-CFM referrals, suggesting increased awareness and acceptance to be considered as donors. Non-CFM were more often eliminated due to med or psych CI. CFM showed greater commitment to complete LKD evaluation, but once approved, both groups were equally likely to follow through with donation. - Close family member (n = 477) Other (n = 1384) p value Positive crossmatch (%) 3 (1.4) 7 (1.8) 0.75 Begin medical workup (%) 248 (52.0) 503 (36.3) < 0.01 Complete medical workup (%) 211 (44.2) 468 (33.8) < 0.01 Medical contraindication (% complete workup) 124 (57.8) 399 (85.3) < 0.01 Complete psychosocial workup (%) 170 (35.6) 169 (12.2) < 0.01 Psychosocial contraindication (% complete workup) 28 (16.5) 60 (35.5) < 0.01 Recipient too ill or dead (%) 14 (2.9) 33 (2.4) 0.51 Approved (%) 83 (17.4) 63 (4.6) < 0.01 Donate (%) 70 (14.7) 55 (4.0) < 0.01 Donate (% approved) 70 (84.3) 55 (87.3) 0.61