Published online Sep 18, 2023. doi: 10.5500/wjt.v13.i5.276
Peer-review started: July 13, 2023
First decision: August 4, 2023
Revised: August 6, 2023
Accepted: August 25, 2023
Article in press: August 25, 2023
Published online: September 18, 2023
Although the availability of related living donors (LDs) provides a better chance for receiving kidney transplantation (KT), the evaluation protocols for LD selection remain a safeguard for the LD’s safety. These protocols are variable from one center to another, resulting in variable rates of decline of the potential LDs (PLDs). The decline of willing PLDs may occur at any stage of evaluation, starting from the initial contact and counseling to the day of operation.
To identify the causes of the decline of PLDs, the predictors of PLD candidacy, and the effect on achieving LDKT.
A retrospective study was performed on the willing PLDs who attended our outpatient clinic for kidney donation to their related potential recipients between October 2015 and December 2022. The variables influencing their candidacy rate and the fate of their potential recipients were studied. Two groups of PLDs were compared: Candidate PLDs after a completed evaluation vs non-candidate PLDs with a complete or incomplete evaluation. A multivariate logistic regression was performed to assess the factors contributing to the achievement of PLD candidacy.
Of 321 willing PLDs, 257 PLDs (80.1%) accessed the evaluation to variable extents for 212 potential recipients, with a mean age (range) of 40.5 ± 10.4 (18-65) years, including 169 females (65.8%). The remaining 64 PLDs (19.9%) did not access the evaluation. Only 58 PLDs (18.1%) succeeded in donating, but 199 PDLs (62.0%) were declined; exclusion occurred in 144 PLDs (56.0%) for immunological causes (37.5%), medical causes (54.9%), combined causes (9.7%), and financial causes (2.1%). Regression and release occurred in 55 PLDs (17.1%). The potential recipients with candidate PLDs were not significantly different from those with non-candidate PLDs, except in age (P = 0.041), rates of completed evaluation, and exclusion of PLDs (P < 0.001). There were no factors that independently influenced the rate of PLD candidacy. Most patients who failed to have KT after the decline of their PLDs remained on hemodialysis for 6 mo to 6 years.
The rate of decline of willing related PLDs was high due to medical or immunological contraindications, release, or regression of PLDs. It reduced the chances of high percentages of potential recipients in LDKT.
Core Tip: The rate of decline of willing related potential living kidney donors (PLDs) was high (82%). The causes of decline included exclusion by the transplant team due to contraindications of donation, release after disqualification of the potential recipients, and regression due to withdrawal of the decision by the PLD. PLD exclusion was the commonest form of decline due to medical or immunological contraindications. The high rate of PLD decline resulted in the loss of chances of kidney transplantation for high percentages of potential recipients who were left on dialysis for variably long periods, who died, or who were lost to an unknown fate.