Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Sep 18, 2023; 13(5): 276-289
Published online Sep 18, 2023. doi: 10.5500/wjt.v13.i5.276
Reasons and effects of the decline of willing related potential living kidney donors
Rabea Ahmed Gadelkareem, Amr Mostafa Abdelgawad, Nasreldin Mohammed, Ahmed Reda, Nashwa Mostafa Azoz, Mohammed Ali Zarzour, Hisham Mokhtar Hammouda, Mahmoud Khalil
Rabea Ahmed Gadelkareem, Amr Mostafa Abdelgawad, Nasreldin Mohammed, Ahmed Reda, Mohammed Ali Zarzour, Hisham Mokhtar Hammouda, Mahmoud Khalil, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Nashwa Mostafa Azoz, Department of Internal Medicine-Nephrology Unit, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Author contributions: Gadelkareem RA, Abdelgawad AM, and Mohammed N designed the research, collected the data, and wrote the paper; Reda A, Azoz NM, and Zarzour MA contributed to statistical analysis, literature review, writing, and revision; Hammouda HM and Khalil M contributed to the literature review, writing, revision, and supervision of the work; All authors approved the paper.
Institutional review board statement: This study was conducted as part of a research project on the outcomes of living donor kidney transplantation performed in our center (Approval No. 17200148/2017).
Informed consent statement: This article is a retrospective study. Hence, the patients were not required to give informed consent to the study because the manipulated data were anonymous and were obtained after each patient, with their potential kidney donor(s), agreed to the plan of management.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: The data supporting this study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Rabea Ahmed Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt.
Received: July 13, 2023
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.

Keywords: Donor decline, Donor evaluation, Donor exclusion, Kidney transplantation, Living kidney donors, Related living donors

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.