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
The evaluation protocols for living kidney donor (LD) selection are usually strict but remain a safeguard against violations of LD safety. Hence, the decline of willing potential living donors (PLDs) may occur at any stage of evaluation due to different causes, resulting in variable rates of decline of PLDs.
The rate of decline of willing related LDs seems to be a modifiable variable for improving LD kidney transplantation (LDKT).
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 willing PLDs who attended our outpatient clinic for kidney donation to their related potential recipients between October 2015 and December 2022. 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 (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. The remaining 64 PLDs (19.9%) did not access the evaluation due to serving as alternatives to essential PLDs, financial causes, and patient-related factors. Only 58 PLDs (18.1%) achieved donation, but 199 PDLs (62.0%) were declined. Exclusion occurred in 144 PLDs (56%) for immunological causes (37.5%), medical causes (54.9%), combined causes (9.7%), and financial causes (2.1%), but regression and release occurred in 55 PLDs (17.1%). The number of potential recipients with candidate PLDs was not significantly different from that with non-candidate PLDs, except in age (P = 0.041), rates of completed evaluation, and exclusion of PLDs (P < 0.001). In the multivariate analysis, there were no independent factors that 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.
Despite the availability of willing related PLDs for most potential recipients, their rate of decline was high. The causes were various, including medical or immunological contraindications, release, and regression of PLDs. Hence, the chances of LDKT were reduced or lost in a high percentage of potential recipients.
Trials to reduce the rate of decline of PLDs should not be at the expense of LD safety. However, revision and identification of the causes of PLD decline may help increase the chances of patients for KT, especially with the application of strategies that overcome the immunological barriers of LDKT and low medical literacy.