Unlocking Rural Live-Kidney Donation Through Insights From a Decade-Long Analysis at a Single Center in the Northern Great Plains.

Background: Data on barriers to live-kidney donation in the rural United States is limited despite its widespread adoption across the country.

Methods: A retrospective review of 1776 self-referrals for live-kidney donation between June 1, 2012, and May 31, 2022, was conducted. Multivariate analyses evaluated independent factors which may have potentially influenced donation at different stages in its process.

Results: Of the 1776 self-referrals, 398 (22.4%) individuals underwent evaluation and 121 (6.8%) of those became live-kidney donors. Middle-aged people (average age = 43 years), Whites (91.7%), and women (70.2%) were the most likely to donate. One thousand, one hundred, eighteen individuals (63.0%) dropped out after completing the intake form and the primary reasons included lost to follow-up (32.1%) and donor retraction (24.6%). Concerns related to personal health and compatibility were the predominant subjective factors for retraction. Following in-person evaluation, the most common reasons were medical comorbidities (34.9%) and inoperable renal anatomy (26.5%). Of the 1655 people that did not donate, 178 (10.8%) individuals discovered a new diagnosis during their evaluation process.

Conclusions: Only a fraction of those who begin the process proceed to donate a kidney, and most withdraw voluntarily before reaching the in-person evaluation phase. Focused approaches aimed at concerns regarding personal health and donor-recipient compatibility in otherwise healthy, motivated candidates in the early phases of donation hold potential for improving retention rates and subsequent donations.