Living Kidney Donation Declining in U.S.

SEATTLE—Living kidney donation has steadily decreased since the peak year of 2004, researchers reported at the 2013 American Transplant Congress.

The downward trend is most pronounced among men, blacks, younger and lower-income adults, siblings, and parents.

After an analysis of data from the Organ Procurement and Transplantation Network (OPTN), James R. Rodrigue, PhD, of the Center for Transplant Outcomes & Quality Improvement at The Transplant Institute, Beth Israel Deaconess Medical Center in Boston, and colleagues concluded that “there is considerable downward pressure” on living donation rates despite novel programs to help patients find a suitable living donor, national financial programs and state tax incentives, and heightened general public awareness of living donation.

OPTN data show that the number of living donors increased from 1,817 in 1988 to 6,647 in 2004, and then declined to 6,572 in 2005. In 2012, 5,618 living donations took place.

For the study, Dr. Rodrigue's team compared two eras: 1998-2004 (era 1) and 2005-2011 (era 2). From era 1 to era 2, the proportion of living donors who were male declined from 41.9% to 39.8% and the proportion of living donors who were black declined from 13.4% to 12.2%.

According to the authors, financial disincentives during an economic slump may be one contributing factor to the downward trend in living donation. Potential living donors may have greater concern about employment security or stability during a recession and less willingness to absorb lost wages, which could happen if donate.

The changing health status of the U.S. general population is another possible reason, the researchers noted. They pointed out that the proportion of adults with diabetes and adults who are obese has increased and hypertension is “alarmingly prevalent.

“Collectively,” they wrote in a poster presentation, “these risk factors increasingly are the most common reasons for [living donation] exclusion, particularly among minorities.”

Another reason for the decline in living donation could be increased emphasis on transplant center performance oversight, Dr. Rodrigue and his colleagues stated. Such oversight might lead to more conservative policies and practices due to potential impact on center performance reports.

They cited a recent report by Jesse Schold, MD, and colleagues in the American Journal of Transplantation (2013;13:67-75) showing that transplant programs receiving a low performance evaluation had an average net decrease of 15 living donor kidney transplants compared with an average decrease of only three LDKTs among centers that did not have a low performance evaluation.

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