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The changing landscape of live kidney donation in the United States from 2005 to 2017
Authors:Fawaz Al Ammary  Mary Grace Bowring  Allan B. Massie  Sile Yu  Madeleine M. Waldram  Jacqueline Garonzik‐Wang  Alvin G. Thomas  Courtenay M. Holscher  Mohamud A. Qadi  Macey L. Henderson  Alexander C. Wiseman  Jane Gralla  Daniel C. Brennan  Dorry L. Segev  Abimereki D. Muzaale
Abstract:
The number of live kidney donors has declined since 2005. This decline parallels the evolving knowledge of risk for biologically related, black, and younger donors. To responsibly promote donation, we sought to identify declining low‐risk donor subgroups that might serve as targets for future interventions. We analyzed a national registry of 77 427 donors and quantified the change in number of donors per 5‐year increment from 2005 to 2017 using Poisson regression stratified by donor–recipient relationship and race/ethnicity. Among related donors aged <35, 35 to 49, and ≥50 years, white donors declined by 21%, 29%, and 3%; black donors declined by 30%, 31%, and 12%; Hispanic donors aged <35 and 35 to 49 years declined by 18% and 15%, and those aged ≥50 increased by 10%. Conversely, among unrelated donors aged <35, 35 to 49, and ≥50 years, white donors increased by 12%, 4%, and 24%; black donors aged <35 and 35 to 49 years did not change but those aged ≥50 years increased by 34%; Hispanic donors increased by 16%, 21%, and 46%. Unlike unrelated donors, related donors were less likely to donate in recent years across race/ethnicity. Although this decline might be understandable for related younger donors, it is less understandable for lower‐risk related older donors (≥50 years). Biologically related older individuals are potential targets for interventions to promote donation.
Keywords:clinical research/practice  donor nephrectomy  donors and donation: living  kidney transplantation/nephrology  kidney transplantation: living donor  registry/registry analysis
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