The online donor screening portal DASH was established in 2016 by the National Kidney Registry (NKR) to manage and track individuals interested in paired kidney donation (PKD). The portal was designed to track individuals through all stages of evaluation, from initial interest to actual donation. Potential donors who enrolled in DASH expressed general interest in PKD or were formally seeking evaluation through an individual NKR partner center.
A.D. Waterman and colleagues conducted a study to assess progress through DASH evaluation stages and predictors of actual donation. Results of the study were reported in a virtual presentation at the 2021 American Transplant Congress titled High Interest, Low Payoff: Understanding Opportunities for Intervention for Those Exploring but Not Pursuing Paired Kidney Donation.
All individuals who enrolled in DASH between October 2016 and October 20, 2020, were included. Progress was tracked through four stages: (1) initial contact; (2) clinical questionnaire screening; (3) online medical history; and (4) actual donation. Failure to proceed to the next stage within a specific time frame (expired) or when clinical/psychosocial factors reported determined donor ineligibility (ruled out) resulted in removal of donors from DASH. Predictors of donation among those who completed screening were identified using multivariable logistic regression.
During the 4-year study period, a total of 111,080 contacts were received by NKR, resulting in only 1227 (1%) actual donations. Among individuals who donated, the median time from initial contact to actual donation was 206 days.
The predictors with positive associations with donation were having at least a college education (adjusted odds ratio [aOR], 1.8; 95% confidence interval [CI], 1.4-2.3), private health insurance (aOR, 2.1; 95% CI, 1.3-3.3), and being a spouse of the recipient (aOR, 1.6; 95% CI, 1.1-2.3). Predictors negatively associated with donation were being of African American race (aOR, 0.5; 95% CI, 0.4-0.8), being a friend of the recipient (aOR, 0.3; 95% CI, 0.2-0.4), leaning about PKD on social media (aOR, 0.1; 95% CI, 0.1-0.3), or having another relationship with the recipient (aOR, 0.5; 95% CI, 0.3-0.7). History of high blood pressure, high cholesterol, obesity, and current tobacco use were also negatively associated donation predictors.
In summary, the researchers said, “While over 100,000 people expressed initial interest in pursuing PKD—enough individuals to solve the entire kidney donor shortage—few actually donated a kidney. With this high level of potential interest, if we can improve education and support of individuals who begin but fail to complete PKD evaluation strategies, more PKDs might result.”
Source: Waterman AD, Wood EH, Thomas A. High interest, low payoff: Understanding opportunities for intervention for those exploring but not pursuing paired kidney donation. Abstract of a presentation at the virtual American Transplant Congress 2021 (abstract #473), June 8, 2021.