How to inform potential donors about living kidney donation?

At present, 40% of all kidney transplants in the Netherlands are performed with kidneys from living donors. A substantial amount of patients who visit our transplant outpatient clinic for the first time, are accompanied by one or more willing donors, such as a spouse or siblings. On the other hand, there exists a group of patients who do not pursue transplantation with a living donor. In previous studies, we have found that about 80% of these patients would be willing to accept the offer of a living donor. Main reason given for not pursuing living kidney donation was reluctance to discuss the issue with the potential donors. If no donor steps forward, patients are likely to interpret this as a refusal to donate. In the same study, we had found evidence that this interpretation not always holds: over one third of the potential donors that we interviewed were in a pre-contemplation phase, open to consider themselves as a potential donor. On the other hand, an in size comparable group of potential donors, was reluctant about donation. Main reasons for donor reluctance were 1) Fear for their own health, 2) The specific relationship with the intended recipient and 3) A lack of information about living kidney donation. In this paper we discuss if and how these barriers for living kidney donation can be overcome, and what we can or should do to assist patients in finding a living kidney donor.