Barriers to living kidney donation identified by eligible candidates with end-stage renal disease

Background. Among eligible transplant candidates with end-stage renal disease, only a minority receive a living donor kidney transplant (LDKT), suggesting that there are barriers to receipt of this optimal therapy. Methods. A validated questionnaire was administered to adults active on the deceased donor transplant waiting list, identified from the Southern Alberta Renal Program database. The questionnaire included both quantitative and qualitative items addressing issues related to LDKT in the categories of knowledge, opportunity, fear and guilt. Results. Of the 196 subjects invited to complete the questionnaire, 145 (74%) responded. Not knowing how to ask someone for their kidney was the most frequently reported barrier, identified by 71% of respondents. Those that stated that living donation did not pose significant long-term health risks to the donor [odds ratio (OR) = 3.40, 95% CI 1.17-9.46, P = 0.01] and those who understood how and why to begin the living donation process (OR = 4.21, 95% CI 1.41-12.04, P = 0.002) were more likely to have discussed living donation with potential donors. Conclusions. Knowledge about living donation was associated with having discussed living donation with a family member or friend. Studies examining the impact of educational programmes which address these barriers to living donor kidney transplantation are required.