Most Americans Aren’t Healthy Enough to Be Kidney Donors

Just over half of adults in the United States—including nearly two-thirds of African Americans—have health conditions that would preclude their becoming living kidney donors, according to a study presented at Kidney Week 2014.

Anthony J. Bleyer, Jr., and colleagues of Wake Forest School of Medicine, Winston-Salem, NC, performed a population-based study to estimate the percentage of Americans healthy enough for kidney donation. The analysis included data on adults aged 21 to 70 years, drawn from The National Health and Nutrition Examination Survey 2010–2011. The investigators studied the presence of common factors that are used to exclude volunteers from donating a kidney in a representative sample of the United States population.

They found that 55.2 percent of the United States population would be ineligible to donate a kidney because of health conditions. A history of hypertension, the most common excluding condition, was present in 19.2 percent of participants. This was followed by obesity, 15.0 percent; excessive alcohol intake (more than four drinks per day), 11.6 percent; and diabetes, 11.5 percent.

The rates of medical ineligibility were higher at lower levels of household income: 60.1 percent of individuals with an income below $35,000 would be unable to donate, versus 49.3 percent with an income above $100,000.

Financial pressures and immigration status are nonmedical factors that often affect the ability to be a kidney donor. With the addition of income below the poverty line and non–United States citizenship, 68.5 percent of the United States population would be ineligible to donate. The figure rose to 75.8 percent after the exclusion of smokers and of individuals with shortness of breath when walking up an incline.

There were significant racial and ethnic differences in the distribution of exclusionary medical conditions, with African Americans having the highest rates of obesity, hypertension, diabetes, and microalbuminuria. Overall, 63.9 percent of African Americans would be ineligible to donate, compared with 54.8 percent of whites.

There is a well-recognized shortage of living kidney donors in the United States. The new report is the first population-based study to evaluate the rates of specific medical conditions and social factors that would exclude individuals from living kidney donation.

“It is well known that African Americans and individuals with lower incomes are at an increased risk of kidney failure. Unfortunately, their potential donors—who are very likely to come from the same social groups—are also much less likely to be kidney donors due to comorbid conditions,” said Anthony Bleyer, the senior investigator in the study. “Increasing the number of living donors will require addressing this important issue.”

Increasing obesity and worsening health of the general population decrease the pool of potential donors. “Financial compensation for time lost at work and lost income would likely improve the ability to donate in 36.1 percent of the eligible donor pool that has an adjusted family household income of less than $35,000,” Bleyer said.