Living donor kidney transplantation is the preferred treatment for people living with kidney failure. However, rates of living kidney donation have not increased significantly over the past decade (1). Furthermore, although the absolute risks are low, living kidney donors (LKDs) lose approximately 30%–35% of their kidney function and have a slightly higher risk of developing kidney failure (2, 3). Thus, research efforts have focused on understanding the care needs of LKDs and the barriers to living donation.
In the February 2024 issue of Kidney International, Loban et al. (4) report the results of their qualitative study of 49 LKDs. Using semi-structured interviews, the aim of the study was to understand the care needs of LKDs from the patient perspective as they traverse the continuum of care, from living donor candidate to the postdonation phase.
There were several important findings from this study. First, LKDs expressed satisfaction with the communication and coordination of care within the donation program. However, it was felt that the coordination between health care teams (i.e., between primary care practitioners and donation programs) was suboptimal and disjointed. This is an important finding since most LKDs in Canada receive long-term follow-up care after donation by their family physician or nurse practitioner. Second, the authors identified substantial variability in the delivery of follow-up care provided to LKDs, both in the short and long term after donation. As a result, a subset of donors expressed feelings of abandonment after donation, in keeping with prior work (5). Third, this study identified a lack of psychosocial support for LKDs, notably in the postdonation phase. Although the majority of LKDs have excellent psychosocial outcomes after donation, a subset of LKDs do experience psychosocial distress, particularly in the event of graft failure in the recipient (6). A prior study has identified that in addition to long-term health outcomes, such as kidney function and kidney failure, psychosocial effects of donation were also highly important outcomes to LKDs (7). The Loban et al. (4) study highlights an important psychosocial care gap among LKDs.
This study yields important insights into the lived experiences of LKDs. Of note, the majority (87%) of LKDs included in the study were White, and further work is needed to better understand the perspectives of racial and ethnic minorities, for whom disparities in access to living donor kidney transplant persist (8). Nevertheless, this study is an important step in better understanding the care needs of LKDs, which is critical in advocating for the necessary infrastructure and dedicated funding to deliver comprehensive and high-quality care to LKDs. Although we have gained a better understanding of the long-term outcomes of LKDs, this study underscores the importance of a comprehensive and collaborative framework to enhance the care and well-being of LKDs.
Footnotes
References
- 1.↑
Lentine KL, et al. OPTN/SRTR 2022 Annual Data Report: Kidney. Am J Transplant 2024; 24:S19–S118. doi: 10.1016/j.ajt.2024.01.012
- 2.↑
Lam NN, et al. Changes in kidney function follow living donor nephrectomy. Kidney Int 2020; 98:176–186. doi: 10.1016/j.kint.2020.03.034
- 3.↑
Muzaale AD, et al. Risk of end-stage renal disease following live kidney donation. JAMA 2014; 311:579–586. doi: 10.1001/jama.2013.285141
- 4.↑
Loban K, et al. Living kidney donors’ health care needs, experiences, and perspectives across their entire donation trajectory: A semi-structured, in-depth interview study. Kidney Int 2024; 105:251–258. doi: 10.1016/j.kint.2023.11.004
- 5.↑
Manera KE, et al. Expectations and experiences of follow-up and self-care after living kidney donation: A focus group study. Transplantation 2017; 101:2627–2635. doi: 10.1097/TP.0000000000001771
- 6.↑
Clemens KK, et al. Psychosocial health of living kidney donors: A systematic review. Am J Transplant 2006; 6:2965–2977. doi: 10.1111/j.1600-6143.2006.01567.x
- 7.↑
Hanson CS, et al. Identifying outcomes that are important to living kidney donors: A nominal group technique study. Clin J Am Soc Nephrol 2018; 13:916–926. doi: 10.2215/CJN.13441217
- 8.↑
Purnell TS, et al. Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014. JAMA 2018; 319:49–61. doi: 10.1001/jama.2017.19152
