Renal transplantation is the best therapy to extend life expectancy and quality of life for patients with end-stage renal disease. As the waiting time of wait-listed patients for deceased donor kidney transplantation continues to increase, the need for living donor kidney transplants become more important. Despite a growing interest in investigating barriers to living kidney donation, published literature is limited. We investigated barriers that may influence access to live donor for kidney transplantations.

A total of 472 potential living kidney donors have been assessed between 2007 and 2017 at Seoul National University Hospital. We retrospectively reviewed 288 potential donors who underwent living donor workup and were excluded as donors. In initial screening, potential donors were interviewed and evaluated to screen for any contraindications to kidney donation, including renal function, cross-match test and a history of cancer, heart disease, diabetes, hypertension or hereditary disease. In second evaluation, potential donors were assessed for radiological and psychological evaluation to decide on the candidacy of potential donor.

The mean age of potential donors were 46 years old, and 48% of candidates were female. Eighty-one candidates (31%) were spouses of the recipient. The number of siblings, relatives and other living unrelated candidates were 62_(24%), 13_(5%), and 18_(7%), respectively. The recipients who had more than two potential candidates be assessedwere 38_ (15%). The causes of inappropriateness for kidney donation were as follows- ; 157 cases were due to medical conditions, and 81 cases were due to disagreement kidney donation. One hundred ninety-one candidates (73%) did not pass the initial health screen; 68 had a positive cross-match (19 had a positive response on flow cytometric test, and 49 had a positive response on complement-dependent cytotoxicity assay), 41 had health problems that were contraindications to kidney donation, 6 cases were cancelled due to recipients’ renal cell carcinoma, 22 had the disagreement of family members, and 38 changed their will to donate. Sixty-nine candidates (27%) did not pass the 2nd evaluation; 20 had underlying medical disease, 9 had nephrolithiasis with high likelihood of recurrence, 7 had the late refusal of family members, 4 had changed their will to donate in the second step, and 4 had low glomerular filtration rate. Despite failure of living donation, 13 recipients received deceased donor kidney transplantation, while 200 recipients have been still on the wait-list.

Elucidation of specific barriers to living donation including health-related and familial factors could contribute to more efficient processing of living donor selection.