AN ASSESSMENT OF THE WORK REQUIRED TO EVALUATE LIVING DONORS

ORGAN DONATION AND ALLOCATION I

C. Rose, P. Blezcinski, L. Sills, R. Mccarrell, W. Gourlay, J. Gill, J. Gill
Nephrology, Medicine, University of British Columbia, Vancouver/BC/CANADA

Body: Introduction: Efforts to increase living donor kidney transplantation are dependent on securing appropriate resources to evaluate potential living donors. Methods: We determined donor conversion rates (number of actual donors / number of evaluated potential donors), time for a complete donor evaluation including donor surgery, and characterized the stage at which potential donors were discontinued from the donor evaluation process including the reasons for donor discontinuation in our program between 2000-2008. Results: During this period n=2533 potential donors were evaluated and 396 individuals donated a kidney. Between 2000-8, the number of donor evaluations increased from 66 to 316, while the number of LDTxs increased from 41 to 47. The overall donor conversion rate was 16%, and decreased over time from 23% in 2000 to 7% in 2008. This decrease was evident irrespective of relationship to the recipient. The time to complete a living donor evaluation decreased from 16 to 12 months from 2000-8. Fifty-nine percent of evaluated donors discontinued after the initial medical questionnaire, 35% of the remaining donors discontinued after completion of laboratory investigations, and 41% of donors who completed laboratory investigations discontinued after the medical/surgical physician assessment. The reasons for discontinuation after each stage in the donor evaluation are shown in the table.

	After Medical and Pyschosocial Survey N=1501/2533	After Laboratory Investigation N=365/1032	After Medical and Surgical Evaluation N=271/667
Medical/psychosocial	20.2	47.1	59.0
ABO /HLA incompatible	19.7	3.6	1.6
Other living donor	16.2	15.9	14.5
Donor withdrew or lost to follow	34.1	23.3	15.6
Recipient issue*	4.6	2.9	6.1
Other	5.2	7.2	3.2
*i.e recipient death, transfer to another program, medically unsuitable for transplant

Conclusion: We conclude that approximately 6 potential donors are evaluated to identify an actual living donor. Although the majority of non-donors discontinue at the earliest stage in the evaluation, 11 % of all evaluated potential donors discontinue only after the completion of the entire evaluation. Among actual donors, an average of 13 months were required to complete the donor evaluation. The work of evaluating individuals who ultimately do not donate should be considered and strategies to minimize attrition of donors should be developed.

Disclosure: All authors have declared no conflicts of interest.