Time to process for evaluation and time to proceed with donation: opportunity to mitigate the delay in living kidney donation
Ekamol Tantisattamo1,2,3, Wanprapit Noree4, Voramol Rochanaroon5, Ben Thiravetyan6, Thitiphan Srikulmontri7, Urairat Chuenchaem8, Narathorn Kulthamrongsri9, Possawat Vutthikraivit10, Chanokporn Puchongmart11, Piengpitch Naunsilp12.
1Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology, Hypertension & Kidney Tx, University of California Irvine School of Medicine, Orange, CA, United States; 2Nephrology Section, Department of Medicine, Tibor Rubin Veterans Affairs Medical Center, Veterans Affairs Long Beach Healthcare System, Long Beach, CA, United States; 3Multi-Organ Transplant Center, Section of Nephrology, Department of Internal Medicine, William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States; 4 , Police General Hospital, Bangkok, Thailand; 5 , Rayong Hospital, Rayong, Thailand; 6Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 7Siriraj Health Science Education Excellence Center, Education Department, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 8 , Bumrungrad International Hospital, Bangkok, Thailand; 9Department of Pharmacology, Faculty of Medicine Siriraj hospital, Mahidol University, Bangkok, Thailand; 10Phramongkutklao College of Medicine, Mahidol University, Bangkok, Thailand; 11Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 12Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
Background: Living kidney donation provides kidney allograft and patient survival benefits as well as improves transplant access. However, with a comprehensive evaluation process, time to donation may be delayed. We aim to examine the association of time used for evaluation and time for donation.
Methods: A single-center retrospective cohort study including living kidney donors from April 1988 to March 2023. The patients were divided into 2 groups based on the median time from referral for donor evaluation to approval for donation (<6 and ≥6 months for short and long evaluation times, respectively). The outcome of interest is donation time defined by the time from donation approval to donation, which was categorized into sooner and later donation times based on a median time of 1.5 months. The association between the evaluation time and donation time was examined by multiple logistic regression analysis.
Results: Of 361 living kidney donors, the mean±SD age was 40±12 y/o and 59% were female. The majority of the patients were living-related donors (66%). The median evaluation and donation times were 6 and 1.5 months, respectively. Compared to patients with short evaluation time, those with long evaluation time had 1.95 times higher odds of having later donation (Odds ratio (OR) 1.95; 95% confidence interval (CI) 1.05, 3.61; P 0.035). After adjusting for age at donation, gender, and type of living kidney donation (related vs. unrelated), the direction of the association between evaluation and donor times remained with a greater magnitude of the association (OR 2.02; 95%CI 1.07, 3.79; P 0.029). There was no effect modification among all covariates used for the multiple logistic regression model.
Conclusions: Although mitigating the lack of transplant access, living kidney donation faces the challenge of the delay in the donation time associated with the long evaluation process greater than 6 months. Root cause analysis involving all stakeholders should be pursued to shorten the time spent for the donor evaluation process and subsequently, time to proceed with donation.
