Rationale & Objective: Understanding national attitudes about living kidney donation will enable us to identify and address existing disincentives to living kidney donation. We performed a national survey to describe living kidney donation perceptions, perceived factors that affect the willingness to donate, and analyzed differences by demographic subgroups. Study Design: The survey items captured living kidney donation awareness, living kidney donation knowledge, willingness to donate, and barriers and facilitators to living kidney donation. Setting & Population: We surveyed 802 US adults (aged 25-65 years) in June 2021, randomly selected from an online platform with diverse representation. Analytical Approach: We developed summed, scaled indices to assess the association between the living kidney donation knowledge (9 items) and the willingness to donate (8 items) to self -reported demographic characteristics and other variables of interest using analysis of variance. All other associations for categorical questions were calculated using Pearson's chi 2 and Fisher exact tests. We inductively evaluated free -text responses to identify additional barriers and facilitators to living kidney donation. Results: Most (86.6%) of the respondents reported that they might or would definitely consider donating a kidney while they were still living. Barriers to living kidney donation included concerns about the risk of the surgery, paying for medical expenses, and potential health effects. Facilitators to living kidney donation included having information on the donation surgery's safety, knowing that the donor would not have to pay for medical expenses related to the donation, and hearing living kidney donation success stories. Awareness of the ability to participate in kidney -paired donation was associated with a higher willingness to donate. Limitations: Potential for selection bias resulting from the use of survey panels and varied incentive amounts, and measurement error related to respondents' attention level. Conclusions: Most people would consider becoming a living kidney donor. Increased rates of living kidney donation may be possible with investment in culturally competent educational interventions that address risks associated with donating, policies that reduce financial disincentives, and communication campaigns that raise awareness of kidney -paired donation and living kidney donation.

To date, thousands of living donor kidneys have been shipped through kidney paired donation (KPD). To expand on this growing segment of living donor transplantation, we evaluated the effect of advanced age donation ("oldest kidneys") and prolonged cold ischemia time ("coldest kidneys") on graft function and survival using the National Kidney Registry database from February 2008 to May 2018. Donors were stratified by age at time of donation (<65 or ≥65 years) and kidneys were stratified by cold ischemia time (<16 or ≥16 hours). We evaluated delayed graft function and death-censored graft failure (DCGF) for up to seven posttransplant years. Of the 2363 shipped living donor kidney transplants, 4.1% of donors were ≥65 years and 6.0% of transplanted kidneys had cold ischemia times ≥16 hours. Delayed graft function and DCGF occurred in 5.2% and 4.7% of cases. There were no significant associations between delayed graft function and donor age (P = .947) or cold ischemia (P = .532). Donor age and cold ischemia time were not predictive of delayed graft function (OR = 0.86,1.20; P = .8, .6) or DCGF (HR = 1.38,0.35, P = .5, .1). These findings may alleviate concerns surrounding the utilization of kidneys from older donors or those originating from distant transplant centers.

Background Kidney paired donation chains are initiated by nondirected donors and propagated by donors within the chain of transplants, or chain donors. Objective To compare psychosocial and functional outcomes, and to test coercion, of chain donors in paired exchange versus traditional directed donors who have an established relationship with the recipient. Methods Thirty chain donors from a transplant center who were part of the National Kidney Registry paired exchange program were compared with 34 traditional donors who donated around the same time. Participants completed online surveys: the post-donation section of the Living Donor Expectancies Questionnaire was used to assess psychosocial and functional outcomes 1 to 6 years after donation. A survey to assess coercion was used as well. Results Chain donors and traditional donors were similar in terms of sex, race, age, and time after donation. The 2 groups had similar altruistic motives in donating their kidney, and both types of donors mentioned psychological benefits. No differences were found on questions regarding psychosocial outcomes save for the “quid pro quo scale” ( P = .01), which suggested that the traditional donors felt more that the recipients are indebted to them. The 2 groups did not differ significantly in the coercion measure. Pressure to donate and stress of donation were not greater in chain donors than traditional donors ( P = .60). Conclusion Kidney donors in kidney paired donation chains do as well as traditional donors psychosocially without any increased tendency toward experiencing coercion.