BACKGROUND: Kidney transplantation is the best mode of kidney replacement therapy. However, the shortage of organ donations has been a major challenge globally. Relatives of patients with end-stage kidney disease (ESKD) are potential kidney donors. We explored their perspectives about kidney donation, kidney commercialisation, and barriers to kidney donation.
METHODS: In-depth interviews were conducted among 28 relatives of ESKD patients across the six geopolitical zones and Federal Capital Territory of Nigeria. The interview focused on potential sources of kidney donors, kidney commercialisation and barriers to kidney donation. ATLAS.ti version 9.0.22.0 was used for data analysis.
RESULTS: Mean age of the study participants was 41.57 ± 14.55 years; 54% were females, 60.7% were married, 93% had tertiary education and 75% were first degree relatives of ESKD patients. There were 7 themes and 28 subthemes generated in this study. The potential sources of kidney donors identified by the study participants included commercial, hospital, family and non-family member donors. While some opined that a family member is the best choice as a kidney donor, others preferred a commercial donor. The majority of those interviewed do not believe that it is wrong to purchase a kidney, and would be willing to do so. Identified factors that promote kidney commercialisation were unwillingness of a family member to donate, having the financial capacity to purchase a kidney, non-fitness of family members to donate. Identified barriers to kidney donation were age, poor health status, polygamy, perceived poor expertise of the medical team, perceived risk of the procedure, parental influence and religious beliefs.
CONCLUSIONS: The majority of participants lacked correct information about kidney donation. Implementation of educational program policies and laws regulating and reinforcing ethical principles of kidney donation and transplantation should be ensured.

Urinary dickkopf 3 (uDKK3) is a marker released by kidney tubular epithelial cells that is associated with the progression of chronic kidney disease (CKD) and may cause interstitial fibrosis and tubular atrophy. Recent evidence suggests that uDKK3 can also predict the loss of kidney function in CKD patients and kidney transplant recipients, regardless of their current renal function. We conducted a prospective study on 181 kidney transplant (KTx) recipients who underwent allograft biopsy to determine the cause, analyzing the relationship between uDKK3 levels in urine, histological findings, and future allograft function progression. Additionally, we studied 82 living kidney donors before unilateral nephrectomy (Nx), 1-3 days after surgery, and 1 year post-surgery to observe the effects of rapid kidney function loss. In living donors, the uDKK3/creatinine ratio significantly increased 5.3-fold 1-3 days after Nx. However, it decreased significantly to a median level of 620 pg/mg after one year, despite the absence of underlying primary kidney pathology. The estimated glomerular filtration rate (eGFR) decreased by an average of 29.3% to approximately 66.5 (±13.5) mL/min/1.73 m2 after one year, with no further decline in the subsequent years. uDKK3 levels increased in line with eGFR loss after Nx, followed by a decrease as the eGFR partially recovered within the following year. However, uDKK3 did not correlate with the eGFR at the single time points in living donors. In KTx recipients, the uDKK3/creatinine ratio was significantly elevated with a median of 1550 pg/mg compared to healthy individuals or donors after Nx. The mean eGFR in the recipient group was 35.5 mL/min/1.73 m2. The uDKK3/creatinine ratio was statistically associated with the eGFR at biopsy but was not independently associated with the eGFR one year after biopsy or allograft loss. In conclusion, uDKK3 correlates with recent and future kidney function and kidney allograft survival in the renal transplant cohort. Nevertheless, our findings indicate that the uDKK3/creatinine ratio has no prognostic influence on future renal outcome in living donors and kidney recipients beyond the eGFR, independent of the presence of acute renal graft pathology, as correlations are GFR-dependent.

OBJECTIVE: A living donor kidney transplant is the optimal treatment for chronic renal impairment. Our objective is to assess if lean skeletal muscle mass and donor factors such as body mass index, hypertension, and age impact on renal function following donor nephrectomy.
METHODS: Potential donors undergo CT angiography as part of their work-up in our institution. Using dedicated software (Horos®), standardized skeletal muscle area measured at the L3 vertebrae was calculated. When corrected for height, skeletal muscle index can be derived. Skeletal muscle mass index below predefined levels was classified as sarcopenic. The correlation of CT-derived skeletal muscle index and postoperative renal function at 12 months was assessed. Co-variables including donor gender, age, body mass index (BMI), and presence of pre-op hypertension were also assessed for their impact on postoperative renal function.
RESULTS: 275 patients who underwent living donor nephrectomy over 10 years were included. Baseline pre-donation glomerular filtration rate (GFR) and renal function at one year post-op were similar between genders. 29% (n = 82) of patients met the criteria for CT-derived sarcopenia. Sarcopenic patients were more likely to have a higher GFR at one year post-op (69.3 vs 63.9 mL/min/1.73 m2, p < 0.001). The main factors impacting better renal function at one year were the presence of sarcopenia and younger age at donation.
CONCLUSIONS: When selecting donors, this study highlights that patients with low skeletal mass are unlikely to underperform in terms of recovery of their renal function postoperatively at one year when compared to patients with normal muscle mass and should not be a barrier to kidney donation.

BACKGROUND: Kidney transplantation is the treatment of choice for patients with end stage renal disease. The primary aim of this study was to assess the demographics of deceased kidney donors over the last ten years and to assess for gender variations in deceased donor demographics over an extended period.
METHODS: A retrospective data analysis was carried out using data from the national renal transplant database. All deceased donors who donated a kidney between 1st January 2012 and 31st December 2021 were included. Data points extracted included gender, age, cause of death and month of death. Descriptive analyses were carried out using Excel v16.67.
RESULTS: A total of 1219 kidneys from 650 donors were donated over the ten-year period. The mean donor age was 44.01 years (range 1-74 years). The most common cause of death overall was subarachnoid haemorrhage (SAH), which was the cause of death in 27.8 % of donors (n = 180). Male donors accounted for 57.8 % of donors overall (n = 376). Variation in causes of death was observed between male and female donors, and between younger and older donors. 9 % of male deaths were from suicide compared with 5 % of female deaths. 6 % of male deaths were due to a traumatic head injury, with this accounting for 2 % of female deaths. Deaths due to assault made up 2 % of male donor deaths, but were not a cause of death for any female donors.
CONCLUSIONS: SAH and intracranial bleeds were the most common cause of death in both groups for deceased donor renal transplantation. Incidence of suicide as cause of death in deceased donors is rising in males.

UNASSIGNED: Chronic kidney disease is associated with significant morbidity and mortality in the general population, but little is known about the incidence and risk factors associated with developing low estimated glomerular filtration rate (eGFR) and moderate-severe albuminuria in living kidney donors following nephrectomy.
UNASSIGNED: Retrospective, population-based cohort study.
UNASSIGNED: Kidney donors in Alberta, Canada.
UNASSIGNED: Donor nephrectomy between May 2001 and December 2017.
UNASSIGNED: Two eGFR measurements <45 mL/min/1.73 m2 or 2 measurements of moderate or severe albuminuria from 1-year postdonation onwards that were at least 90 days apart.
UNASSIGNED: Associations between potential risk factors and the primary outcome were assessed using Cox proportional hazard regression analyses.
UNASSIGNED: Over a median follow-up period of 8.6 years (IQR, 4.7-12.6 years), 47 of 590 donors (8.0%) developed sustained low eGFR or moderate-severe albuminuria with an incidence rate of 9.2 per 1,000 person-years (95% confidence interval, 6.6-11.8). The median time for development of this outcome beyond the first year after nephrectomy was 2.9 years (IQR, 1.4-8.0 years). Within the first 4 years of follow-up, a 5 mL/min/1.73 m2 lower predonation eGFR increased the hazard of developing postdonation low eGFR or moderate-severe albuminuria by 26% (adjusted HR, 1.26; 95% CI, 1.10-1.44). Furthermore, donors were at higher risk of developing low eGFR or albuminuria if they had evidence of predonation hypertension (adjusted HR, 2.52; 95% CI, 1.28-4.96) or postdonation diabetes (adjusted HR, 4.72; 95% CI, 1.54-14.50).
UNASSIGNED: We lacked data on certain donor characteristics that may affect long-term kidney function, such as race, smoking history, and transplant-related characteristics.
UNASSIGNED: A proportion of kidney donors at an incidence rate of 9.2 per 1,000 person-years will develop low eGFR or albuminuria after donation. Donors with lower predonation eGFR, predonation hypertension, and postdonation diabetes are at increased risk of developing this outcome.
The purpose of this study was to understand the risk of developing kidney disease in living kidney donors after donation. We followed 590 donors in Alberta, Canada for almost 9 years. Approximately 8% of donors developed reduced kidney function (low estimated glomerular filtration rate) or increased protein in the urine (albuminuria). Donors with lower kidney function before donation, hypertension before donation, or diabetes after donation had a higher likelihood of experiencing these kidney outcomes. This research provides important insights to patients and health care providers to better support the long-term kidney health of living kidney donors.

Chronic kidney failure poses a risk to human life and quality of life. Patients often receive renal replacement therapy or a kidney transplant, with the latter considered superior, though often inaccessible due to long waiting lists. While most kidney donations originate from the deceased, Israel has transformed as the first country where most kidney donations originate from altruistic living donors. This creates a social environment in which patients are tasked with kidney solicitation which often occurs on digital social networks. This study examines the phenomenon of digital kidney solicitation by employing a thematic analysis of 76 attempts of solicitation on Facebook. The analysis revealed the act of digital solicitation comprises of reflecting the inner conflicts of solicitation and justifying the kidney donation both in general and for the particular solicitor. This study sheds light on the phenomenon of people with kidney failure attempting to save their own lives through digital social networks. A phenomenon that could influence the social-health debate concerning the fair distribution of health resources in society.

UNASSIGNED: Kidney donation is the donation of a kidney from a living or dead person to another living person who requires transplantation. The scarcity of kidneys is a great public health concern worldwide, owing to an increase in end-stage renal failure. There is no sufficient evidence regarding the intention to donate kidneys in Ethiopia.
UNASSIGNED: To assess the intention to donate kidneys and its associated factors among Bahir Dar University students in Ethiopia in 2023 by the application of theory of planned behavior.
UNASSIGNED: This institution-based cross-sectional study was conducted from March 7 to April 5, 2023. A multistage sampling technique was used to select 630 participants. Self-administered structured questionnaires were used to collect data. Data were entered into Epi-data version 4.6, and exported to the Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Bivariate and multivariate linear regression analyses were performed. Findings with a p-value <0.05 at the 95% confidence interval were considered statistically significant and interpreted by the unstandardized beta (ß) coefficient.
UNASSIGNED: The mean score of intention to donate the kidney was 12.9 ± 4.1 standard deviation. Direct attitude (B = 0.341, 95% CI = 0.265, 0.416), direct subjective norm (B = 0.088, 95% CI = 0.010, 0.167), direct perceived behavioral control (B = 0.353, 95% CI 0.251, 0.455), knowledge (B = 0.417, 95% CI 0.251, 0.583), and previous experience of blood donation (B = 0.915, 95% CI 0.321, 1.510) were factors associated with intention to kidney donation.
UNASSIGNED: The mean score of intention to donate kidneys was 12.9 ± 4.1 SD. Direct attitude, direct subjective norm, direct perceived behavioral control, experience with blood donation, and knowledge of participants were significant factors for the intention to donate kidneys. Therefore, social and behavioral change communication strategies should address these factors in order to increase kidney donation.

Cancer transmission from deceased donors is an exceedingly rare but potentially fatal complication in transplant recipients. We aimed to quantify the likelihood of non-utilization of kidneys for transplantation from donors with a prior cancer history. We included all intended and actual deceased donors in Australia and New Zealand between 1989 and 2017. Association between prior cancer history and non-utilization of donor kidneys was examined using adjusted logistic regression. Of 9,485 deceased donors, 345 (4%) had a prior cancer history. Of 345 donors with a prior cancer history, 197 (57%) were utilized for transplantation. Donor characteristics of age, sex and comorbidities were similar between utilized and non-utilized donors with prior cancer. The time from cancer to organ donation was similar between utilized and non-utilized donors, irrespective of cancer subtypes. Donors with a prior cancer history were less likely to be utilized [adjusted OR (95% CI) 2.29 (1.68-3.13)] than donors without prior cancer. Of all actual donors, the adjusted OR for non-utilization among those with prior cancer was 2.36 (1.58-3.53). Non-melanoma skin cancer was the most frequent prior cancer type for utilized and non-utilized potential donors. Donors with prior cancers were less likely to be utilized for transplantation, with no discernible differences in cancer characteristics between utilized and non-utilized donors.

Currently, there are more than 100,000 patients on the transplant waitlist in the United States. There exists a significant gap between the supply and demand for kidney transplants. Despite this, about a quarter of kidneys recovered from deceased donors are not being utilized. There is a significant variation in kidney acceptance criteria by transplant centers. The current kidney allocation system allows transplant centers to place kidneys into appropriate recipients who may not be at the top of the list to increase organ utilization. A recent study questioned this practice of \"list diving.\" In this editorial, we seek to support \"list diving\" through a discussion of the various factors a transplant center could take into consideration while evaluating organ offers.

BACKGROUND: The Hispanic community has a high demand for organ donation but a shortage of donors. Studies investigating factors that could promote or hinder organ donation have examined emotional video interventions. Factors acting as barriers to organ donation registration have been classified as: (1) Bodily integrity; (2) medical mistrust; (3) \"ick\"-feelings of disgust towards organ donation; and (4) \"jinx\"-fear that registration may result in one dying due to premeditated plans. We predict that by providing necessary information and education about the donation process via a short video, individuals will be more willing to register as organ donors.
OBJECTIVE: To determine perceptions and attitudes regarding barriers and facilitators to organ donation intention among Hispanic residents in the New York metro politan area.
METHODS: This study was approved by the Institutional Review Board at Northwell Health. The approval reference number is No. 19-0009 (as presented in Supplementary material). Eligible participants included Hispanic New York City (NYC) residents, 18 years of age and above, who were recruited voluntarily through Cloud Research and participated in a larger randomized survey study of NYC residents. The survey an 85-item Redcap survey measured participant demographics, attitudes, and knowledge of organ donation as well as the intention to register as an organ donor. Attention checks were implemented throughout the survey, and responses were excluded for those who did fail. Participants were randomly assigned two-between subject conditions: To view a short video on organ donation and then proceed to complete the survey (i.e., video first) and view the same video at the end of the survey (video last). No intra-group activities were conducted. This study utilized an evidenced-based emotive educational intervention (video) which was previously utilized and was shown to increase organ donation registration rates at the Ohio Department of Motor Vehicles. Results were analyzed using Jamovi statistical software. Three hundred sixty-five Hispanic individuals were included in the analysis. Once consent was obtained and participants entered the survey (the survey sample is presented in Supplementary material), participants were asked to report on demographic variables and their general impression of organ donation after death. The video depicted stories regarding organ donation after death from various viewpoints, including from the loved ones of a deceased person who died waiting for a transplant; from the loved ones of a deceased person whose organs were donated upon death; and, from those who were currently waiting for a transplant.
RESULTS: Using a binomial logistic regression, the analysis provides information about the relationship between the effects of an emotive video and the intention to donate among Hispanic participants who were not already registered as donors. The willingness to go back and register was found to be significantly more probable for those who watched the emotive video before being asked about their organ donation opinions (odds ratio: 2.05, 95% confidence interval: 1.06-3.97). Motivations for participation in organ donation were also captured with many stating the importance of messages coming from \"people like me\" and a message that highlights \"the welfare of those in need\". Overall, the findings suggest that using an emotive video that addresses organ donation barriers to prompt organ donation intentions can be effective among the Hispanic populous. Future studies should explore using targeted messaging that resonates with specific cultural groups, highlighting the welfare of others.
CONCLUSIONS: This study suggests that an emotive educational intervention is likely to be effective in improving organ donation registration intent among the Hispanic population residing in NYC.