背景:活体肾移植是治疗终末期肾病的最佳方法,开始评估的在世捐赠者候选人(LDC)很少真正捐赠。虽然一些最不发达国家被认为在医学上不合格,其他人因潜在的可修改原因而停止。
方法:在五个移植中心,我们进行了一项前瞻性队列研究,测量了LDC的临床和社会心理特征,教育准备,准备捐赠,和健康的社会决定因素。我们在评估后跟踪了最不发达国家12个月,以确定他们是否捐赠了肾脏,选择中止,有可修改的中止理由,在医学上不合格,或有其他与收件人相关的原因停止。
结果:在2184个最不发达国家中,18.6%捐赠,38.2%的人选择或有可修改的理由中止,由于医疗或接受者相关原因,43.2%被认为不合格。多变量分析比较成功的最不发达国家与那些没有完成捐赠的变化的原因(N=1241)发现,最不发达国家在评估之前与接受者讨论捐赠(OR,2.31;95%CI,1.54-3.46),完成了高中学业(或者,2.01;95%CI,1.21-3.35),或者与他们的接收者有“密切关系”(或者,1.89;95%CI,1.33-2.69)更有可能捐赠。相反,报告宗教重要的最不发达国家(或,0.55;95%CI,0.38-0.80),是非白人(或,0.70;95%CI,0.49-1.00),或焦虑评分总体较高(或,0.92;95%CI,0.86-0.99)捐赠的可能性较小。
结论:只有不到五分之一的最不发达国家捐款,制定计划以提供更大的情感支持并促进最不发达国家与受援国之间的公开讨论,可能会提高生活捐赠率。
BACKGROUND: Living donor kidney transplantation is the optimal treatment for end-stage kidney disease; however, few living donor candidates (LDCs) who begin evaluation actually donate. While some LDCs are deemed medically ineligible, others discontinue for potentially modifiable reasons.
METHODS: At five transplant centers, we conducted a prospective cohort study measuring LDCs\' clinical and psychosocial characteristics, educational preparation, readiness to donate, and social determinants of health. We followed LDCs for 12 months after evaluation to determine whether they donated a kidney, opted to discontinue, had modifiable reasons for discontinuing, were medically ineligible, or had other recipient-related reasons for discontinuing.
RESULTS: Among 2184 LDCs, 18.6% donated, 38.2% opted to or had modifiable reasons for discontinuing, and 43.2% were deemed ineligible due to medical or recipient-related reasons. Multivariable analyses comparing successful LDCs with those who did not complete donation for modifiable reasons (N = 1241) found that LDCs who discussed donation with the recipient before evaluation (OR, 2.31; 95% CI, 1.54-3.46), had completed high school (OR, 2.01; 95% CI, 1.21-3.35), or were a \"close relation\" to their recipient (OR, 1.89; 95% CI, 1.33-2.69) were more likely to donate. Conversely, LDCs who reported religion as important (OR, 0.55; 95% CI, 0.38-0.80), were Non-White (OR, 0.70; 95% CI, 0.49-1.00), or had overall higher anxiety scores (OR, 0.92; 95% CI, 0.86-0.99) were less likely to donate.
CONCLUSIONS: With fewer than a fifth of LDCs donating, developing programs to provide greater emotional support and facilitate open discussions between LDCs and recipients earlier may increase living donation rates.