Abstract
BACKGROUND: Living donor kidney transplantation provides superior outcomes for patients with end-stage kidney disease, yet rates of living donation remain low. Identifying factors that influence willingness to donate is essential for developing effective interventions. METHODS: Data were analyzed from 600 U.S. relatives of kidney disease patients in the 2019 Families of Renal Patients Survey. Respondents rated how 14 considerations, including financial, health, and relational factors, affected their willingness to be evaluated as living donors. Associations between each consideration and the number of donation-related actions taken were estimated using Poisson regression models with and without sociodemographic controls. RESULTS: Improving or extending the recipient's life and the donor-recipient relationship were the strongest motivators, while concerns about donor health, surgery, and finances were key deterrents. Willingness differed across demographic groups. Older adults were less likely than younger respondents to report reduced willingness for financial reasons, while younger adults more often reported increased willingness based on match likelihood, current health, and knowledge of living donation. Older respondents more often indicated that their own health reduced willingness, and adults aged 40 to 59 most often cited negative effects on their family. Women were more likely than men to report reduced willingness related to financial and recovery concerns. Asian or Pacific Islander and Black respondents more often reported reduced willingness due to financial issues and the surgery itself, while Hispanic and White respondents more often reported increased willingness related to extending the recipient's life.Greater willingness related to match likelihood, current health, the donor-recipient relationship, and the potential to extend the recipient's life was associated with completing more donation-related actions. Lower willingness tied to general views on organ donation, surgery, or recovery was associated with completing fewer actions. After adjustment for demographic factors and relationship to the patient, significant associations remained for match likelihood, current health, the donor-recipient relationship, the potential to extend the recipient's life, and general views on organ donation. CONCLUSIONS: Interpersonal and health-related considerations were the strongest predictors of donation behavior. Interventions that address these factors may increase willingness to pursue living kidney donation and reduce disparities in access.