Donor–Recipient Closeness, Perceived Life Extension Drive Living Kidney Donation Decisions, With Mary Roberts, PhD

New data from a US-based survey suggest the closeness of the donor–recipient relationship and perceived health benefits for the recipient may be strong motivators for living donors, with insights that could inform counseling strategies in transplant programs.1

There are 90,000 individuals awaiting kidney transplants in the US alone, making up 86-87% of the national transplant waiting list. In 2025, the US achieved a record of organ transplants, with a 3% increase in individuals becoming living organ donors, according to data from the Organ Procurement and Transplantation Network. Living donor kidney transplantation has been associated with superior graft survival and improved patient outcomes for patients with ESKD, rates of living donation remain low.2

“One of the major gaps in the living donation literature that we were really focused on was that most research examines barriers from the patient or provider perspective,” Mary K Roberts, PhD, Post Doctoral Researcher at the Leverhulme Centre for Demographic Science at the University of Oxford, explained. “We know much less about the donor side, especially in the US, and prior studies have mostly focused on financial concerns.”

In the analysis, Roberts and investigators leveraged data from 600 US relatives of patients with kidney disease who completed the 2019 Families of Renal Patients Survey. In the survey, participants rated 14 considerations, including financial, health, and relational factors, which affected their willingness to be evaluated as living donors.1

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.1

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.1

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.1

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.1

“The findings really suggest that counseling centered around relational and health related motivations tend to really drive action,” said Roberts. “So prior to evaluation, it would be important to explore donor-recipient relationships and acknowledge that, you know, interpersonal closeness might be a motivator for a lot of donors.”

References

1. Roberts MK, Ryan-Claytor C, Salim Z, Kirk JM, Rowe-Nicholls I, Daw J. Factors influencing willingness to pursue living kidney donation among relatives of patients with kidney disease in the United States. BMC Nephrology. Published online February 9, 2026. doi:https://doi.org/10.1186/s12882-026-04806-3

2. 90,000 people are waiting for a kidney. Here’s one way to get them a kidney faster. - UNOS. UNOS. Published January 27, 2025. https://unos.org/news/90000-people-are-waiting-for-a-kidney-heres-one-way-to-get-them-a-kidney-faster/