Living Donor Donation Works When Relationships Matter With Mary Roberts, PhD

Despite the benefits of living donor kidney transplantation, donation rates remain low, and recent data suggests willingness to donate is shaped by more than financial concerns.1

New research shows that interpersonal and health-related factors, as well as age, sex, and racial or ethnic background, strongly influence whether potential donors take steps toward donation.1

“Ultimately, combining structural support with relationally grounded, culturally responsive counseling is likely more effective for increasing living donation than focusing on finances alone,” said Mary K. Roberts, PhD, postdoctoral researcher at the Leverhulme Centre for Demographic Science at the University of Oxford.

Analyzing data from 600 U.S. relatives of kidney disease patients in the 2019 Families of Renal Patients Survey, Roberts and colleagues identified the strongest motivators and deterrents influencing donation behavior. Improving or extending the recipient’s life and the donor–recipient relationship emerged as the most important motivators, while concerns about donor health, surgery, and finances were the primary barriers.1,2

Willingness to donate also varied across demographic groups. Younger adults were more influenced by match likelihood, current health, and knowledge of living donation, while older adults were more likely to cite their own health as a limiting factor. Women reported greater concerns about finances and recovery than men, and Black and Asian/Pacific Islander respondents were more likely to indicate that surgery or financial concerns reduced willingness. Hispanic and White respondents more often highlighted the potential to extend the recipient’s life as a motivator.1

Investigators saw greater willingness was driven by health, relationship, match likelihood, and potential benefit to the recipient, and was linked to completing more donation-related actions, even after adjusting for demographic factors. Conversely, lower willingness related to general views on organ donation, surgery, or recovery predicted fewer actions, underscoring the influence of both personal and relational factors on behavior.1

“Programs integrating culturally tailored, patient-focused, and family-centered education can help patients navigate these conversations with potential donors,” Roberts said. “Ensuring donors have ways to access donation services, proactively discussing medical and process concerns, and providing transparency around long-term health risks are especially critical for communities that historically experience disparities in transplant access.”

Roberts suggests improving living kidney donation rates requires a multidimensional approach that addresses both structural barriers and interpersonal concerns, rather than focusing solely on financial support. By combining culturally responsive counseling with practical and medical support, clinicians can help reduce disparities and increase donor engagement across diverse populations.1

Editor’s Note: Roberts reports no relevant disclosures.

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. .DePasquale N, Cabacungan A, Ephraim PL, Lewis-Boyér L, Powe NR, Boulware LE. Family Members’ Experiences With Dialysis and Kidney Transplantation. Kidney Medicine. 2019;1(4):171-179. doi:https://doi.org/10.1016/j.xkme.2019.06.001