*Purpose: Increasing the rates of living donor kidney transplantation is a priority, yet not much is known about the members of an end-stage renal disease patient’s social network who offer to donate but are never evaluated by the transplant center.

*Methods: In this study, we piloted a researcher administered online REDCap social network survey in an urban Mid-Atlantic hemodialysis clinic. We identify which network members offer to donate, which offers are accepted, who gets tested, and how these factors are affected by the size of their networks. Using a thematic analysis of open-ended and multiple-choice questions, we examine why some offers are not accepted, why others are not tested, and why those who were tested do not donate.

*Results: Sixty-five patients participated. The participants’ mean age was 58 +/- 13 years old. Half (51%) identified as female and 94% identified as black. Sixty one percent of patients were on the transplant list or undergoing testing. Participants identified a mean of 5 network members (Standard Deviation of 2, range 1-11). 26% of participants had one member offer to donate, while 22% had 2 or more offers (maximum of 6). Older participants received less offers (r -0.30; p = 0.01). Those with larger networks received more donation offers (r = 0.30; p = 0.01). We also analyzed the 60 network members who offered to donate. Most offers came from the participants’ children (26%), siblings (23%), friends (17%), and extended family (15%). Of the 23 participants who were in romantic relationships, 13% had their partner offer a kidney. Almost half (48%) of the participants did not accept the offers despite most (90%) wanting a living donor transplant. Two main reasons for not accepting were guilt from accepting the kidney (39%), donor age, and health issues (32%). Offers were accepted from 50% of friends, 44% of extended family, 31% of the children, and 29% of siblings. Of the 22 network members whose offers were accepted only 6 (10%) proceeded to get tested. Those who were never tested, never followed up (36%), never followed through, were not a match (23%), or were excluded for medical concerns (19%).

*Conclusions: Most (90%) social network members who offered to donate never made it to the transplant center. Research is underway to examine whether participants with larger networks will benefit from a living donor intervention. Future research should focus on the members who offer to donate and identify their barriers with donating as this could be a missed opportunity for the patient.

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