Background: The number of living kidney donors has failed to increase in over a decade. There is limited data on the percentage of living kidney donor candidates who are approved for donation or the variables that impact kidney donor denial. We hypothesized that given the increasing average body mass index (BMI) in the United States, elevated BMI is a major factor for kidney donor candidate denial.

Methods: We identified all living kidney donor candidates at a single Midwest transplant center from January 1, 2010, to December 31, 2011. We analyzed the following demographic variables to determine if they impacted whether a patient was approved for donation: age, gender, ethnicity, BMI, marital status, education level, state of residence, and relationship to the recipient. We also identified the indication for denial among candidates not approved for donation.

Results: There were 450 total living kidney donor candidates during the study period. 121 (26.9%) were denied as their intended recipient was either transplanted or ineligible for listing. 84 (18.7%) withdrew after either partial or complete evaluation. 52 (11.6%) were approved and underwent donation. Candidates who were approved had an average BMI of 25.9, while candidates who were denied had an average BMI of 28.9 (p<0.001). Additional demographics that correlated with denial included: female gender, non-Caucasian ethnicity, in-state residence, and education level less than a 4-year college degree. The major medical indications for denial included: hypertension (10.2%), BMI>35 (9.6%), renal disease (6.2%), and cardiovascular disease (2.9%).

Conclusion: Only a small fraction of potential living donor candidates proceed to donation. Elevated BMI is a major contributor to living kidney donor denial both as an absolute contraindication (BMI>35) and also by increasing the incidence of other factors that are a contraindication to donation such as hypertension and cardiovascular disease. Given the increasing obesity epidemic in the United States, it is unlikely that significant increases in the number of living kidney donors will be attainable.

« Back to 2013 American Transplant Congress