*Purpose: In 2016, the National Kidney Registry (NKR) established an online donor screening portal (DASH) to manage and track individuals interested in kidney paired donation (KPD) through different stages of evaluation from indicating initial interest to actual donation. Potential donors generally interested in KPD or formally seeking evaluation through an individual NKR partner center enrolled in DASH. This study aims to describe progress through DASH evaluation stages and predictors of actual donation.

*Methods: We included all individuals enrolled in DASH between 10/2016-10/10/2020, tracking their progress through 4 stages: Initial Contact, Clinical Questionnaire Screening, Online Medical History, and Actual Donation. Donors were removed from DASH for failure to proceed to the next stage within a specific time window (expired) or when clinical/psychosocial factors reported determined donor ineligibility (ruled out). We used multivariable logistic regression to identify predictors of donation among those who completed screening.

*Results: NKR received 111,080 total contacts during the 4-year study period which translated into only 1,227 (1%) actual PKD donations (Figure). Among those that did donate, the median time from initial contact to actual donation was 206 days (IQR: 136, 307). Predictors positively associated with donation included having at least a college education (aOR 1.8, 95% CI: 1.4-2.3), private health insurance (aOR 2.1, 95% CI: 1.3-3.3), and being a spouse of the recipient (aOR: 1.6, 95% CI: 1.1-2.3). Predictors negatively associated with donation included being of African American race (aOR 0.5, 95% CI: 0.4-0.8), being a friend of the recipient (aOR: 0.3, 95% CI: 0.2-0.4), learning about PKD on social media (aOR: 0.1, 95% CI: 0.1-0.3), or having another relationship with the recipient (aOR: 0.5, 0.3, 0.7), history of high blood pressure, history of high cholesterol, history of obesity, and current tobacco use. The model AUC was 0.734.

*Conclusions: While over 100,000 people expressed initial interest in pursuing PKD – enough individuals to solve the entire kidney donor shortage – few actually donated a kidney. With this high level of potential interest, if we can improve education and support of individuals who begin but fail to complete PKD evaluation stages, more PKDs might result.

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