*Purpose: Live kidney donation can be an overwhelming process even for the highly motivated individuals. Live donors may have to spend up to $5000 for various direct and indirect costs. There are multiple systematic and financial barriers, and these are compounded for remote donors. Living donation is not financially neutral for donors. Direct costs such as travel and lodging and indirect costs such as dependent care, lost wages and vacation time quickly escalates for remote donors. We report our initial experience using telemedicine for live donor work up for remote donors.

*Methods: Telehealth evaluations via secure institutional platform were offered to all potential remote live donors. A combination of phone, email and physician telehealth evaluations were conducted by our multidisciplinary team. All investigational studies (except CT abdomen angiogram) were done locally. All potential donors were also evaluated by their local primary care physician for physical exam as a prerequisite. Subsequently, provisional decision regarding candidacy was made in multidisciplinary meeting. Provisional surgical date was also provided upfront to help with donor travel plans. Potential donors then traveled to the transplant center within two weeks prior to donation date and met with multidisciplinary team. If suitable, they also completed preadmission testing and cross-sectional imaging as a part of the 1-2-day evaluation process.

*Results: Of the candidates evaluated, about 25% were African Americans, two thirds were related to recipient and one third were male. Pre-donation median donor eGFR and serum creatinine were 121ml/min, and 0.85mg/dl respectively. Median time from telehealth evaluation to actual donor surgery was 68 days (IQR 29-234 days). The surgical date was strongly influenced by both donor’s travel plans and recipient readiness.

*Conclusions: Donors reported high satisfaction rates, lessened financial burden and travel needs. This process protected their vacation time and minimized travel/ lodging expenses. There were seven potential donors who were either deemed ineligible for donation based on telehealth medical evaluation or aborted plans to donate based on education provided leading informed decision making. We will continue to utilize telehealth medicine for remote live donors, to lessen financial disincentives and more importantly to avoid delays in donor work up. The potential impact and wider adoption of this technology should be monitored in coming years to assess if this will positively impact live donor experience and can result in growth.

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