BACKGROUND: There is a large ethnical disparity in the rate of living kidney donation. We analyzed possible causes of this difference.

METHOD: We performed a single-center retrospective observational cohort study of 1805 potential donors for 874 recipients referred from Jan-07 to May-12. Donor demographics and causes of not donating were collected. The center's IRB committee approved the study.

RESULTS: Ethnical distribution was: 41.6% African Americans (AA), 24% Hispanics (HIS), 19.56% Caucasian (CAU) and the remaining were of other origins (7.8%) or missing information (6.9%). Living donation occurred in 43% of AA, 58.7% in CAU and 64.3% in HIS (p<0.001). Mean number of available donors was 2, similar across ethnicities; one donor volunteered in 56.8% of the recipients, 35.7% had between 2-4 donors and the remaining 7.5% had more than 5 donors volunteering. Non-completion for non-medical reasons rates were highest in AA (28%) compared to CAU (13%) or HIS (18.3%). Exclusion due to medical reasons was 30% in AA, 23.8% in CAU and 18.9% in HIS (p=0001). The rate of donors deciding not to proceed with the work-up was higher in HIS (24.6%) and CAU donors (21.8%) than AA (13.3%). Immunological incompatibility, recipient related problems and psychosocial causes for not donating were similar across the different ethnicities. The main medical cause for declining a donor was HTN (42.2%), 73.5% of them in AA. Decreased renal function was the second most common cause of medical exclusions (17.7%) with similar distribution across ethnicities. Diabetes mellitus (9.9%) was more commonly found in CAU (22.9%) and HIS (21.9%). The overall mean BMI was 31.6 Kg/m2 in AA, 29.6 Kg/m2 in CAU and 30.2 Kg/m2 in HIS. Compared to the actual donor BMI means of 30.5 Kg/m2 in AA, 28 Kg/m2 in CAU and 29.5 Kg/m2 in HIS. Distance to travel to our center was similar across ethnicities, mean of 59 miles is AA (max 1747.9), 117.8 miles in CAU (max 1752.8), 64.3 miles in HIS (max 1829) and 74.9 miles (max 1749.2) in other ethnicities (p=0.002).

CONCLUSION: The rate of living donor renal transplantation is lower in African American population than other ethical groups. The combination of higher non-completion of the work up for non-medical reasons and higher hypertension rates explains the lower donation in this group. We did not find any significant effect on the rate of donation among ethnicities based on the candidate’s BMI or the distance to travel to our center.

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