Understanding Non-Clinical Donor Factors in Post-Donation Follow-Up to Improve Care for Living Kidney Donors: A Mixed Methods Study

PROJECT SUMMARY Over 600,000 patients with end-stage kidney disease (ESKD) are on dialysis in the United States, with nearly 100,000 awaiting kidney transplantation. In California, the wait times for deceased donors can extend to 10 years. Living donor kidney transplantation reduces the wait and offers superior survival compared to deceased donation. However, living kidney donors have declined over the last two decades. While donors receive comprehensive pre-donation and perioperative care, post-donation follow-up is often compromised. Despite a U.S. mandated donor follow-up policy, over 40% of donors are lost to follow-up within 2 years. Donors face increased risks of post-donation complications, with inadequate access to post-donation follow-up care. Barriers such as limited access to care, financial strain, and distance from transplant centers exacerbate post-donation follow-up care. Non-clinical donor factors, including education, income, insurance status, and residence status, further compound these challenges. These real-life factors shape targeted interventions, emphasizing the need for person-centered approaches. Effective programs and strategies are urgently needed to address challenges to post-donation follow-up and improve care for all donors. We are tailoring a telemedicine care coordination model to assist donor candidates in completing predonation evaluations. By extension, we envision telemedicine as a potential solution to reduce barriers to post-donation follow-up care. A knowledge gap exists regarding the interplay of non-clinical donor factors in post-donation follow-up and the role of telemedicine as a potential solution to mitigate the modifiable factors. We will conduct mixed-methods research to combine quantitative national data with qualitative donor interviews for a comprehensive understanding of this interplay. Our scientific goal is to understand how non-clinical donor factors influence variations in post-donation follow-up and help mitigate modifiable factors. Our findings will identify high-risk groups and provide insights for tailoring a future telemedicine intervention in post-donation follow-up. This award will support Dr. Al Ammary in completing this proposed research and generating preliminary data for an R01 application to establish and test telemedicine intervention to improve post-donation care for all donors and foster public trust.