title: Racial disparities in living kidney donation: is there a lack of willing donors or an excess of medically unsuitable candidates?
abstract: BACKGROUND
  Live kidney donation is safe for healthy donors and an effective treatment for patients with end-stage renal disease. Many potential donors are referred for live kidney donation, but only a small percentage donate. This study aims to determine reasons for nondonation and establish if racial differences exist.
  
  
  METHODS
  A retrospective database and chart review of all patients that were referred for potential live kidney donation from January 1, 2000 to December 31, 2004 was conducted.
  
  
  RESULTS
  In all, 30.3% of referred potential live kidney donors were lost to follow-up. Primary reasons for nondonation (n=1,050) included unsuitable donor health (43.1%) and recipient-based causes (41.3%). Immunologic incompatibility accounted for 9.7% of all nondonations. Racial differences indicated more African Americans had incompatible blood types (P=0.01) or ineligible recipients (26.7% vs. 14.4%, P<0.01). More non-African Americans donated (13.2% vs. 4.6%, P<0.01) or were halted because the potential recipient received another organ (living/cadaveric) (20.0% versus 7.9%, P<0.01). Nondonation due to overall donor health (including diabetes and hypertension) did not differ between races, but subanalysis indicated more African American nondonation was due to high body mass index (P=0.01).
  
  
  CONCLUSIONS
  Determining the reason behind nondonation is a first step towards understanding low rates of live kidney donation. More African American donor referrals are lost to follow-up while rates of other reasons were similar among races. This may indicate that African Americans are not more frequently medically unsuitable, but that the divergence in rates of live kidney donation is caused by a disparity in willingness to donate among African Americans.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, SC 29425, USA.
authors.forename: Shayna L
authors.initials: SL
authors.lastname: Lunsford
authors.forename: Kit S
authors.initials: KS
authors.lastname: Simpson
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Chavin
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Menching
authors.forename: Lucia G
authors.initials: LG
authors.lastname: Miles
authors.forename: Lilless M
authors.initials: LM
authors.lastname: Shilling
authors.forename: Gilbert R
authors.initials: GR
authors.lastname: Smalls
authors.forename: Prabhakar K
authors.initials: PK
authors.lastname: Baliga
mesh_terms: D001294:Attitude to Health; D044383:Black People / Q000706:statistics & numerical data*; D006801:Humans; D007668:Kidney; D019520:Living Donors / Q000523:psychology / Q000706:statistics & numerical data*; D009657:North Carolina; D012189:Retrospective Studies; D044465:White People / Q000706:statistics & numerical data*; D001741:Black or African American