title: Live donor champion:  finding live kidney donors by separating the advocate from the patient.
abstract: BACKGROUND
  Lack of education and reluctance to initiate a conversation about live donor kidney transplantation is a common barrier to finding a donor. Although transplant candidates are often hesitant to discuss their illness, friends or family members are often eager to spread awareness and are empowered by advocating for the candidates. We hypothesized that separating the advocate from the patient is important in identifying live donors.
  
  
  METHODS
  We developed an intervention to train a live donor champion (LDC; a friend, family member, or community member willing to advocate for the candidate) for this advocacy role. We compared outcomes of 15 adult kidney transplant candidates who had no prospective donors and underwent the LDC intervention with 15 matched controls from our waiting list.
  
  
  RESULTS
  Comfort in initiating a conversation about transplantation increased over time for LDCs. Twenty-five potential donors contacted our center on behalf of LDC participants; four participants achieved live donor kidney transplantation and three additional participants have donors in evaluation, compared with zero among matched controls (P < 0.001).
  
  
  CONCLUSIONS
  Transplant candidates are ill equipped to seek live donors; by separating the advocate from the patient, understandable concerns about initiating conversations are reduced.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jacqueline M
authors.initials: JM
authors.lastname: Garonzik-Wang
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Berger
authors.forename: Reside Lorie
authors.initials: RL
authors.lastname: Ros
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Kucirka
authors.forename: Neha A
authors.initials: NA
authors.lastname: Deshpande
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Boyarsky
authors.forename: Robert A
authors.initials: RA
authors.lastname: Montgomery
authors.forename: Erin C
authors.initials: EC
authors.lastname: Hall
authors.forename: Nathan T
authors.initials: NT
authors.lastname: James
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000368:Aged; D003144:Communication Barriers; D005260:Female; D006266:Health Education; D006801:Humans; D016030:Kidney Transplantation; D016014:Linear Models; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010344:Patient Advocacy / Q000193:education; D011446:Prospective Studies; D009927:Tissue and Organ Procurement / Q000379:methods*