title: From potential donor to actual donation: does socioeconomic position affect living kidney donation? A systematic review of the evidence.
abstract: Evidence from Europe, Australia and the United States demonstrates that socioeconomically deprived individuals with advanced chronic kidney disease are less likely to receive a living kidney transplant compared with less deprived individuals. This systematic review focuses on how socioeconomic position (SEP) may influence hypothetical and actual living kidney donors and where appropriate, summarizes the quantitative evidence.In the general population, a higher SEP appears to be associated with an increased 'hypothetical' willingness to be a living kidney donor but with marked heterogeneity in the absolute differences (I = 95.9%, P < 0.001). In a commercial setting, lower SEP motivates people to donate. Outside of this setting, there is no evidence of discordance in the SEP of donors and recipients that would suggest undisclosed financial exchange. There is evidence for a complex interaction between SEP and other variables, such as ethnicity, sex, and the national economic climate. Some evidence suggests that measures to remove financial disincentives to donation are associated with an increase in living donation rates. Future research needs to study how SEP impacts the potential donor population from willingness to donate, progression through donor assessment to actual donor nephrectomy.
authors.affiliation: 1 School of Social and Community Medicine, Canynge Hall, University of Bristol, Bristol, United Kingdom. 2 The Richard Bright Renal Unit, Southmead Hospital, Bristol, United Kingdom. 3 Address correspondence to: Phillippa Bailey, B.A., B.M., B.Ch., M.R.C.P., D.T.M.&H. School of Social and Community Medicine, Canynge Hall, University of Bristol, Bristol, BS8 2PS, United Kingdom.
authors.forename: Phillippa
authors.initials: P
authors.lastname: Bailey
authors.forename: Charles
authors.initials: C
authors.lastname: Tomson
authors.forename: Saira
authors.initials: S
authors.lastname: Risdale
authors.forename: Yoav
authors.initials: Y
authors.lastname: Ben-Shlomo
mesh_terms: D001294:Attitude to Health; D001315:Australia; D005006:Ethnicity; D005060:Europe; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics*; D019520:Living Donors; D008297:Male; D009042:Motivation; D009392:Nephrectomy / Q000191:economics; D011203:Poverty; D012923:Social Class; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement / Q000191:economics*; D014481:United States