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Abstract: SA-PO810

Barriers to "The Big Ask" and Opportunities to Increase Living Donor Kidney Transplant Among Dialysis Patients and Care Givers

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical


  • Eaton, Karen-Marie, Davita Clinical Research, Minneapolis, Minnesota, United States
  • O'Shea, Michael H., DaVita Inc, Denver, Colorado, United States
  • Brunelli, Steven M., Davita Clinical Research, Minneapolis, Minnesota, United States
  • Tentori, Francesca, Davita Clinical Research, Minneapolis, Minnesota, United States

Living donor kidney transplant (LDKT) offers patients another treatment option for kidney failure. Previous studies indicate that while many dialysis patients and care partners are aware of LDKT, they are unable to leverage their personal networks to obtain a living donation. In this study, we sought to understand current barriers to kidney transplant and living donation for dialysis patients and care partners.


A total of 38 participants were interviewed by phone between May and August 2021. Interviews ranged in time from 10-45 minutes and included a spectrum of participants including dialysis patients and their care partners. Interviews were recorded and transcribed verbatim (Figure 1); responses were analyzed separately using the inductive thematic analysis procedure.


Results from the study indicated that many participants were reluctant to make the “big ask” for a kidney from people within their networks and instead relied on volunteers. Reasons for this were varied, but it was a key driver of LDKT hesitancy. Interestingly, male participants tend to report more “organic” donor conversations, while females report proactively bringing up the topic of living donation. Some participants stated that they have difficulty getting past the information-sharing stage of the LDKT conversation and the conversation stops before getting to the “big ask”. Many participants stated that they have “lived a good life,” and do not want to inconvenience anyone. More specifically, older patients felt “less worthy” of receiving a kidney over younger dialysis patients and/or receiving a kidney from a younger donor who has “more life” left to live and may need two functioning kidneys. Additionally, patients are especially averse to the idea of accepting a kidney from their own children - even when they have expressed initial interest in donating. Finally, almost all participants acknowledged future concerns for prospective donors.


Significant barriers to LDKT consideration were largely social and psychological, including unwillingness to make the “big ask” of their social network