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Abstract: SA-PO814

A Social Network Analysis of Barriers to Requesting or Accepting an Offer for a Living Donor Kidney Transplant for People With ESKD

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical


  • Lee, Briana Eugene, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
  • Gardiner, Heather Marie, Temple University College of Public Health, Philadelphia, Pennsylvania, United States
  • Gadegbeku, Crystal A., Cleveland Clinic, Cleveland, Ohio, United States
  • Reese, Peter P., University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
  • Obradovic, Zoran, Temple University, Philadelphia, Pennsylvania, United States
  • Fink, Edward L., Temple University, Philadelphia, Pennsylvania, United States
  • Gillespie, Avrum, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States

Living donor kidney transplant (LDKT) is the optimal but underutilized treatment for end-stage kidney disease (ESKD). Most living kidney donations come from a patient’s social network through donation offers or requests. Our study aims to identify barriers to living kidney donations by analyzing a patient’s social network.


Data were collected via cross-sectional survey of hemodialysis patients at two facilities. We used a multilevel binary logistic regression model to examine from which network member a participant would accept a living donation offer from or make a living donor request to. The independent variables included mean strength of relationships in the network, cohabitation, and emotional support. Confounding variables included patient demographic factors. We performed a qualitative analysis of open-ended responses to assess reasons for declining an offer or non-request.


The mean age of 106 patients is 60; 55% are female, 75% self-identify as Black, 16% made a living donor request. The mean network size is 4.6, 70% of the network was eligible for donation, 8% of network members received a donation request, 21% of members offered with 41% of total offers accepted. 73% of members did not offer or receive a request. The odds of accepting an offer or receiving a request is higher for members who lived with the patient (OR: 3.58, 95% CI: 1.07-12.0) and with greater network strength (OR: 3.38, 95% CI:1.47-7.79). In addition, the odds of accepting an offer or requesting was lower for members that provided the patient with emotional support (OR: 0.15, 95% CI: 0.05-0.44). Feeling guilty/concerned for the donor is the most common reason for declining an offer (48%) or not requesting (28%).


Patients with stronger relationships in their network were more likely to accept an offer or request. However, participants were less likely to accept an offer or request from network members that provided emotional support because of guilt/concern for the member. Further network interventions to strengthen relationships, assist in identifying potential donors within the network and alleviate concerns about donation for the patient and their networks may help overcome social barriers to LDKT.


  • NIDDK Support