Living Donor Candidates’ Self-reported Health and Health Perceptions and Completion of Donor Evaluation: A Cohort Study

Rationale & Objective: Given the organ shortage in the United States, increasing living donation is vital to improving access to kidney transplantation, but many donor candidates do not complete the donor evaluation. Our objective was to understand potential living donors’ perceived health and its association with the likelihood of completing the donor evaluation process. Study Design: Potential donors’ self-reported health was ascertained using the Patient Reported Outcomes Measurement Information System (PROMIS) global physical and mental health and the Davies and Ware Health Perceptions surveys. Setting & Participants: Potential living donors who expressed interest in donation at a single medical center were recruited prospectively between 2017 and 2022. Exposure: Donors' self-reported health and health perceptions. Outcomes: Completion of the donor evaluation. Analytical Approach: Adjusted linear and logistic regression models were used to examine the association between self-reported health and health perceptions with outcomes. Results: A total of 1,347 individuals were included for study; 46% (N = 613) were < 40 years of age, 71% (n = 951) were female, 22% (n = 294) were of Hispanic ethnicity, and 16% (n = 215) completed the donor evaluation. The mean PROMIS global physical health (17.0 ± 1.9) and mental health (15.5 ± 2.7) raw scores were higher among donor candidates proceeding to completion of the donor evaluation when compared with those who withdrew early in the process (16.3 ± 2.2 for physical health and 14.9 ± 3.1 for mental health). Every z-score change in the PROMIS physical health score was associated with 1.48-fold higher odds of completing the donor evaluation (95% CI, 1.19-1.85). Fully adjusted models incorporating the PROMIS scores for predicting the completion of donor evaluations had a c-statistic of 0.70. Potential donors’ Davies and Wares health perceptions did not predict the likelihood of completing the donor evaluation in fully adjusted models. Limitations: Data are derived from a single center and may not generalize to the donor evaluation process at other transplant centers. Conclusions: Donor candidates’ self-reported physical health may serve as a predictor of the likelihood of completing the donor evaluation process and a potential avenue for future interventions. Plain Language Summary: This study was designed to understand the health perceptions of living donor candidates. We found that donor candidates’ self-reported physical health strongly predicted their likelihood of completing the donor evaluation process. Further studies are needed to understand whether addressing donors’ self-perceptions of health may increase rates of completion of the donor evaluation.