NDT Advance Access originally published online on February 20, 2006
Nephrology Dialysis Transplantation 2006 21(5):1178-1183; doi:10.1093/ndt/gfl029
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Dialysis and Transplantation News
Australian nephrologists' attitudes towards living kidney donation
1 Menzies School of Health Research and Institute of Advanced Studies, Charles Darwin University, Darwin, 2 School of Public Health, University of Sydney, Sydney, 3 The George Institute for International Health, Sydney, 4 Central Clinical School, University of Sydney, Sydney, 5 Statewide Renal Services, Royal Prince Alfred Hospital, Sydney and 6 Cooperative Research Centre for Aboriginal Health, Darwin, Australia
Correspondence and offprint requests to: Dr Alan Cass, Head, Renal Program, The George Institute for International Health, PO Box M201 Missenden Rd, Sydney NSW 2050, Australia. Email: acass{at}thegeorgeinstitute.org
Background. The demand for deceased donor kidneys far outweighs the supply. The rate of living kidney donation (LKD) has been steadily increasing world-wide and is associated with excellent outcomes for the recipient. With respect to donors’ outcomes, however, a strong evidence base is lacking. This study explores the attitudes and perceptions of Australian nephrologists towards LKD, specifically regarding donor risk, their willingness to recommend LKD and their own preparedness to become a live donor.
Methods. A postal survey of Australian nephrologists was conducted. Responses to six multiple choice questions about LKD were collected as a separate focus of a larger study.
Results. We achieved a survey response rate of 52.4% and analysed responses from 184 practicing nephrologists and trainees. Australian nephrologists and trainees were generally supportive of LKD. The vast majority (95%) of respondents indicated that they would recommend it to a suitable donor or would themselves (97%) donate a kidney to an immediate family member. However, fewer than half (43%) would recommend LKD to a potential donor, where their relative's end-stage kidney disease (ESKD) had been attributed to diabetes and where there was a strong family history of diabetes. A minority thought that LKD increased the donor's risk of mortality (12%) or of ESKD (25%). Few nephrologists (4%) indicated their preparedness to be an altruistic donor – to a recipient unknown to them.
Conclusions. Although LKD is clearly supported by the nephrologists, the increasing incidence of ESKD attributable to diabetes, now the leading cause of ESKD in Australia, might, however, progressively limit its use. Meeting the growing demand for kidney transplantation will require an increased supply of both live and deceased donor kidneys. We should develop, evaluate and implement best-practice approaches to achieve this.
Keywords: access; attitudes to treatment; living related kidney transplantation; nephrologists; organ donation