Participation of compatible kidney donor-recipient pairs in the Dutch Kidney Exchange Program (KEP): an exploration of the decision-making process

M. de Klerk, E.K.J. Massey, J. van de Wetering

Wednesday 4 march 2020

14:50 - 15:00h at Leo Franssen zaal

Parallel session: Parallel sessie V – Donatie en Verpleegkundige abstracts

Background: Participation of compatible pairs in KEP would increase the chances for the incompatible pairs. For compatible pairs too, it can offer advantages by e.g. finding a donor with a better HLA match. Which factors influence the decision of compatible pairs to participate in our voluntary (v)KEP? How do they experience the education about vKEP?

Methods: During June 2016-September 2017, all new recipients and donors who visit our outpatient clinic for the first time were informed orally and by means of a leaflet about vKEP. If during the next visit they were compatible, we discussed the willingness to participate in our vKEP and gave them a questionnaire.

Results: Of the 93 approached, 62 persons completed the questionnaire. 12 (6 pairs) intended to participate in vKEP and 50 did not. Among those who did not want to participate, common reasons were: ‘My kidney fits well with my recipient’ (32/50),and ‘it doesn’t feel good’ (19/50). A longer waiting time (29/38) and that the donor would donate in another hospital (23/39) were seen as barriers. Among those who intended to participate in vKEP, the most important motivation was that it felt good (8/10), hope for a better kidney (7/10) and altruism (4/10). A longer waiting time (6/10) and that the donor would donate in another hospital (7/10) were seen as obstacles. In both groups, anonymity was not seen as a barrier (40/52), they were very satisfied with the verbal explanation (50/55) and the leaflet (45/53). There was little objection to being informed about vKEP (5/53). Ultimately 4 compatible pairs participated in our KEP which resulted in 11 transplants instead of 4.

Conclusions: The decision whether or not to participate as a compatible pair in our vKEP is based on emotional, logistical and medical factors. Donors and recipients were open to education about and consideration of this program. Insights into barriers and facilitators will be incorporated into our vKEP policy and processes.