Age and racial/ethnic differences in willingness to donate live kidneys in the United States

Background: Despite older adults' and racial/ethnic minorities' greater need for live kidney transplants (LKT) to treat the epidemic of life-threatening end stage renal disease, they are less likely to receive donated kidneys from others. Reasons for disparities in live kidney donation among older adults and minorities are poorly understood.

Methods: In a national study, we assessed potential age and racial/ethnic disparities in willingness to donate live kidneys. Participants rated their willingness (0 (least) to 10 (most)) to donate to relatives (parent/child/sibling/spouse) or non-relatives (friend/celebrity/stranger). We assessed racial/ethnic and age differences in willingness and mediation of differences by attitudes of medical mistrust and religiosity.

Results: Among 845 participants (mean age 45 years; 12% African American (AA), 15% Hispanic), more stated they were extremely willing (rating=10) to donate to relatives (90%) than non-relatives (43%). After multivariable adjustment, older age was associated with less willingness to donate to relatives (β: -0.0167, p<0.01). AAs age 51-65 were less willing to donate than their White counterparts (β: -0.7664, p<0.05); and AAs and Hispanics age >65 were less willing to donate than Whites (β: -0.90 and -1.836, respectively, p<0.05). Mistrust and religiosity were associated with less willingness to donate among older minorities and significantly attenuated differences in willingness to donate among older AAs but not Hispanics when added to models.

Conclusion: Disparities in willingness to donate among older racial/ethnic minorities may contribute to less LKT in these populations. Efforts to address mistrust and religious concerns, particularly among older AAs, could improve access to LKT.