Kidney transplant candidates' understanding of increased risk donor kidneys: A qualitative study

Background: The Organ Procurement and Transplantation Network (OPTN) requires specific informed consent when "increased risk" (IR) donor organs are utilized. Little is known about kidney transplant candidates' understanding of IR donor kidneys. Methods: We assessed kidney transplant candidates' perceptions, reasons for accepting or declining a future IR donor kidney offer, and information needs through semi-structured interviews. Results: One hundred and sixty-two (80%) patients participated. Patients perceived IR donors as having poor health (44%), advanced age (38%), and poor kidney quality (24%). Patients (31%) would accept IR donor kidneys to get off dialysis (n=18/50), to improve health by receiving a transplant quickly (n=13/50), and felt that the risk of infection was low (n=10/50). Patients (47%) would decline IR donor kidneys for fear of infection transmission (n=34/76), perceived poor-quality kidneys (n=32/76), and their health was good enough to wait for an average-risk kidney (n=23/76). Undecided patients (22%) needed information about the donation situation. Patients desired information about IR donors, their kidneys, and their impact on patients' health. Conclusions: Patients confuse risk posed by OPTN-defined IR donors and other non-standard risk donors. Greater efforts are needed to educate kidney transplant candidates about IR donor kidneys and refine terminology used to describe risks to patients.