Socioeconomic, Demographic and Policy Comparisons of Living and Deceased Kidney Transplantation Rates Across 53 Countries.

Abstract

There are more than 1.7 million sufferers of end stage kidney disease (ESKD) worldwide and for many a donated kidney provides the only chance of regaining independence from dialysis. Unfortunately, the demand for kidneys for transplantation far exceeds the available supply. It is important, therefore, that we understand the factors that may influence kidney donation rates. While certain socio-demographic factors have been linked to kidney donation rates, few studies have examined the influence of multiple socio-demographic factors on rates of both living and deceased kidney transplantation (KT) and none have examined their comparative effect in large numbers of culturally and socio-politically diverse countries. In this study, we performed univariate and multivariate analyses of the influence of 15 socio-economic factors on both the living donor (LD) and the deceased donor (DD) kidney transplantation rates (KTR) in 54 countries. Our analyses demonstrated that factors such as UN HDI (United Nations Human Development Index), religion, education, age, healthcare expenditure, presumed consent legislation and existence of a nationally managed organ donation program were associated with higher deceased KTR. In contrast, the only factors associated with living KTR were a highly significant negative association with presumed consent and variable associations with different religions. We suggest that by identifying factors that affect kidney transplantation rates these can be used to develop programs for enhancing donor rates in individual countries where those rates are below the leading countries. Keywords Organ Donation, Kidney Transplantation; Living Donor Transplantation, Deceased Donor Kidneys, Socioeconomics; Public Policy; Demographics; Presumed Consent Lay summary Using data from 53 countries, this study shows that Human Development Index, religion, Gross Domestic Product (GDP), education, age, healthcare expenditure, presumed consent legislation and existence of a nationally managed organ donation programme were associated with higher deceased donation rates. For living transplants, a negative association was noted with presumed consent and variable associations with different religions. These factors could be targeted in countries with low donation rates.