Standardized Long-Term Care for Living Kidney Donors

Kidney transplantation is the optimal treatment of patients with ESKD because it is associated with better quality of life and survival when compared with dialysis.1 As the worldwide prevalence of patients with kidney disease reaching kidney failure grows, it is important to increase the rate of living kidney donation. To meet this need, more attention must be placed on the living kidney donors themselves to ensure their safety and long-term health, including standards on follow-up care. I commend the authors of the recent CJASN publication entitled “Perspectives on Long-Term Follow-Up among Living Kidney Donors” for examining how living donors want to be followed over time in Canada.2 I think it is fair to say that most living kidney donors have altruistic values and motivations that often surpass any subsequent risks. As a patient caregiver whose child has had two living kidney transplants and has ongoing relationships with both living donors, the donor's well-being is just as important to me as my child's. This study presents valuable insights into the perspectives of living kidney donors in Canada regarding long-term follow-up. The comprehensive survey of 685 donors provides a strong analysis, which indicates that the significant majority or 73% of living kidney donors had received follow-up care, albeit a large number from primary care providers (PCPs). The high rate of satisfaction among living kidney donors implies that many donors feel their follow-up health care needs are being met, although there is room for improved care. I do, however, wonder if there is a gap in education for which donors and PCPs do not fully understand the need to monitor for and the risks associated with changes in clinical and laboratory assessments that would affect the rates of satisfaction. This may be a point of follow-up insight gathering in the future. I would like to see longer term data and outcomes to measure more long-term satisfaction rates. The focus on the need for annual monitoring and access to specialized care does, however, address the significant lack of post–living donation support and highlights an important area for improvement in health management systems. The survey findings show that follow-up rates were higher among living donors who received reminders from their transplant centers, which suggests that preemptive outreach could improve participation in follow-up care and outcomes. While many living donors were comfortable and even preferred follow-up care with their primary care physician, they also expressed a desire for specialist involvement when facing new health challenges, indicating a need for integrated care approaches that could address potential issues and provide reassurance to donors. This type of collaboration is difficult for patients living with existing kidney disease, so I am skeptical that living donors would get to a specialist in time if they were solely being monitored by PCPs, especially because the article states that a large number of Canadians are not established with a PCP. For these reasons, I would strongly advocate and agree with the authors that all follow-up care should be coordinated and led by the transplant center while perhaps the PCPs administer some care points. This model would increase the odds that living donors’ care needs and information desires are met. I believe that this study is a good starting point and should lead to subsequent studies outside of Canada to provide broader application to all living donors. Although there is not a one-size-fits-all solution, these findings can influence the living donor perspectives and needs in other regions and could provide a more comprehensive solution. In subsequent studies, it would also be interesting to obtain qualitative feedback from donors about their experiences to deepen understanding of their needs. Overall, this study effectively emphasizes the critical need for structured and standardized follow-up care and communication in supporting living kidney donors and highlights opportunities for improving post–living donation care, education, and frameworks to roll out the red carpet for selfless living kidney donors and ensure their kidney health outcomes. I look forward to seeing how we continue to grow living kidney donation services in the future.

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