CJASN ePress. Published on September 2, 2016 as doi: 10.2215/CJN.

01360216
Article

Delays in Prior Living Kidney Donors Receiving Priority

on the Transplant Waiting List
Jennifer L. Wainright,* David K. Klassen,† Anna Y. Kucheryavaya,* and Darren E. Stewart*

Abstract
Background and objectives Prior living donors (PLDs) receive very high priority on the Organ Procurement and
Transplantation Network (OPTN) kidney waiting list. Program delays in adding PLDs to the waiting list, setting
*Research
their status to active, and submitting requests for PLD priority can affect timely access to transplantation. Department and
†
Office of the Chief
Design, setting, participants, & measurements We used the OPTN and the Centers for Medicare and Medicaid Medical Officer,
Services data to examine timing of (1) listing relative to start of dialysis, (2) activation on the waiting list, and (3) United Network for
Organ Sharing,
requests for PLD priority relative to listing date. There were 210 PLDs (221 registrations) added to the OPTN Richmond, Virginia
kidney waiting list between January 1, 2010 and July 31, 2015.
Correspondence:
Results As of September 4, 2015, 167 of the 210 PLDs received deceased donor transplants, six received living Dr. Jennifer
donor transplants, two died, five were too sick to transplant, and 29 were still waiting. Median waiting time to L. Wainright, United
deceased donor transplant for PLDs was 98 days. Only 40.7% of 221 PLD registrations (n=90) were listed before Network for Organ
Sharing Research
they began dialysis; 68.3% were in inactive status for ,90 days, 17.6% were in inactive status for 90–365 days, Department, 700 4th
8.6% were in inactive status for 1–2 years, and 5.4% were in inactive status for .2 years. Median time of PLDs Street North,
waiting in active status before receiving PLD priority was 2 days (range =0–1450); 67.4% of PLDs received PLD Richmond, VA 23219.
priority within 7 days after activation, but 15.4% waited 8–30 days, 8.1% waited 1–3 months, 4.1% waited 3–12 Email: jennifer.
months, and 5.0% waited .1 year in active status for PLD priority. After receiving priority, most were trans- wainright@unos.org
planted quickly. Median time in active status with PLD priority before deceased donor transplant was 23 days.

Conclusions Fewer than one half of listed PLDs were listed before starting dialysis. Most listed PLDs are
immediately set to active status and receive PLD priority quickly, but a substantial number spends time in active
status without PLD priority or a large amount of time in inactive status, which affects access to timely transplants.
Clin J Am Soc Nephrol 11: ccc–ccc, 2016. doi: 10.2215/CJN.01360216

Introduction Recent findings on increased ESRD risk for LKDs

Although living kidney donation is generally consid-
ered to be safe, living kidney donors (LKDs) are
subject to the risk of complications (1–5) and a small
risk of perioperative mortality (6,7). They also have an
increased relative risk of developing ESRD after dona-
tion. LKDs’ rates of ESRD compare favorably with those
of the general population (8) but show an increase in
risk over nondonors matched on important demo-
graphic and predonation health criteria (9,10).
Although development of ESRD is a relatively rare
event among LKDs, the number of prior living donors
(PLDs) who subsequently needed a kidney transplant is
not negligible. About 40–50 PLDs are added to the Or-
gan Procurement and Transplantation Network (OPTN)
kidney waiting list each year (Figure 1), for a total of 422
PLDs between September 2, 1996 and July 31, 2015 (465
registrations, including 16 multiple registrations and 27
relistings). Given that .130,000 LKDs have donated
over the past several decades and the increasing length
of time since the earliest donors donated, it is unsurpris-
ing that the number of PLDs added to the waiting list
each year has increased over time.
have heightened interest in PLDs’ access to kidney
transplantation. The transplant community’s efforts
to ensure appropriate waiting list access for PLDs in
need of transplant, however, predate these develop-
ments. PLDs began receiving priority (regardless of
waiting time) over most other local candidates on the
OPTN kidney waiting list in September of 1996, and
PLDs are allowed to receive this priority more than
once if needed. To receive kidney offers through PLD
priority, a PLD’s transplant program must request
priority by submitting a request to the United Net-
work for Organ Sharing (UNOS) Organ Center.
Recent work has shown that PLDs’ priority on the wait-
ing list is serving them well, with waiting times notably
shorter than those of comparable non–PLD candidates
(11,12). Muzaale et al. (11) and Potluri et al. (12) found
median waiting times of 2.8 months and 145 days to de-
ceased donor kidney transplant, respectively. These wait-
ing times include both active and inactive time and thus,
reflect the PLDs’ actual experience on the waiting list.
Although existing research suggests that the priority
system is working well for PLDs in need of transplant,

www.cjasn.org Vol 11 November, 2016 Copyright © 2016 by the American Society of Nephrology 1
2 Clinical Journal of the American Society of Nephrology
Figure 1. | Prior living kidney donors added to the Organ Procurement and Transplantation Network (OPTN) kidney waiting list by year of
listing: January 1, 1997 to December 31, 2015.
there are numerous factors that affect how rapidly a PLD
receives a deceased donor kidney transplant. The most
important factor is whether the PLD is added to the waiting
list soon after diagnosis. Prompt listing allows the possi-
bility of preemptive transplant, which spares the donor the
physical and lifestyle burdens of dialysis.
After a PLD has been approved for transplant and added
to the waiting list, the next factor that affects speed of
transplantation is setting the candidate’s waiting list status
to active. PLD candidates may be placed in inactive status
for a variety of reasons, only some of which are within the
control of the transplant program. Possible reasons for in-
active status include incomplete workup and the candi-
date temporarily being too sick. Although a PLD still
accrues waiting time in inactive status, waiting time is
not the primary determinant of time to transplantation
for PLDs because of their elevated priority, and they can-
not receive organ offers unless in active status.
Another factor that determines how quickly a PLD receives a
transplant is the timeliness of the transplant program’s request
for PLD priority. Until the program submits the request, a PLD
who is listed in active status may receive organ offers but will
not have PLD priority. In practical terms, this means that the
PLD will appear on match runs interspersed with all other
kidney candidates, many of whom will have far more waiting
time than a PLD recently added to the waiting list. As soon as
PLD priority is processed, the PLD may begin receiving organ
offers through their PLD priority.
The purpose of this study was to characterize the
timeliness of PLDs’ listing and activation on the waiting
list and programs’ request for PLD priority status, as well
as examine patient characteristics that are associated with
delays in any of these events. This is the first study explor-
ing delays in requests for PLD waiting list priority.
Materials and Methods
This study used data from the OPTN. The OPTN data
system includes data on all donors, waitlisted candidates,
and transplant recipients in the United States submitted by
the members of the OPTN and has been described else-
where. The Health Resources and Services Administration
(HRSA), US Department of Health and Human Services
provides oversight to the activities of the OPTN contractor.
Our cohort included all PLDs who were added to the
kidney waiting list and received PLD priority between
January 1, 2010 and July 31, 2015 in the United States as
reported to the OPTN. This cohort excluded any PLDs who
developed ESRD but were not listed for transplant, or who
were listed but never received PLD priority.
We determined active waiting list status of kidney
candidates and time in active status without PLD priority
using the OPTN waiting list audit data, which track
changes in a candidate’s waiting list status over time.
We assessed time from the start of chronic maintenance
dialysis to listing using dialysis dates from Centers for
Medicare and Medicaid Services Form 2728 and the
OPTN waiting list. We calculated Kaplan–Meier median
waiting times two different ways: (1) to reflect PLD expe-
rience (i.e., including time in inactive status or without
PLD priority) and (2) to reflect time spent on the waiting
list with allocation priority (i.e., excluding time spent in
inactive status or without PLD priority).
We used logistic regression to estimate the independent
effects of patient covariates on three response variables:
timing of listing, timing of active status, and timing of PLD
priority. Generalized estimating equations were used in the
regression analyses to account for possible center effects
(clustering because of some PLDs being listed by the same
center). It was hypothesized that the following variables
potentially affect timing of listing, activation, and PLD
priority: sex, age at listing, race/ethnicity, calculated panel
reactive antibody, region, blood type, diagnosis, and the
transplant center waiting list volume. To avoid model
overfitting because of small sample sizes, not all covariates
could be included, and additional covariates could not be
explored.
The clinical and research activities being reported are
consistent with the Principles of the Declaration of Istanbul
Clin J Am Soc Nephrol 11: ccc–ccc, November, 2016 Prior Living Donor Priority, Wainwright et al. 3

as outlined in the Declaration of Istanbul on Organ Traffick- were first listed between 51 and 70 years old, and 10.0%
ing and Transplant Tourism. Institutional review board were first listed at 71 years old or older at listing. As of
exemption was obtained from the US Department of Health September 4, 2015, 167 of the 210 PLDs received deceased
and Human Services HRSA. donor transplants, six received living donor transplants, two
died, five were too sick to transplant, and 29 were still wait-
ing. Several PLDs received more than one transplant or were
Results relisted for a second transplant. Kaplan–Meier median wait-
There were 210 transplant candidates (221 registrations) ing time to deceased donor transplant, including time spent
with PLD priority who were added to the kidney waiting list inactive or without PLD priority, was 98 days (95% confi-
between January 1, 2010 and July 31, 2015 (Table 1): 38.1% of dence interval, 78 to 141).
these PLDs were women, 44.3% of PLDs were white, 38.1%
were black, 11.0% were Hispanic, 2.9% were Asian, 2.4% Prompt Listing
were Native American, and 1.4% were other or multiracial. Of 221 PLD registrations, 40.7% (n=90) were added to
Of these PLDs, 1.0% were first listed at ages 18–30 years old, the kidney waiting list before they began regular mainte-
25.7% were first listed between 31 and 50 years old, 63.3% nance dialysis, and just six of these preemptively listed
PLDs began dialysis after listing. Of the 131 PLD registra-
tions (59.3%) that were not preemptive, the median time
Table 1. Characteristics of prior living kidney donors added to between dialysis and listing was 332 days (range =3–4934
the Organ Procurement and Transplantation Network kidney days); 6.8% of PLD registrations were listed within 3 months
waiting list between January 1, 2010 and July 31, 2015 of the initiation of dialysis, 25.3% of PLD registrations were
listed between 3 and 12 months, 12.2% of PLD registrations
n=210 PLD
Characteristic were listed between 1 and 2 years, and 14.9% of PLD regis-
Candidates
trations were listed .2 years after initiation of dialysis
Sex (Figure 2). Multivariable modeling revealed no associations
Women 80 (38.1%) between timing of listing (preemptive versus after initiation
Men 130 (61.9%) of dialysis) and patient and center characteristics (Table 2).
Ethnicity/race
White 93 (44.3%)
Black 80 (38.1%) Active Status
Hispanic 23 (11.0%) The median time spent in inactive status on the waiting
Asian 6 (2.9%) list was 3 days (range =0–2020 days); 68.3% of PLDs were
American Indian/ 5 (2.4%) in inactive status for ,90 days, 17.6% of PLDs were in
Native American inactive status for 90–365 days, 8.6% of PLDs were in in-
Multiracial 3 (1.4%) active status for 1–2 years, and 5.4% of PLDs were in in-
Age at listing, yr active status for .2 years (Figure 3). Of the 31 PLD
Mean (SD) 56.7 (10.5) registrations (14.0%) who were in inactive status .1
Median (IQR) 57.5 (50.0–64.0) year, 21 were inactive because of incomplete workup,
Range 28.0–81.0 two were inactive because of candidate choice, two were in-
CPRA
active because of being temporarily too well, one was inac-
0 155 (73.8%)
1–79 40 (19.1%) tive because of insurance issues, one was inactive because of
80–94 7 (3.3%) being temporarily too sick, two were inactive because of in-
95–100 8 (3.8%) complete workup plus being temporarily too sick, one was
Primary diagnosis inactive because of incomplete workup plus insurance issues,
Hypertensive nephrosclerosis 65 (31.0%) and one was inactive because of inappropriate weight and
Diabetes mellitus 44 (21.0%) medical noncompliance. Multivariable modeling revealed no
GN 6 (2.9%) associations between time in inactive status (.1 versus #1
Retransplant/graft failure 5 (2.4%) year) and patient and center characteristics (Table 2).
Other 90 (42.9%)
ABO
A 42 (20.0%) PLD Priority
B 2 (1.0%) The median time for actively waiting PLDs before receiv-
AB 30 (14.3%) ing their PLD priority was 2 days (range =0–1450 days);
O 136 (64.8%) 67.4% of PLDs received PLD priority within 7 days after
Preemptive at listing (not on 85 (40.5%) activation, but 15.4% of PLDs waited 8–30 days, 8.1%
dialysis) waited 1–3 months, 4.1% waited 3–12 months, and
Days on dialysis before listing 5.0% waited in active status .1 year for PLD priority
(excluding preemptive (Figure 4). Also, 25% of black PLD registrations were in
listings) active status .30 days before receiving PLD priority ver-
Mean (SD) 631.5 (838.1) sus 12.4% of nonblack registrations, and this association
Median (IQR) 332 (195–670)
was statistically significant (P=0.04) in multivariable
Range 3–4934
modeling (Table 2).
After PLDs received their PLD priority, most were trans-
PLD, prior living donor; IQR, interquartile range; CPRA,
calculated panel reactive antibody; ABO, blood type.
planted quickly. The Kaplan–Meier median waiting time
spent in active status with PLD priority (i.e., excluding all
4 Clinical Journal of the American Society of Nephrology

Figure 2. | Time between initiation of maintenance dialysis and addition to the Organ Procurement and Transplantation Network kidney
waiting list for prior living kidney donor registrations added to the waiting list January 1, 2010 to July 31, 2015 (n=221).

time in inactive status or without PLD priority) before de-
ceased donor transplant was 23 days (95% confidence inter-
val, 20 to 30).
Discussion
In this study, some PLDs who were in need of kidney
transplant experienced delays in access to transplantation
because of delays in (1) being added to the kidney waiting
list, (2) being listed in active status, and (3) receiving PLD
priority. Many PLDs are exposed to months or years on
dialysis before being added to the waiting list, with only
40.7% of registrations occurring before initiation of main-
tenance dialysis, and one half of PLDs who do not receive
preemptive transplants are on dialysis for 332 days or
longer before listing. Given that waiting time and time
on dialysis are not major determinants of organ offers
for PLDs, this practice exposes PLDs to potentially avoid-
able time on dialysis. After listing, most PLDs are put in
active status in a timely manner, but a substantial number
(14.0%) remains ineligible to receive organ offers because
of inactive status for .1 year. There are valid medical and
other reasons why a candidate could be kept in inactive
status; it is impossible to ascertain whether programs
update a candidate’s inactive reasons if those reasons
change during a candidate’s time in inactive status, but
transplant programs should work to minimize inactive
time to the extent possible. A notable proportion of
PLDs (17.2%) is spending 1 month or longer in active sta-
tus without PLD priority, which denies these PLDs the
high priority entitled to them by OPTN policy. After listed,
set to active status, and awarded priority, PLDs are trans-
planted very rapidly (median of 23 days), and recently
published research has shown that PLDs’ access to rapid
transplantation has been maintained after implementation
of the new Kidney Allocation System (13).
The OPTN Board recognized the critical contribution of
living donors in 1996 when it approved policy that granted
PLDs priority access on the OPTN kidney waiting list.
OPTN policy requires transplant programs to inform living
donors of this priority as part of their predonation in-
formed consent, and delays in providing PLD priority may
undermine trust in the system. Program delays in these
requests result in unnecessary delays in access to trans-
plantation for PLDs. Given transplant programs’ respon-
sibility to provide the best possible care for their
candidates and the transplant community’s responsibility

Table 2. Multivariable logistic regression models evaluating patient and hospital characteristics associated with prior living kidney
donor outcomes

Odds Ratio (95% CI)

Risk Factor Listing after Initiation of Inactive Time .1 yr, Active without PLD
Maintenance Dialysis, n=31 Yes and Priority .30 d, n=38
n=131 Yes and n=90 No n=190 No Yes and n=183 No

Race, black versus nonblack 1.31 (0.70 to 2.42) 1.14 (0.49 to 2.64) 2.31 (1.05 to 5.08)a
Sex, women versus men 0.81 (0.44 to 1.50) 1.25 (0.53 to 2.92) 1.40 (0.63 to 3.14)
Age at listing per 1 yr 1.01 (0.98 to 1.04) 0.97 (0.93 to 1.00) 1.00 (0.96 to 1.03)
CPRA, 80%–100% versus 0%–79% 2.59 (0.67 to 9.94) 0.67 (0.10 to 4.23) 1.81 (0.47 to 7.04)
Center waiting list volume 0.99 (0.96 to 1.02) 1.04 (1.00 to 1.08) 1.02 (0.98 to 1.06)
per 100 additional patients

P value .0.05 unless otherwise indicated. 95% CI, 95% confidence interval; PLD, prior living donor; CPRA, calculated panel reactive
antibody at 4 weeks (or removal if before 4 weeks).
a
P=0.04.
Clin J Am Soc Nephrol 11: ccc–ccc, November, 2016 Prior Living Donor Priority, Wainwright et al. 5

Figure 3. | Time in inactive status on the Organ Procurement and Transplantation Network kidney waiting list for prior living kidney donor
registrations added to the waiting list January 1, 2010 to July 31, 2015 (n=221).

to promote the wellbeing of living donors (14), these de-
lays are unacceptable. Some PLDs may choose to forgo a
possible deceased donor transplant in favor of solely
pursuing a living donor transplant, but no PLD should
be on the waiting list in active status but without PLD
priority for longer than the time necessary for the program
to contact the UNOS Organ Center to request priority. The
Organ Center fulfills PLD priority requests within 1 busi-
ness day. Transplant programs should ensure that their
staff understands the OPTN policy on PLD priority and
the process to obtain priority for the program’s PLD can-
didates. Transplant programs may contact the UNOS Or-
gan Center with questions.
Because some PLDs were waiting in active status on the
kidney waiting list without PLD priority, the OPTN
implemented a new process in May of 2015 to identify as
many of these PLDs as possible and make their respective
transplant programs aware of the situation. UNOS now
regularly links the current OPTN kidney waiting list with the
OPTN’s list of all known living donors in the United States
who donated on or after October 1, 1987. The OPTN proac-
tively contacts programs with candidates who seem to
have a match on the living donor list so that they can de-
termine if the candidate truly is a PLD and if so, request PLD
priority for the candidate. Because the OPTN does not
possess living donor data for all donors and because data-
base linkages are not always successful, some PLDs cannot
be identified through this process. As a result, programs
should implement their own processes to identify all PLDs
among their candidates and promptly request priority.
Transplant programs also should consider their proto-
cols for preemptively listing and transplanting PLD can-
didates. PLD priority is a far more important determinant
of organ offers for PLD candidates than waiting time and
time on dialysis, and a PLD who is listed preemptively is
likely to receive a transplant before dialysis is required.
Although some PLDs may choose to postpone being added
to the waiting list, transplant programs should ensure that
PLDs who present at their program are aware of the
benefits of preemptive transplantation and the ability of
most PLDs to receive a transplant quickly. Programs
should consider that some PLDs, such as those who are
highly sensitized, may face a long wait for a kidney even
with PLD priority. Such PLDs could be especially good
candidates for preemptive listing. For PLDs who do need
dialysis, education of dialysis providers about the trans-
plant priority that PLDs should receive could be beneficial
to PLDs under their care.
Previous research on outcomes for PLDs on the waiting
list has measured time to transplant using all of a candidate’s

Figure 4. | Time in active status without prior living donor priority for prior living kidney donor registrations on the Organ Procurement and
Transplantation Network kidney waiting list added to the waiting list January 1, 2010 to July 31, 2015 (n=221).
6 Clinical Journal of the American Society of Nephrology
waiting time, including time in inactive status and time in
active status without PLD priority. This assessment of actual
waiting time accurately portrays the experience of PLDs after
listing. It does not, however, accurately portray the true
speed of the allocation system experienced by PLDs who
are added to the waiting list in active status with PLD prior-
ity in a timely manner, because their waiting times are much
shorter. Both clinicians and researchers should be aware of
this distinction when interpreting PLD waiting times for clin-
ical and research purposes.
One limitation of this study was our inability to identify
PLDs added to the waiting list for whom PLD priority was
never requested. As a result of this limitation, we are
unable to accurately assess the full extent of the problem,
because it is possible that additional PLDs were listed
without ever receiving PLD priority. Because the ability to
identify PLDs on the waiting list varies according to certain
demographic characteristics (e.g., a PLD who is a woman is
more likely to change her last name, and a foreign national
PLD is less likely to have a Social Security Number in the
donor record), analyses of demographic characteristics of
PLDs on the waiting list must be interpreted with caution.
Another limitation of this study is the small sample size,
which portends low statistical power for identifying factors
significantly associated with delays in listing, active status,
and PLD priority. However, we did find that black PLDs
were more likely than nonblack PLDs to spend 1 month or
longer in active status without PLD priority. Although this
finding is statistically significant (P=0.04), it should be inter-
preted cautiously because it is the result of performing mul-
tiple hypotheses tests simultaneously, which can lead to
false positives. Additional data are needed to confirm its
validity. Still, a potential disparity associated with ethnicity
is highly concerning, and although it is unlikely that this
difference is on the basis of intentional discrimination, black
PLDs may have less access to information about their right
to PLD priority. The inclusion of this right in the recent
OPTN policy requirements for the informed consent of liv-
ing donors may remedy this difference in the future.
In conclusion, most PLDs are listed in active status and
receive PLD priority in a timely manner, but a substantial
number of PLDs are spending time in active status without
PLD priority or a large amount of time in inactive status,
which affects their access to timely transplants. Additionally,
many PLDs are exposed to months or years on dialysis before
being added to the waiting list. After PLDs are listed in active
status with PLD priority, most are transplanted quickly.
Increased awareness among transplant programs of the
benefit of timely listing and the process for quickly obtaining
PLD priority is needed. Researchers also must consider this
issue to properly interpret PLD waiting times after listing.
Acknowledgments
This work was conducted under Organ Procurement and Trans-
plantation Network (OPTN) contract 234-2005-370011C.
Preliminary results were presented as a poster at the American
Society of Transplant Surgeons 16th Annual State of the Art Winter
Symposium, Miami Beach, FL, and at the 2016 American Trans-
plant Congress, Boston, MA.
As a United States government–sponsored work, there are no re-
strictions on its use. The data reported here have been supplied by the
United Network for Organ Sharing as the contractor for the OPTN.
The interpretation and reporting of these data are the responsibility of
the authors and in no way should be seen as an official policy of or
interpretation by the OPTN or the United States government.
Disclosures
None.
References
1. Lentine KL, Lam NN, Axelrod D, Schnitzler MA, Garg AX, Xiao
H, Dzebisashvili N, Schold JD, Brennan DC, Randall H, King EA,
Segev DL: Perioperative complications after living kidney do-
nation: A national study. Am J Transplant 16: 1848–1857, 2016
2. Schold JD, Goldfarb DA, Buccini LD, Rodrigue JR, Mandelbrot
DA, Heaphy EL, Fatica RA, Poggio ED: Comorbidity burden and
perioperative complications for living kidney donors in the
United States. Clin J Am Soc Nephrol 8: 1773–1782, 2013
3. Schold JD, Goldfarb DA, Buccini LD, Rodrigue JR, Mandelbrot D,
Heaphy EL, Fatica RA, Poggio ED: Hospitalizations following
living donor nephrectomy in the United States. Clin J Am Soc
Nephrol 9: 355–365, 2014
4. Patel S, Cassuto J, Orloff M, Tsoulfas G, Zand M, Kashyap R, Jain
A, Bozorgzadeh A, Abt P: Minimizing morbidity of organ dona-
tion: Analysis of factors for perioperative complications after
living-donor nephrectomy in the United States. Transplantation
85: 561–565, 2008
5. Friedman AL, Cheung K, Roman SA, Sosa JA: Early clinical and
economic outcomes of patients undergoing living donor ne-
phrectomy in the United States. Arch Surg 145: 356–362, 2010
6. Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto
SE, McBride MA, Montgomery RA: Perioperative mortality and
long-term survival following live kidney donation. JAMA 303:
959–966, 2010
7. Mjøen G, Øyen O, Holdaas H, Midtvedt K, Line PD: Morbidity
and mortality in 1022 consecutive living donor nephrectomies:
Benefits of a living donor registry. Transplantation 88: 1273–
1279, 2009
8. Cherikh WS, Young CJ, Kramer BF, Taranto SE, Randall HB, Fan
PY: Ethnic and gender related differences in the risk of end-stage
renal disease after living kidney donation. Am J Transplant 11:
1650–1655, 2011
9. Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride
MA, Wainright JL, Segev DL: Risk of end-stage renal disease
following live kidney donation. JAMA 311: 579–586, 2014
10. Mjøen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Øyen O,
Reisæter A, Pfeffer P, Jenssen T, Leivestad T, Line PD, Øvrehus M,
Dale DO, Pihlstrøm H, Holme I, Dekker FW, Holdaas H: Long-
term risks for kidney donors. Kidney Int 86: 162–167, 2014
11. Muzaale AD, Massie AB, Kucirka LM, Luo X, Kumar K, Brown RS,
Anjum S, Montgomery RA, Lentine KL, Segev DL: Outcomes of
live kidney donors who develop end-stage renal disease. Trans-
plantation 100: 1306–1312, 2016
12. Potluri V, Harhay MN, Wilson FP, Bloom RD, Reese PP: Kidney
transplant outcomes for prior living organ donors. J Am Soc
Nephrol 26: 1188–1194, 2015
13. Stewart DE, Kucheryavaya AY, Klassen DK, Turgeon NA, Formica
RN, Aeder MI: Changes in deceased donor kidney trans-
plantation one year after KAS implementation. Am J Transplant
16: 1834–1847, 2016
14. Newell KA, Formica RN, Gill JS: Engaging living kidney donors
in a new paradigm of postdonation care. Am J Transplant 16: 29–
32, 2016
Received: February 5, 2016 Accepted: July 7, 2016
Published online ahead of print. Publication date available at www.
cjasn.org.