Donor Evaluation Research Articles

Associations between blood donors, component modifications, and the alloimmunization of transfusion recipients.

Prior studies have evaluated transfusion recipient variables impacting red blood cell (RBC) alloimmunization, but few focused on potentially modifiable blood donor or blood component variables. Data from the Recipient Epidemiology and Donor Evaluation Study (REDS)-III, which links donor, component, and patient data in an integrated database, were accessed. For any given RBC unit with sufficient blood donor and component data, we determined if the transfusion recipient experienced a new RBC alloimmunization event ("case") within 16 weeks of the transfusion or not ("control"). Recipient diagnoses were included in the case-control matching algorithm. A total of 2676 cases were matched with 10,160 controls. In a multivariate conditional logistic regression analysis, recipients who received an RBC unit from donors with a different ABO group had a higher risk of alloimmunization (OR 1.60, 95% CI: 1.35-1.89, p < .001). Likewise, recipients who received RBCs from older donors had a higher risk of RBC alloimmunization (OR 1.01 per year of age, 95% CI: 1.00-1.01, p < .001). Irradiated RBCs were associated with a decreased risk of RBC alloimmunization in transfusion recipients (OR 0.52, 95% CI: 0.46-0.59, p < .001), though a sub-analysis of RBCs transfused to people with sickle cell disease showed no such association (p = .75). Recipients who received RBCs stored for a longer duration also had a lower risk (OR 0.99 per day of storage, 95% CI: 0.99-0.99, p < .001) of alloimmunization. This case-control study identified donor and component variables associated with recipient RBC alloantibody formation. Future mechanistic studies exploring these associations are warranted.

The Diagnostic Yield of Genomic Sequencing-Based Genetic Kidney Disease Testing in Kidney Transplant Candidates: Experience at an Urban US Transplant Center.

Recent studies suggest that approximately 10% of patients with chronic kidney disease (CKD) have disease-causing genetic variants, an observation relevant to evaluation of kidney transplant candidates. We retrospectively investigated the diagnostic yield of genetic testing in kidney transplant candidates evaluated at our program (January 1, 2021-December 8, 2022). Inclusion criteria were as follows: first-degree relative(s) with CKD/end-stage kidney disease (ESKD), early-onset CKD, focal segmental glomerulosclerosis, cystic kidney disease, alternative complement pathway-associated diseases, or ESKD of unknown cause. One hundred eleven patients underwent genetic kidney disease testing. The most common indication for testing was early-onset CKD (34.2%), followed by a family history of CKD (23.4%), focal segmental glomerulosclerosis (18.0%), cystic kidney disease (9.0%), alternative complement pathway diseases (3.6%), and ESKD of unknown cause (11.7%). Overall diagnostic yield was 46.9% (52/111), and yield was highest among candidates with a family history of CKD (61.5%; 16/26). Among cases with positive testing, the most common diagnostic variant was APOL1, with 2 renal risk variants identified in 57.7% (30/52), while monogenic causes of CKD were identified in 42.3% (22/52). Genetic testing led to further evaluation or to a different diagnosis than the initial clinical diagnosis in 8.1% (9/111) of the cohort. For 24 transplant candidates, their identified diagnostic variants indicated the need for genetic testing of related living donor candidates; of these, 6 living donor candidates were evaluated and underwent testing, of whom donation was excluded in 1 candidate. Pretransplant genetic testing increases understanding of CKD cause, and provides information for living donor evaluation and risk assessment of posttransplant disease recurrence.

Late corneal guttae recurrence in bilateral penetrating keratoplasty grafts.

To describe a case of guttae recurrence in bilateral corneal grafts in a patient with a known diagnosis of Fuchs endothelial dystrophy, more than three decades following penetrating keratoplasty. Case Report. A 79-year-old White woman presented with declining vision, right eye worse than the left. She had previously undergone bilateral penetrating keratoplasty (P.K.) for Fuchs Endothelial Keratoplasty 35- and 34- years ago, of the right and left eye respectively. The slit-lamp biomicroscopy exam revealed corneal edema as well as presence of guttae affecting bilateral grafts. She underwent PK of the right eye. Histopathological analysis of the removed PK graft showed posterior nodular excrescences consistent with guttae. Guttae development in corneal grafts is relatively uncommon and the mechanism of this entity remains unclear. The observation of guttae development in transplanted grafts has raised questions surrounding donor cornea screening and evaluation by eye banks, as well as those relating to recipients' genetics and intrinsic factors that lead to guttae recurrence in the transplanted grafts. We herein describe the case of guttae recurrence in bilateral corneal grafts in a patient with a known diagnosis of Fuchs endothelial dystrophy, more than 34 years following penetrating keratoplasty.

The Role of Race and Socioeconomic Status in Live Donor Kidney Transplant Interest and Evaluation

The Role of Race and Socioeconomic Status in Live Donor Kidney Transplant Interest and Evaluation

Genetic Assessment of Living Kidney Transplant Donors: A Survey of Canadian Practices.

Kidney failure is a prevalent condition with tendency for familial clustering in up to 27% of the affected individuals. Living kidney donor (LKD) transplantation is the optimal treatment option; however, in Canada, more than 45% of LKDs are biologically related to their recipients which subjects recipients to worse graft survival and donors to higher future risk of kidney failure. Although not fully understood, this observation could be partially explained by genetic predisposition to kidney diseases. Genetic testing of potential LKDs may improve risk assessment and inform the safety of donation. The strategies to evaluate these donors are still evolving. In Canada, little is known about the practice of assessing for genetic conditions among LKDs. The aim was to examine the Canadian practices regarding LKDs genetic assessment. Questionnaires were sent to 23 Canadian adult transplant centers to examine their protocols for LKDs genetic assessment. The questionnaire comprised of 10 sections and 21 questions including case scenarios of different LKD encounters. Major domains of the survey addressed general demographics, information sharing practices, effect of mode of inheritance on candidacy decision, having a policy for LKD genetic evaluation, and case scenarios covering the following conditions: autosomal dominant polycystic kidney disease (ADPKD), Alport syndrome, Fabry disease, familial focal and segmental glomerulosclerosis (FSGS), atypical hemolytic uremic syndrome (aHUS), autosomal dominant tubulointerstitial kidney disease (ADTKD), sickle cell, and apolipoprotein L1 mutation (APOL1). The questionnaire was sent to the living-donor assessment committee representative (nephrologist) in adult and pediatric kidney transplant centers across Canada. In total, 16 of 23 Canadian centers responded to the survey. Of the 8 surveyed genetic conditions, ADPKD, Alport syndrome, and aHUS were the most frequently encountered. More centers have specific policies for donor evaluation for ADPKD (25%) and aHUS (21.4%) vs none to very few for other genetic conditions. The most cited guidelines are Kidney Disease Improving Global Outcomes (KDIGO), Canadian Society of Nephrology/Canadian Society of Transplantation (CSN/CST), and the Canadian Blood Services' Kidney Paired Donation Protocol. Canadian transplant centers follow a case-by-case approach rather than a standard protocol for genetic assessment of LKDs given that current guideline recommendations are based on expert opinion due to a lack of a reliable body of evidence. With the expected rise in utilization of the increasingly available genetic testing, early multidisciplinary assessment including medical geneticists has the potential to improve personalized management. Studies examining long-term donor and graft outcomes are needed to construct the basis for evidence-based recommendations and inform the safety of donations.

Do Factors Influencing Acceptance of Kidney Stone Formers as Donors Predict Subsequent Stone Events?

This study aimed to assess whether kidney stone burden and risk factors at the time of kidney donor evaluation were associated with a symptomatic stone event post-donor evaluation. We identified adults evaluated at Mayo Clinic (two sites) (2000-2011) for living kidney donation and had either a personal history or radiological evidence of kidney stone disease. We analyzed demographics, stone risk factors, stone number/size, and the committee's donation decision and reasons. A follow-up survey (2022-2023) assessed post-evaluation symptomatic kidney stones and related morbidity. Among 412 potential donors with kidney stone disease, 258 donated, 75 did not donate due to kidney stones, and 79 did not donate for other reasons. Multivariable analysis showed that candidates not donating due to stones had higher body mass index (BMI), prior symptomatic kidney stones, multiple stones on imaging, bilateral kidney stones, and diameter of largest stone ≥3mm. Of 147 who completed the survey, 26 (18%) had a symptomatic kidney stone post-donor evaluation. Younger age (p=0.031) and multiple stones on imaging (p=0.02) were significant predictors of post-evaluation symptomatic stones regardless of donation status (p=0.41). Stone burden on imaging and prior symptomatic stone events were associated with not donating. Younger age and stone burden on imaging were the primary risk factors for a symptomatic kidney stone event after donor evaluation.

Comparison between non-contrast-enhanced MRA and contrast-enhanced CTA in the assessment of hepatic arterial vasculature of donors before liver transplantation

BackgroundRadiologic evaluation is crucial in minimizing transplant complications and guaranteeing the donor’s safety, as a variety of anatomical variations characterizes hepatic vascularity. Computed tomographic angiography (CTA) is the gold standard in hepatic vascularity evaluation in donors before liver transplantation. Still, the procedure necessitates intravenous contrast medium injection, which entails nephrotoxicity risk and hypersensitivity reactions. These concerns about contrast medium safety encouraged new developments in non-contrast-enhanced magnetic resonance angiography (NC-MRA) techniques for imaging the vascular anatomy of the liver.ResultsThis study was conducted on 40 patients of potential liver donors. Thirty-six cases (90%) showed excellent image quality by CTA versus 14 cases (35%) by NC-MRA; on the other hand, 21 cases (52.5%) showed good image quality by NC-MRA while versus 2 cases (5%) by CTA and NC-MRA documented 5 cases (12.5%) with fair image quality versus two cases documented by CTA. Both modalities provided diagnostic image quality in all cases. Michel’s classification was employed to identify four distinct kinds of hepatic artery anatomy using CTA. Thirty-nine cases out of 40 were successfully identified using NC-MRA. Segment IV hepatic artery origin could not be identified in 6 cases using NC-MRA versus one case using CTA. Artifacts were noted in 20 cases (50%) using NC-MRA versus 2 cases (5%) using CTA.ConclusionCTA is the gold standard for pre-liver transplant donor evaluation. The emerging technology of non-contrast MRA has an added value with fewer patient complications. It may function as an additional donor examination when CTA is unable to provide adequate diagnostic information. Non-contrast MRA yields reliable results and eliminates the necessity for contrast medium and additional radiation exposure.

Attitudes Toward Use of an APOL1 Genetic Testing Chatbot in Living Kidney Donor Evaluation: A Focus Group Study.

Living kidney donor (LKD) candidates of African ancestry are increasingly asked to undergo Apolipoprotein L1 (APOL1) genetic testing during the donor evaluation process to better understand their risk of kidney disease. LKD candidates' attitudes about using a clinical chatbot on APOL1 remain unknown. This study builds on prior work to culturally adapt the Gia (Genetic Information Assistant) chatbot on APOL1 by assessing donor, recipient, and community member attitudes about the Gia chatbot for enhancing the integration of APOL1 testing into the LKD clinical evaluation workflow. This study involved focus groups and a post-focus group survey in two US cities about the APOL1 Gia chatbot. Qualitative data were analyzed via thematic analysis, and descriptive statistics were used for demographic data. We conducted 10 focus groups including 54 participants (25 LKDs, 23 community members, and 6 living donor kidney transplant recipients of African ancestry). Five themes emerged: (1) participants supported LKD candidates using the Gia chatbot before the nephrologist clinic visit, (2) participants were interested in undergoing APOL1 testing after using Gia, (3) APOL1 testing costs may influence LKD candidates' willingness to get tested, (4) patients of African ancestry may hold varying preferences for using chatbots in the healthcare setting, and (5) individual-level barriers may limit the use of Gia in the healthcare setting. Individuals of African ancestry were highly receptive to integrating the APOL1 chatbot into LKD candidate clinical evaluation, which bodes well for integrating chatbots into the APOL1 clinical genetic testing process.

Ferroptosis regulates hemolysis in stored murine and human red blood cells

AbstractRed blood cell (RBC) metabolism regulates hemolysis during aging in vivo and in the blood bank. However, the genetic underpinnings of RBC metabolic heterogeneity and extravascular hemolysis at population scale are incompletely understood. On the basis of the breeding of 8 founder strains with extreme genetic diversity, the Jackson Laboratory diversity outbred population can capture the impact of genetic heterogeneity in like manner to population-based studies. RBCs from 350 outbred mice, either fresh or stored for 7 days, were tested for posttransfusion recovery, as well as metabolomics and lipidomics analyses. Metabolite and lipid quantitative trait loci (QTL) mapped >400 gene-metabolite associations, which we collated into an online interactive portal. Relevant to RBC storage, we identified a QTL hotspot on chromosome 1, mapping on the region coding for the ferrireductase Steap3, a transcriptional target to p53. Steap3 regulated posttransfusion recovery, contributing to a ferroptosis-like process of lipid peroxidation, as validated via genetic manipulation in mice. Translational validation of murine findings in humans, STEAP3 polymorphisms were associated with RBC iron content, lipid peroxidation, and in vitro hemolysis in 13 091 blood donors from the Recipient Epidemiology and Donor Evaluation Study. QTL analyses in humans identified a network of gene products (fatty acid desaturases 1 and 2, epoxide hydrolase 2, lysophosphatidylcholine acetyl-transferase 3, SLC22A16, glucose 6-phosphate dehydrogenase, ELOVL, and phospholipase A2 group VI) associated with lower levels of oxylipins. These polymorphisms were prevalent in donors of African descent and were linked to allele frequency of hemolysis-linked polymorphisms for Steap3 or p53. These genetic variants were also associated with lower hemoglobin increments in thousands of single-unit transfusion recipients from the vein-to-vein database.

Matching the opposites: liver transplantation from a situs viscerum inversus totalis donor.

Situs viscerum inversus totalis (SIT) is a rare congenital anomaly. Deceased donors with this condition are often declined because of the technical issues in both the organ's procurement and its transplant. Only eight cases of deceased donor organs with SITwere reported to be used for liver transplantation (LT). We herein present a case of LT using a graft from an SIT donor: a modified retroversus piggyback technique was used. A 15year-old female was referred to our institution as a potential donor. An SIT condition was discovered during standard donor evaluation together with the presence of a complex triple arterial pedicle. Procurement operative time was 125min, from skin incision to cross-clamp. Liver extraction occurred 32min after cold flush. The recipient was a 56year-old male affected by recurrent hepatocellular carcinoma (HCC) on hepatitis C related liver cirrhosis. Position and orientation trials of the graft were made and it was decided to implant it with the retroversus technique. Direct duct-to-duct biliary reconstruction was achieved. The postoperative course was uneventful. To our knowledge, this is the first implant with retroversus technique combined to direct biliary reconstruction and the first repetition of that technique. Cases like this highlight how technical complexity can be overcome leading to successful management of difficult scenarios in a safe manner.

The role of artificial intelligence measured preoperative kidney volume in predicting kidney function loss in elderly kidney donors: a multicenter cohort study.

The increasing use of kidneys from elderly donors raises concerns due to age-related nephron loss. Combined with nephrectomy, this loss of nephrons markedly increases the risk of developing chronic kidney disease (CKD). This study aimed to investigate the prognostic value of preoperative kidney cortex volume in predicting the loss of kidney function in elderly donors, by developing an artificial intelligence (AI)-based model for precise kidney volume measurement and applying it to living kidney donors. A multicenter retrospective cohort study using data from living donors who underwent donor nephrectomy between January 2010 and December 2020 was conducted. An AI segmentation model was developed and validated to measure kidney cortex volume from pre-donation computer tomographic (CT) images. The association between measured preoperative kidney volumes and post-nephrectomy renal function was analyzed through a generalized additive model. A total of 1074 living kidney donors were included in the study. Validation of the developed kidney cortex volume model showed a Dice similarity coefficient of 0.97 and a Hausdorff distance of 0.76mm. The measured cortex volumes exhibited an age-related decrease, which correlated with declining kidney function. Elderly donors showed greater decreases in estimated glomerular filtration rates (eGFR) post-donation compared to young donors ( P =0.041). Larger preoperative remnant kidney cortex volume was associated with significantly less decline of eGFR post-donation than those with smaller preoperative remnant kidney cortex volume ( P <0.001). This study highlights the critical role of preoperative kidney cortex volume in the donor assessment process, particularly for elderly donors. The fully automated model for measuring kidney cortex volume provides a valuable tool for predicting post-donation renal function and holds promise for enhancing donor evaluation and safety.

Techno-optimism versus techno-reality: an analysis of internationally funded technological solutions against illegal unreported and unregulated (IUU) fishing in Ghana and Guinea-Bissau

ABSTRACT Maritime governance has been immersed in growing techno-optimism. Technological developments have largely increased the capacity of states to render legible activities at sea and thus more effectively govern them. One area in which such techno-optimism has gained force but is yet to prove itself is the fight against Illegal, Unreported, and Unregulated (IUU) fishing. While technology-aided international cooperation has been crucial in curbing piracy, it has been slower to tame IUU fishing. In this article, we study international projects introducing technology-based solutions against IUU fishing in West Africa. Triangulating project documentation, donor evaluations, interviews, and other secondary sources, we assess how the techno-optimism driving those initiatives meets the techno-reality of their contexts of implementation. We find that, while grounds for optimism are far from unwarranted, realizing the potential of technological solutions against IUU fishing requires securing parallel cooperation that allows states to transform technology-based awareness into action.

Living Donor Candidates’ Self-reported Health and Health Perceptions and Completion of Donor Evaluation: A Cohort Study

Rationale & ObjectiveGiven the organ shortage in the US, increasing living donation is vital to improving access to kidney transplantation, but many donor candidates do not complete the donor evaluation. Our objective was to understand potential living donors’ perceived health and its association with the likelihood of completing the donor evaluation process. Study DesignPotential donors’ self-reported health was ascertained using the Patient Reported Outcomes Measurement Information System (PROMIS) global physical and mental health and the Davies and Ware health perceptions surveys. Setting & ParticipantsPotential living donors who expressed interest in donation at a single medical center were recruited prospectively between 2017-2022. OutcomesCompletion of the donor evaluation. Analytical ApproachAdjusted linear and logistic regression models were used to examine the association between self-reported health and health perceptions with outcomes. Results1,347 individuals were included for study; 46% (N=613) were <40 years of age, 71% (N=951) female, 22% (N=294) were Hispanic, and 16% (N=215) completed the donor evaluation. Mean PROMIS global physical health (17.0 ± 1.9) and mental health (15.5 ± 2.7) raw scores were higher among donor candidates proceeding to completion of the donor evaluation compared with those who withdrew early in the process (16.3 ± 2.2 for physical health and 14.9 ± 3.1 for mental health). Every z-score change in the PROMIS physical health score was associated with 1.48-fold higher odds of completing the donor evaluation (95% CI 1.19-1.85). Fully adjusted models incorporating the PROMIS scores for predicting the completion of donor evaluations had a c-statistic of 0.70. Potential donors’ Davies and Wares health perceptions did not predict the likelihood of completing the donor evaluation in fully adjusted models. LimitationsData are derived from a single center and may not generalize to the donor evaluation process at other transplant centers. ConclusionsDonor candidates’ self-reported physical health may serve as a predictor of the likelihood of completing the donor evaluation process and a potential avenue for future interventions.

Urine Epidermal Growth Factor as a Potential Biomarker of Functional Kidney Mass for the Evaluation of Kidney Transplant Donors and Recipients

Urine Epidermal Growth Factor as a Potential Biomarker of Functional Kidney Mass for the Evaluation of Kidney Transplant Donors and Recipients

Optimization of surgical evaluation algorithms for living donor liver transplantation

BackgroundLiving donor liver transplantation (LDLT) is an established and endorsed alternative for deceased donor liver transplantation with better recipient outcomes. Nevertheless, while extensive evaluation of potential donors is crucial, evaluation algorithms differ between transplant centres and guidelines. MethodsWe included 317 individuals evaluated for LDLT between 07/2007–07/2022 in a retrospective analysis. The evaluation process was analysed to identify the key reasons for declining 77 potential donors. Additionally, 146 donors that underwent LDLT were analysed regarding risk factors for complications. ResultsThe main reasons for donor refusal were liver volumetry (40.3 %) and metabolic factors including obesity or steatotic liver disease (20.8 %). Contrast-enhanced computed tomography (CECT) identified 63.6 % of all declined donors; CECT combined with assessment of medical history, physical examination, blood testing and ultrasonography, identified 87.0 % of declined potential donors. Associated with this selection, complication rates in donors were low (≥II in 17.1 %; none with ≥IVb). Notably, higher age was a risk factor for developing a complication ≥II after hemi-hepatectomy (p = 0.0373). ConclusionsWe propose a progressive 4-step evaluation algorithm that begins with a very basic assessment combined with up-front CECT. This early phase of testing is expected to identify nearly 90 % of ineligible donors, thereby conserving critical resources, time and money, as well as minimising burden for potential donors. FundingJ.M.W. received funding by grant We-4675/6–1 from the Deutsche Forschungsgemeinschaft (DFG) in Bonn, Germany.

A Comparison of Close Family Members and Other Relationships in Live Kidney Donor Evaluation

A Comparison of Close Family Members and Other Relationships in Live Kidney Donor Evaluation

Perspectives on donor-derived infections from Germany.

Often, organ transplantation is the only option to improve the life expectancy and quality of life of patients with terminal organ failure. Despite improved donor and organ assessment, a residual risk remains for transmitting infection, tumor, or other disease from the donor to recipients. Analysis, reporting, and managing of donor-derived diseases through a vigilance and surveillance system (V&S) is mandatory in many countries. We report on suspected and proven/probable donor-derived infections (DDI) in Germany over a period of 8 years (2016-2023). All incoming serious-adverse-event and serious-adverse-reaction (SAE/SAR) reports from 01.01.2016 to 31.12.2023 were evaluated for suspected DDI. Analysis of imputability followed the definition of the US Disease Transmission Advisory Committee (DTAC). Only probable and proven cases according to DTAC classification were defined as DDI. During the study period, 9771 donors in Germany donated post-mortem organs to 27919 recipients. In that period 612 SAE/SAR cases were reported, 377 (62%) involved infections. 41 cases were proven/probable DDI affecting 58 recipients (seven recipients died, 12%). Suspected infections were bacterial (182/377, 48%), fungal (135/377, 36%), viral (55/377, 15%), and parasitic (5/377, 1%). In case of bacterial DDI, no recipient died, but organ loss occurred in six recipients. In case of fungal or viral DDI, 19% (3/16) and 21% (3/14) of the recipients died, respectively. DDI are rare in solid organ transplantation (58/27919, 0.21%), but when they occur, they are associated with high morbidity and mortality in affected recipients. Careful and detailed donor evaluation and a reliable V&S help improve recipient safety.

Pushing the Survival Bar Higher: Two Decades of Innovation in Lung Transplantation.

Survival after lung transplantation has significantly improved during the last two decades. The refinement of the already existing extracorporeal life support (ECLS) systems, such as extracorporeal membrane oxygenation (ECMO), and the introduction of new techniques for donor lung optimization, such as ex vivo lung perfusion (EVLP), have allowed the extension of transplant indication to patients with end-stage lung failure after acute respiratory distress syndrome (ARDS) and the expansion of the donor organ pool, due to the better evaluation and optimization of extended-criteria donor (ECD) lungs and of donors after circulatory death (DCD). The close monitoring of anti-HLA donor-specific antibodies (DSAs) has allowed the early recognition of pulmonary antibody-mediated rejection (AMR), which requires a completely different treatment and has a worse prognosis than acute cellular rejection (ACR). As such, the standardization of patient selection and post-transplant management has significantly contributed to this positive trend, especially at high-volume centers. This review focuses on lung transplantation after ARDS, on the role of EVLP in lung donor expansion, on ECMO as a principal cardiopulmonary support system in lung transplantation, and on the diagnosis and therapy of pulmonary AMR.

A Single-Center Retrospective Study to Identify Causes of Sex Differences in the Living Kidney Donor Evaluation Process.

Multiple studies have shown that females are living donors for kidney transplantation at higher rates than males. However, the underlying reasons for this observation are not well-understood. We examined the living donor evaluation process to determine the point at which sex imbalance arises. Based on a previous study, we hypothesized that both sexes are equally likely to become approved as living donors, but females are more likely to follow through with donation. Single institution retrospective chart review of self-referrals for living donor evaluation between 1/2009 - 12/2022. Self-referrals identified using the Organ Transplant Tracking Record database and cross referenced with billing data. Exclusion at each stage of evaluation was recorded and compared between sexes using log binomial regression; unadjusted and adjusted (for donor age, race, ethnicity, relationship to recipient, and recipient sex) risk ratios (RRs) with 95% confidence interval (CI) were determined. 1,861 self-referrals were reviewed, including 1,214 (65.2%) females and 647 (34.8%) males, resulting in 146 approvals and 125 donations (76/125, 60.8% females, 49/125 39.2% males). Adjusted RRs indicated no significant differences between sexes in completing medical and/or psychosocial workup, having medical and/or psychosocial contraindications, being approved for donation, and proceeding with donation. The top medical contraindications for both sexes were obesity, hypertension, and nephrolithiasis. Female overrepresentation among living donors is likely due to the 1.9 times higher rate of self-referral for evaluation. After this point, both sexes were equally likely to complete workup, be approved, and follow through with donation. Increased efforts to engage males at the initial self-referral stage has the potential to expand access to living donor kidney transplantation.

301.7: Vibration-controlled transient elastography as a non-invasive tool to exclude hepatic steatosis in living liver donor evaluation.

301.7: Vibration-controlled transient elastography as a non-invasive tool to exclude hepatic steatosis in living liver donor evaluation.