{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T21:17:33Z","timestamp":1771190253278,"version":"3.50.1"},"reference-count":49,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2018,10,28]],"date-time":"2018-10-28T00:00:00Z","timestamp":1540684800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100001146","name":"Greenwall Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001146","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006920","name":"University of Pennsylvania","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006920","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>A better understanding of the consequences of being turned down for living kidney donation could help transplant professionals to counsel individuals considering donation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In this exploratory study, we used survey instruments and qualitative interviews to characterize nonmedical outcomes among individuals turned down for living kidney donation between July 1, 2010 and December 31, 2013. We assembled a comparator group of kidney donors.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 83 turned\u2010down donors with contact information at a single center, 43 (52%) participated in the study (median age 53\u00a0years; 53% female; 19% black). Quality of life, depression, financial stress, and provider empathy scores were similar between individuals turned down for donation (n\u00a0=\u00a043) and donors (n\u00a0=\u00a0128). Participants selected a discrete choice response to a statement about the overall quality of their lives; 32% of turned\u2010down donors versus 7% of donors (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.01) assessed that their lives were worse after the center's decision about whether they could donate a kidney. Among turned\u2010down donors who reported that life had worsened, 77% had an intended recipient who was never transplanted, versus 36% among individuals who assessed life as the same or better (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.02). In interviews, the majority of turned\u2010down donors reported emotional impact, including empathy, stress, and other challenges, related to having someone in their lives with end\u2010stage kidney disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Generic instruments measuring quality of life, depression, financial stress, and provider empathy revealed no significant differences between kidney donors and turned\u2010down donors. However, qualitative interviews revealed preliminary evidence that some turned\u2010down donors experienced emotional consequences. These findings warrant confirmation in larger studies.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.13408","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T13:21:33Z","timestamp":1537104093000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Outcomes for individuals turned down for living kidney donation"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1440-069X","authenticated-orcid":false,"given":"Peter P.","family":"Reese","sequence":"first","affiliation":[{"name":"Department of Biostatistics and Epidemiology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"},{"name":"Renal Division University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"},{"name":"Department of Medical Ethics and Health Policy University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"},{"name":"Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew B.","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Medicine Brigham and Women\u2019s Hospital Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline","family":"Carney","sequence":"additional","affiliation":[{"name":"Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Leidy","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simona","family":"Levsky","sequence":"additional","affiliation":[{"name":"School of Arts and Sciences University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruchita","family":"Pendse","sequence":"additional","affiliation":[{"name":"School of Arts and Sciences University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam S.","family":"Mussell","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisca","family":"Bermudez","sequence":"additional","affiliation":[{"name":"Princeton University Princeton New Jersey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shimrit","family":"Keddem","sequence":"additional","affiliation":[{"name":"Crescenz Veterans Affairs Medical Center, Center for Evaluation of the Patient Aligned Care Team Philadelphia Pennsylvania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carrie","family":"Thiessen","sequence":"additional","affiliation":[{"name":"Department of Surgery Yale University School of Medicine New Haven Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5589-4919","authenticated-orcid":false,"given":"James R.","family":"Rodrigue","sequence":"additional","affiliation":[{"name":"Department of Surgery Beth Israel Deaconess, Harvard Medical School Boston Massachusetts"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ezekiel J.","family":"Emanuel","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy 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