{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T20:30:21Z","timestamp":1786480221968,"version":"build-2736575974"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Kidney360"],"published-print":{"date-parts":[[2026,2]]},"abstract":"\n Key Points<\/jats:title>\n \n \n \n Innovations targeting living kidney donor disincentives increase living kidney donation.<\/jats:p>\n <\/jats:list-item>\n \n By addressing known barriers, these programs can expand the donor pool, improve efficiency in donor evaluation, and improve donor experience.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n While up to 59% of the US population report willingness to donate a kidney, only about 6000 living kidney donations (LKD) occur annually. This study described the use and impact of National Kidney Registry (NKR) programs designed to eliminate disincentives to LKD.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n This was a retrospective cohort analysis using administrative data records from the NKR, a national database capturing information on potential living kidney donors at 103 transplant centers across the continental United States. Descriptive statistics were used to summarize donor characteristics, program participation, and outcome measures. An interrupted time series was used to analyze changes in registration conversion rates before and after program implementation.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n After the implementation of Donor Connect, the registration conversion rate increased from 8.4% immediately preceding implementation to 18.4% by the end of follow-up. At the time of intervention, a statistically significant 8% increase in registration conversion rate was observed (\n P<\/jats:italic>\n < 0.001), with an additional 0.3% increase per quarter thereafter (\n P<\/jats:italic>\n = 0.017). Remote donors were significantly more likely to live >150 miles from the recipient's transplant center (84% versus 21%); the Remote Donor Program reduced travel burden by 597 [205, 1196] miles. Referral conversion rates were significantly higher for donors living within 50 miles (8.3%) compared with those 51\u2013150 miles (6.5%,\n P<\/jats:italic>\n < 0.001) and >150 miles (5.3%,\n P<\/jats:italic>\n < 0.003), corresponding to an increased donation odds of 1.31 and 1.62, respectively). Fifty-one percent of donors received cost reimbursement through the Donor Shield program. Donors who participated were more racially diverse and were more likely to reside further from the transplant center.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n This analysis indicates that the outcomes from NKR's programs support the efficacy of disincentive-targeted innovations as a way to increase donation rates by supporting donors and streamlining the donation process. These innovations represent a modern, donor-centered approach to LKD. By addressing known barriers, these programs have the potential to expand the donor pool, improve the efficiency in donor evaluation, and improve the overall donor experience.<\/jats:p>\n <\/jats:sec>\n \n Podcast<\/jats:title>\n This article contains a podcast at https:\/\/dts.podtrac.com\/redirect.mp3\/\/www.asn-online.org\/media\/podcast\/JASN\/2026_02_09_KTS_February2026.mp3<\/jats:p>\n <\/jats:sec>","DOI":"10.34067\/kid.0000001001","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:00:45Z","timestamp":1759334445000},"page":"397-407","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":3,"title":["Strategic Innovations to Reduce Disincentives and Increase Living Kidney Donation"],"prefix":"10.34067","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9810-9298","authenticated-orcid":false,"given":"Amanda","family":"Leonberg-Yoo","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Redfield","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of California Irvine, Irvine, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5941-0659","authenticated-orcid":false,"given":"Ty","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9686-3107","authenticated-orcid":false,"given":"James N.","family":"Fleming","sequence":"additional","affiliation":[{"name":"National Kidney Registry, Greenwich, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9199-1904","authenticated-orcid":false,"given":"Janny","family":"Fonk","sequence":"additional","affiliation":[{"name":"National Kidney Registry, Greenwich, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garet","family":"Hil","sequence":"additional","affiliation":[{"name":"National Kidney Registry, Greenwich, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3438-9638","authenticated-orcid":false,"given":"Matthew","family":"Cooper","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"issue":"6","key":"B1-20260226","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1056\/NEJM199508103330601","article-title":"High survival rates of kidney transplants from spousal and living unrelated donors","volume":"333","author":"Terasaki","year":"1995","journal-title":"N Engl J Med."},{"issue":"3","key":"B2-20260226","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1177\/15269248231189879","article-title":"Long-term care of living kidney donors needs a better model of healthcare delivery","volume":"33","author":"Loban","year":"2023","journal-title":"Prog Transplant."},{"issue":"5","key":"B3-20260226","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1053\/j.ackd.2016.07.001","article-title":"Current status of kidney transplant outcomes: dying to survive","volume":"23","author":"Wang","year":"2016","journal-title":"Adv Chronic Kidney Dis."},{"issue":"10","key":"B4-20260226","doi-asserted-by":"crossref","first-page":"2406","DOI":"10.1111\/j.1600-6143.2007.01922.x","article-title":"Association between waiting times for kidney transplantation and rates of live donation","volume":"7","author":"Segev","year":"2007","journal-title":"Am J Transplant."},{"issue":"3","key":"B6-20260226","doi-asserted-by":"crossref","first-page":"100788","DOI":"10.1016\/j.xkme.2023.100788","article-title":"National attitudes toward living kidney donation in the United States: results of a public opinion survey","volume":"6","author":"Kaplow","year":"2024","journal-title":"Kidney Med."},{"issue":"9","key":"B7-20260226","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1111\/tri.13693","article-title":"Paired kidney exchange transplantation - pushing the boundaries","volume":"33","author":"Kher","year":"2020","journal-title":"Transpl Int."},{"issue":"3","key":"B8-20260226","doi-asserted-by":"crossref","first-page":"e251675","DOI":"10.1001\/jamanetworkopen.2025.1675","article-title":"Supply, demand, and a growing US kidney transplant waiting list","volume":"8","author":"Cron","year":"2025","journal-title":"JAMA Netw Open."},{"key":"B9-20260226","doi-asserted-by":"crossref","first-page":"20543581221137179","DOI":"10.1177\/20543581221137179","article-title":"Motivators and barriers to living donor kidney transplant as perceived by past and potential donors","volume":"9","author":"Zazoulina","year":"2022","journal-title":"Can J Kidney Health Dis."},{"issue":"1","key":"B10-20260226","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12882-021-02262-9","article-title":"An intersectional gender analysis in kidney transplantation: women who donate a kidney","volume":"22","author":"Rota-Musoll","year":"2021","journal-title":"BMC Nephrol."},{"issue":"2","key":"B11-20260226","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1053\/j.ajkd.2024.07.010","article-title":"Medical suitability and willingness for living kidney donation among older adults","volume":"85","author":"Villain","year":"2025","journal-title":"Am J Kidney Dis."},{"issue":"8","key":"B12-20260226","doi-asserted-by":"crossref","first-page":"2041","DOI":"10.1111\/ajt.17093","article-title":"Telemedicine services for living kidney donation: a US survey of multidisciplinary providers","volume":"22","author":"Al Ammary","year":"2022","journal-title":"Am J Transplant."},{"issue":"3","key":"B13-20260226","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1111\/ajt.16262","article-title":"Your path to transplant: a randomized controlled trial of a tailored expert system intervention to increase knowledge, attitudes, and pursuit of kidney transplant","volume":"21","author":"Waterman","year":"2021","journal-title":"Am J Transplant."},{"issue":"1","key":"B14-20260226","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1111\/ajt.16821","article-title":"Motivations and outcomes of compatible living donor-recipient pairs in paired exchange","volume":"22","author":"Chipman","year":"2022","journal-title":"Am J Transplant."},{"issue":"2","key":"B22-20260226","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.transproceed.2023.01.008","article-title":"Red flags in the living kidney donor process","volume":"55","author":"Lagging","year":"2023","journal-title":"Transpl Proc."},{"issue":"1","key":"B23-20260226","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1177\/1526924820978599","article-title":"Education priorities and what matters to those considering living kidney donation","volume":"31","author":"Schick-Makaroff","year":"2021","journal-title":"Prog Transplant."},{"issue":"8","key":"B24-20260226","doi-asserted-by":"crossref","first-page":"1349","DOI":"10.1681\/ASN.2019030242","article-title":"Removing disincentives to kidney donation: a quantitative analysis","volume":"30","author":"McCormick","year":"2019","journal-title":"J Am Soc Nephrol."}],"container-title":["Kidney360"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001001","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T19:58:45Z","timestamp":1786478325000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.34067\/KID.0000001001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":16,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.34067\/kid.0000001001","relation":{},"ISSN":["2641-7650"],"issn-type":[{"value":"2641-7650","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]},"assertion":[{"value":"2025-07-10","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-26","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}