Table 2.

Example of a projection tool to estimate kidney failure risk in donor candidates (32) and a method for communicating such risks (9,33)

Suggested Steps and Considerations
(1) An online tool (http://www.transplantmodels.com/esrdrisk/) estimates the projected lifetime risk of permanent kidney failure treated by dialysis or transplantation in the absence of donation according to baseline demographic and clinical characteristics included in the online tool
(2) This projected predonation risk can be multiplied by the best available estimate for donation-attributable risk to obtain the projected postdonation risk; for example, Grams et al. (34) report a relative risk of 3.5–5.3 for 15-yr kidney failure risk according to sex and race
(3) The projected risk estimate can be compared with the program’s postdonation threshold of acceptable risk
(4) Use the tool cautiously when there is concern that the individual has risk factors not captured in the tool (e.g., familial or genetic risk) and for younger candidates
(5) When communicating kidney failure risk to donor candidates:
 Use plain language to make written and verbal materials more understandable
 Present data using absolute risks
 Present information in pictographs if graphs are included
 Present data using frequencies
 Use an incremental risk format to highlight how postdonation risks change from preexisting baseline levels
 Be aware that the order in which risks and benefits are presented can affect risk perceptions
 Consider using summary tables that include all risks and benefits associated with donation
 Consider presenting only the information that is most critical to the patients’ decision making, even at the expense of completeness
 Repeatedly draw patients’ attention to the time interval over which a risk occurs
  • A model was developed to project the estimated 15-year and lifetime risk of kidney failure in the absence of donation (“baseline risk”) on the basis of simultaneous consideration of each candidate’s profile of demographic and health characteristics. In brief, cohort studies on kidney failure risk are only available for approximately 150,000 living donors, but they are available for millions of healthy persons in the general population. To leverage the information available in general population cohorts, the Kidney Disease: Improving Global Outcomes Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors Work Group collaborated with the CKD Prognosis Consortium to model the long-term risk of kidney failure in the absence of donation on the basis of ten candidate predonation demographic and health characteristics. The multistep modeling process was complex and independently published (34), and the risk projection tool is available online at http://www.transplantmodels.com/esrdrisk/. For clinical application, estimates provided for the predicted incidence of kidney failure in the absence of donation are then multiplied by the donation-attributable relative risk of kidney failure (which in the analysis was 3.5–5.3 according to sex and race).