The Determinants and Consequences of Living Donor Discussion Direction.

All data came from a single Southeastern United States transplant center and a nonprobability convenience sample, so the results may not apply to other regions or the broader kidney transplant population. The analytical sample was 66 candidates, restricted to non-Hispanic White and non-Hispanic Black respondents, so it does not cover Latino/a candidates or other racial/ethnic groups. The center's population differed from the UNOS region and the United States, with more Black candidates and fewer Latino/a candidates, and the age distribution differed from the center and region. Discussion direction and agreement were measured by candidate report in a cross-sectional survey, not by observing conversations or following outcomes over time. The study did not measure candidate or potential donor attitudes, beliefs, or reasons for agreeing or refusing. Of 290 reported discussions, 26 had no outcome response, so 264 were analysed. The text describes a network member sample of 1481, while Table 2 reports 1421; the supplied text does not explain the difference. The paper's suggestion that interventions promoting potential-donor-initiated discussions would be more effective is not tested in this study.

The authors declared no potential conflicts of interest. Funding was from NIDDK grant R01DK114888, the University of Alabama at Birmingham Comprehensive Transplant Institute, the Penn State Social Science Research Institute, and the Population Research Institute at Penn State University, supported by NICHD grant P2CHD041025.

Do not conclude that asking a family member causes refusal or that a nurse-led strategy will increase agreements. This is a cross-sectional survey of candidate-reported discussions, not a test of an intervention.