Randomized Controlled Trial of a Digital Intervention (KidneyTIME) to Promote Live Donor Kidney Transplantation

Background: Digital behavioral interventions are promising to support patients’ pursuit of live donor kidney transplantation (LDKT). This study examined the effectiveness of a patient-led digital intervention (KidneyTIME) versus active control on facilitating LDKT. Methods: An individually randomized (1:1) parallel-group trial was conducted at a safety-net hospital transplant program with adult kidney transplant candidates in referral, evaluation, or listed phases who were English-speaking and had email or text access. KidneyTIME participants received animated video LDKT education and outreach enablement via video sharing. The primary outcome was ≥1 live donor inquiry within 12 months in the intent-to-treat population. Secondary outcomes included LDKT knowledge, attitudes, behaviors toward listing and donor outreach, extent of video sharing, and intervention acceptability assessed by survey at 4 timepoints post-exposure. Results: Between 4/22 and 7/23, 422 candidates (mean age 54 years; 57% male, 45% income < $30,000) were randomized to KidneyTIME (n = 212) or active control (n = 210). Between-group differences in donor outreach behaviors and receipt of a donor inquiry were not detected. KidneyTIME participants had higher LDKT knowledge (p = 0.002), new listing behaviors (IRR:1.62, p = 0.005), and extent of video sharing (p = 0.016). In planned as-treated analysis, intervention participants who viewed at least one optional video had significantly higher cumulative donor inquiry probability than those who did not (viewer 22.9%; non-viewer 9.8%, p = 0.029). Intervention acceptability scores were high. Conclusion: A digital intervention self-administered by patients did not increase donor inquiries. Preliminary dose effect findings suggest the need to consider how to encourage people to engage more with the intervention.