# Contextual factors of implementing APOL1 genetic testing into living kidney donor clinical evaluation

## TL;DR

This study examines the factors influencing the implementation of APOL1 genetic testing for Black living kidney donors to improve informed decision-making and reduce health disparities.

## Contribution

The study identifies contextual facilitators and barriers to implementing APOL1 genetic testing in clinical practice for living kidney donors.

## Key findings

- Facilitators included alignment with clinical priorities and strong organizational support.
- Barriers included time constraints and the need for evidence-based guidelines.
- High acceptability and sustainability of the APOL1 program were reported by participants.

## Abstract

Living donor kidney transplantation (LDKT) is the preferred treatment for patients with end-stage kidney disease, offering longer graft survival and improved quality of life. However, LDKT poses risks to living donors. Black living donors face disproportionately higher risks of postdonation kidney disease than White counterparts, necessitating deeper understanding of the factors contributing to this disparity. This study evaluated the implementation of the APOL1 Genetic Testing and Counseling Program at two transplant centers to improve donors’ informed decision-making, which entailed examining the contextual factors influencing its adoption and sustainment.

We conducted a mixed-methods evaluation involving semistructured interviews guided by the Consolidated Framework for Implementation Research and surveys with transplant nephrologists to identify facilitators and barriers of intervention implementation.

Eleven nephrologists participated. Key facilitators included alignment with clinical priorities, strong organizational support, and value attributed to the intended goal of enhancing donors’ informed consent process and to the integration of culturally sensitive counseling practices. Key barriers included time constraints and the need for clear evidence-based guidelines. Participants reported high acceptability, appropriateness, feasibility, and sustainability of the APOL1 Program.

Our study identified facilitators and barriers that should be addressed to ensure the APOL1 program’s sustainment and potential to improve donors’ informed consent. Future research should leverage system-level implementation strategies to overcome identified barriers when taking the APOL1 Genetic Testing and Counseling Program to scale.

The online version of this article (10.1007/s00103-025-04068-8) contains supplementary material, which is available to authorized users.