The goal of this feasibility clinical trial is to learn if telemedicine can be used to provide education and evaluation and counseling for people who are considering living kidney donation. The study will also learn how participants improve decision-making about living kidney donation. The main questions to answer are:

• Is telemedicine a practical way to facilitate donor education and evaluation and counseling?
• Does telemedicine shared decision making help improve donor candidate decision and engagement during the donor evaluation process?

Researchers will compare standard care with a telemedicine care coordination approach.

Participants will:

- Receive either standard care or telemedicine video visits to support shared decision making.

Living kidney donation provides a vital treatment option for patients with kidney failure, but many willing individuals face challenges in completing the donor evaluation and committing to donation. Donor education and counseling are essential for informed decision-making, yet these steps are often limited to in-person visits at transplant centers. This can create logistical challenges, delays, and variations in access to the living donor evaluation process. Telemedicine offers an opportunity to deliver a shared decision making approach to donor education and evaluation and counseling remotely, but its feasibility, acceptability, and impact have not been well studied.

This pilot feasibility clinical trial is designed to test whether a telemedicine care coordination can support donor decision-making and engagement during the evaluation process for living kidney donation.

Participants will be randomly assigned to one of two groups:

• Standard Care Group (Control): A recorded video education session and an in-person donor evaluation and counseling with a nephrologist.
• Telemedicine Group (Intervention): Two live telemedicine video sessions-one for education with a transplant provider and one for donor evaluation and counseling with a nephrologist.

The findings from this feasibility trial will provide important information about the practicality and acceptability of telemedicine shared decision-making for living kidney donor candidates. Generated preliminary data will inform larger trials and ultimately guide transplant practice and policy to improve decision-making, efficiency, and access to living kidney donation.

Inclusion Criteria:

• 18 years of age or older
• Reside in the State of California
• Registered living kidney donor candidate at UC Irvine Medical Center

Exclusion Criteria:

- Individuals with a contraindication to living kidney donation (for example, heart disease, cancer)

De-identified participant data that underlie the results reported in publications will be shared. This will include baseline demographic characteristics, survey responses, and donor candidate disposition data. Data will be deposited in Dryad and accompanied by a data dictionary, study protocol, and statistical analysis plan.

Shared data will be made available at the time of publication of the primary results. Data will remain available in the Dryad repository for a minimum of 5 years.

Shared data will be made available through the Dryad digital repository. Supporting materials will include a data dictionary, study protocol, and statistical analysis plan. In accordance with the NIH Data Management and Sharing Plan and UC Irvine IRB guidance, no personally identifiable information will be included. Data will be shared under a CC0 waiver, allowing other researchers to reuse the de-identified data for health, medical, or biomedical research purposes.