This paper discusses the barriers to living donor kidney transplantation (LDKT) in New Zealand. While LDKT is the preferred treatment for many people with end-stage renal failure (ESRF), a significant and growing gap exists between the number of people who might benefit from a transplant and those who receive one in New Zealand. One hundred and ninety-three patients on the New Zealand waiting list for a kidney transplant responded to a postal survey about live transplantation. Their responses provide evidence about patterns of donor recruitment activity amongst New Zealand patients. While many patients are willing to discuss LDKT with family and friends, most are reluctant to go on to ask others directly to consider live donation. Patients who have not discussed LDKT with others are significantly less likely to have received even one offer from a potential donor. Pākehā and Māori are more likely to have received an offer to donate and to have had someone go on to be tested for compatibility than either Pacific or Other ethnic groups. Information gaps, ineffective donor recruitment strategies, donor incompatibility and donor medical unsuitability appear to be major barriers to LDKT. Many barriers are amenable to intervention and the implications for policy and practice are discussed.
