Introduction: Living donation is an important strategy to address the rising gap between wait list additions and available deceased donor organs and is associated with improved long-term graft survival. However, many potential donors are unable to donate due to modifiable risk factors that increase the risk of donation such as smoking and obesity. Many of these candidates could achieve donation with lifestyle changes, but few resources are available to support these potential donors. The purpose of Project Donor (PD) is to help potential donors improve their health through weight loss and smoking cessation interventions prior to donation.
Methods:  Liver or kidney donor candidates are referred to Project Donor by transplant centers, partner organizations like the National Kidney Registry, or self-referral. Participants meet with a Project Donor case manager who provides support through the donation process. Case managers refer participants to resources based on their goals at no cost including weight loss programs (Noom and WeightWatchers), nutritionists (OnPoint Nutrition), nicotine replacement therapy, teletherapy (BetterHelp), and an online support community. Participants are followed by case managers and are referred back to the transplant center to complete the donor evaluation once their goals are met. To reduce the risk of regaining weight or restarting smoking, participants continue the program for one year after donation and may continue using resources as needed thereafter. All meetings are conducted virtually or over the phone.
Results: Between 5/13/2022 and 1/8/2025, 680 participants from 46 U.S. states, 3 countries, and 97 transplant centers were onboarded, including 598 intended kidney donors and 65 intended liver donors. Among the 327 participants who completed the program, 67 (21%) reached their pre-donation goal (Figure 1). Of those, 53 (16%) donated a kidney or liver. The average time to reach the goal was 190±129 days. Participants with weight loss goals (N=313) lost an average of 4.8±5.8 kg, or 4.9% of their starting body weight (Figure 2). Among those who reached donation, average weight loss was 6.2±5.4 kg. Donation was achieved by 49 kidney and 4 liver donors. Among the 14 who reached their goal but have not donated, 2 are approved for surgery, 1 is in evaluation, and 11 have been delayed for donor or recipient-related reasons.

Conclusion: Project Donor is a scalable, virtual intervention that supports potential living donors in achieving donation eligibility through weight loss and smoking cessation. Among those who completed the program, over one in five achieved their goals and nearly one in six proceeded to donation. Project Donor reaches a diverse group of donors in multiple countries by relying on virtual case management and referrals to  external service providers. Project Donor demonstrates how increased support for living donors can facilitate more life-saving transplants and improve the health of donors and recipients alike.