Cadaveric donation rates have remained static, whereas transplant waiting lists continue to rise as demand for renal transplants far exceeds supply. One solution to bridge the supply and demand gap is to increase live donation. If live donation is to increase, it is important to offer evidence-based psychologic and social support to ensure that transplant clinical success is not at the cost of psychologic and social harm. This article reports the findings of two substantive qualitative studies, both examining similar aspects of live donation: study A from a psychologic perspective and study B from a social-cultural perspective. The findings show that living-related renal donors do not express regret after donation and do report enhanced self-esteem. The decision to donate is immediate and altruistic for most parents, although some fathers expressed a degree of ambivalence. The decision to donate is more difficult and complex for siblings and may lead to conflict between family of birth and family of marriage. Reciprocity and feelings of obligation did not appear to cause relationship difficulties for siblings but were reported by some of the adolescent recipients who had received a parental graft, leading to psychologic distress and social-familial alienation. These two qualitative studies have demonstrated psychosocial risks within the live donation process. These risks should be recognized within transplant programs and professional care provided to ensure confidential presurgery donor and recipient advocacy and continuing psychosocial support for the family unit postdonation.

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Eight recommendations have been made, covering ICU bed provision, neurosurgical provision, transplant surgical staffing, the transplant co-ordinator network, reimbursement to donor units, asystolic donation, live donor transplantation, and interventional ventilation.

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