Live related renal transplantation: psychological, social, and cultural issues

Abstract

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.

Assessment of living donors with respect to pre- and posttransplant psychosocial properties and posttransplant family functioning in pediatric liver transplantation

“…In a study of living-related kidney transplantation, Reimer et al (19) observed that the donation led to family conflict in 5 cases (10.6%) and divorce in 3 cases (6.4%). A United Kingdom study (20) of renal transplantation again examined the psychologic and social-cultural perspectives of live donation and determined that donation may lead to anxiety regarding marriage and marital failure, and affect the other members of the family. Rodrigue et al (21) examined the parenting stress, coping strategies and family functioning among 27 mothers of children undergoing bone marrow, liver, kidney, and heart transplantation at the pretransplant stage and at 1-and 6-month posttransplant stages.…”

Improving transplant education in the dialysis setting: the “explore transplant” initiative

“…[19][20][21] Many patients are also unaware that living donors report positive benefi ts from donating, including getting to help a loved one and having increased selfworth. 22,23 Multiple randomized controlled trials have shown that improved education about deceased and living donation can signifi cantly increase patients' knowledge and informed transplant decision-making. [24][25][26][27][28] However, with dialysis patients varying in their level of readiness regarding pursuing deceased or living-donor transplant, transplant education must be tailored by a patient's level of transplant readiness to support each individual in making an informed transplant choice.…”

Similarity not favourability

“…Jacobs et al (1998) have observed also that donors were more likely to feel pressured to donate if the recipient was a sibling or offspring and the initial approach for donation came from family members. This external pressure may be felt when family members or medical professionals make a direct request for living donation to the potential donor and there is a psychological cost to the potential donor if they refuse (e.g., Franklin & Crombie, 2003;Russell & Jacob, 1993;Schroder, McDonald, Etringer, & Snyders, 2008). Potential donors may be motivated also to donate while living to a relative or partner because of feelings of responsibility, duty, or internal pressure to do the morally correct thing for their family member (Hilhorst, Kranenburg, & Busschbach, 2007;Russell & Jacob, 1993).…”