“They Don't Have to Suffer for Me”: Why Dialysis Patients Refuse Offers of Living Donor Kidneys

Abstract

In the present climate of organ shortage, high demand for kidney transplants, and better clinical outcomes from living donors, health care professionals expect and encourage patients to accept offers of living related donor (LRD) kidneys. When patients decide not to adhere to this course of treatment, scholars and policy makers may question why, given that it delays their chances of receiving a transplant. This article reports on patients' decisions to refuse LRD kidney offers. An 18-month study was conducted of treatment decisions by hemodialysis patients (N = 79). Fewer than half of those offered an LRD kidney (N = 64) were willing to accept it, suggesting that sociocultural factors inform decisions. Patients expressed concerns about the potential donors' well-being over their own and about compromising their relationships with the donors. This article concludes that social relations, emotions, and ethnomedical beliefs play an important role in patients' treatment decisions and thus contributes to the anthropology of decision making.

Sex Differences and Attitudes toward Living Donor Kidney Transplantation among Urban Black Patients on Hemodialysis

“…For the majority of patients with ESRD, living donor kidney transplantation (LDKT) is the treatment of choice (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, LDKT is underused by several disadvantaged groups, including women and blacks.…”

Considering adult living donor liver transplantation: A qualitative study of patients and their potential donors

“…It should also be noted that the donors interviewed were nominated by the patient and were 18 all considered close family members. It would also be of interest to interview more distant relatives on their views of living liver donation (Gordon, 2001).…”

“…In addition, Gordon (2001) conducted an interview study with patients with end stage renal disease and found that many patients did not want to accept a living kidney donation due to risk to the donor, however if the patient believed they were close to death, the offer of a living donation would be accepted. Similar to our study, patients perhaps saw living donation as a 'last option'.…”

“…personal experience, emotions and, social and environmental contexts (Gordon, 2001). Psychologists have incorporated such advanced decision making theories into models of health behaviour e.g.…”

Anthropological issues in renal care

“…4,5 This research has also shown how African American patients often draw on the experiences of the people around them-in their families and communities-to draw their own conclusions about their illness and its likely outcomes. Not necessarily trusting that standard medical statistics are relevant to them, such patients act as what has been called 'natural empiricists' or 'natural epidemiologists.'…”