Understanding donation experiences of unspecified (altruistic) kidney donors

Clarke, Alexis; Mitchell, Annie; Abraham, Charles

doi:10.1111/bjhp.12048

Cited by 39 publications

(81 citation statements)

References 52 publications

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“…The compelling nature of organ donation for participants in this study has also been found in existing research with directed kidney donors (Clarke et al, 2013;Franklin and Crombie, 2003;Gill and Lowes, 2008;Lennerling et al, 2003). The current research goes further in addressing the way that altruistic donors use ideas about emotions and rationality in their discursive repertoires, suggesting the possible subjective experience that each allows for.…”

Section: Health 0(0)supporting

confidence: 68%

“…This binary construction of altruistic donors as heroes or as potentially 'mad' reduces opportunities for a more useful understanding of what leads people to want to be altruistic donors. The reduction of the donor's motives to being either 'mad' or 'brave' has also been found by Clarke et al, (2013). There are important implications for assessment, regulation and practice.…”

Section: Discussionmentioning

confidence: 89%

“…This more complex understanding of the act is so difficult to vocalise that the interviewer (J.C.) also struggled not to affirm the hero discourse. This finding has been reflected in outcome studies of altruistic donations (Clarke et al, 2013;Massey et al, 2010). Participants' discourses of rationality, risk and logic might therefore be considered to be a response to the explicit suggestion of madness by people close to donors, and the implication of psychopathology that resides in psychiatric assessment.…”

Section: Discussionmentioning

confidence: 98%

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‘It seemed churlish not to’: How living non-directed kidney donors construct their altruism

Challenor

Watts

2013

Health (London)

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent repository link Jay WattsUniversity of London, UK AbstractOur objective was to explore how prospective altruistic kidney donors construct their decision to donate. Using a qualitative design and biographical-narrative semistructured interviews, we aimed to produce text for analysis on two levels: the social implications for subjectivity and practice and a tentative psychodynamic explanation of the participants' psychological investment in the discourses they used. A total of six prospective altruistic kidney donors were interviewed. A psychosocial approach to the analysis was taken. In-depth discourse analysis integrated Foucauldian with psychodiscursive approaches and psychodynamic theory was applied to sections of text in which participants seemed to have particular emotional investment. Analysis generated three major discursive themes: other-oriented, rational and self-oriented discourses. The desire to donate was experienced as compelling by participants. Participants used discourses to position themselves as concerned with the needs of the recipient, to resist questioning and criticism, and to manage difficult feelings around mortality. Participants tended to reject personal motivations for altruistic donation, positioning relatives' disapproval as selfish and illogical. These results suggest that the term 'altruistic' for living non-directed organ donation constrains available discourses, severely limiting what can be said, felt, thought and done by donors, clinicians and the public. A more useful approach would acknowledge potential psychological motives and gains for the donor.

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Section: Health 0(0)supporting

confidence: 68%

Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 98%

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‘It seemed churlish not to’: How living non-directed kidney donors construct their altruism

Challenor

Watts

2013

Health (London)

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“…In-depth qualitative analysis has shown “discouraging donation” produces interpersonal stress and emotional distress due to conflict with social ties. 23,31 It is possible that social conflict due to disagreement about donation could lead to emotional distress that is expressed in response to pain.…”

Section: Discussionmentioning

confidence: 99%

Early Postoperative Pain and its Predictors in the Adult to Adult Living Donor Liver Transplantation Cohort Study

et al. 2016

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Background Little is known about how well postoperative pain is managed in living liver donors, despite pain severity being the strongest predictor of persistent pain with long-lasting disability. Methods We conducted a prospective multicenter study of 172 living liver donors. Self-reported outcomes for pain severity, activity interference, affective (emotional) reactions, adverse effects to treatment, and perceptions of care were collected using the American Pain Society Patient Outcomes Questionnaire-Revised. Mixed effects linear regression was used to identify demographic and psychosocial predictors of subscale scores. Results Donors were young (36.8±10.6) and healthy. Of 12 expert society analgesic recommendations for postoperative pain management, 49% received care conforming to 3 guidelines, and only 9% to 4 or 5. More than half reported adverse effects to analgesic treatment for moderate to severe pain that interfered with functional activity; however, emotional distress to pain was unexpectedly minimal. Female donors had higher affective (Beta=0.88, p=0.005) and adverse effects scores (Beta=1.33, p<0.001). Donors with 2 or more medical concerns prior to surgery averaged 1 unit higher pain severity, functional interference, adverse effects, and affective reaction subscale scores (Beta range 1.06–1.55, all p<0.05). Receiving information about pain treatment options increased perception of care subscale scores (Beta=1.24, p=0.001), while depressive symptoms before donation were associated with lower scores (Beta=-1.58, p=0.01). Conclusions Donors have a distinct profile of pain reporting that is highly influenced by psychological characteristics. Interventions to improve pain control should consider modifying donor behavioral characteristics in addition to optimizing pain care protocols.

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“…31 Non-directed altruistic donors, much like directed donors, report being motivated by a desire to benefit other people or society as a whole, a compelling desire to donate and recognise personal psychosocial gains. [32][33][34] Where commercial organ trading exists, or where donation is financially incentivised, most unrelated donors report financial motivation. [35][36][37][38] Payment for donation is illegal in almost all countries.…”

mentioning

confidence: 99%