Evaluation of Living Kidney Donor and Recipient Candidates: The Experience of Our Center

"Weighing the Pros and Cons of Everything": A Qualitative Descriptive Study Exploring Perspectives About Living Donor Kidney Transplantation From Parents of Chinese Canadian Pediatric Patients With Chronic Kidney Disease

Background

As of 2021, more than 6000 children and youth in Canada were living with end-stage kidney disease (ESKD), for which kidney transplantation is considered the preferred treatment by health professionals. Research shows that living donor kidney transplantation (LDKT) has superior allograft and recipient survival compared to deceased donor kidney transplantation (DDKT). However, in a pediatric setting, the choice of LDKT or DDKT is a summative consideration of factors weighed carefully by the patient's family, health care team, and patient. Decision-making surrounding transplantation may be more complex for racial and ethnic minorities as culturally specific values and beliefs are interwoven within dominant understandings and concepts of health and accepted models of health care. For example, Chinese Canadians have an increased risk of ESKD, yet reduced access to LDKT compared to White patients, despite being the largest visible minority population in Canada.

Objective

The objective of this qualitative study is to deepen our understandings of the decision-making process surrounding DDKT versus LDKT among parents of Chinese Canadian pediatric patients with chronic kidney disease (CKD).

Design

Qualitative descriptive study design.

Setting

The Nephrology Program at The Hospital for Sick Children in Toronto, Canada.

Participants

Caregivers of Chinese Canadian patients with CKD, 18 years of age or older, and who spoke English, Cantonese, or Mandarin.

Methods

One-on-one, semistructured interviews were conducted virtually, by a member of the research team and were audio-recorded and transcribed verbatim. Thematic analysis was used to explore participants' shared experience.

Results

Seven interviews were conducted with 6 mothers and 1 father of 6 Chinese Canadian pediatric patients with CKD: 4 patients had undergone a kidney transplant, and 2 were not yet listed for transplant. Analysis of data highlighted that cultural influences affected whether parents shared with others about their child's illness and experience. The cultural understanding that it is inappropriate to burden others contributed to the creation of an isolating experience for participants. Cultural influences also impacted whether parents asked others to be a living donor as participants articulated this would place a physical burden on the living donor (e.g., potential risk to their health) and an emotional burden on the participant as they would be indebted to a willing donor. Ultimately, parents' decision to choose DDKT or LDKT for their patient-child was a result of evaluating both options carefully and within an understanding that the ideal treatment choice reflected what was best for all family members.

Limitations

Findings reflect experiences of a small sample from a single recruitment site which may limit transferability.

Conclusions

Parents in this study felt that they had access to the necessary evidence-based information to make an informed decision about the choice of DDKT versus LDKT for their child. Participant narratives described feeling isolated within cultural communities of family and friends and participants' suggestion of benefiting from increased support may guide future research directions. Practitioners can offer direct and indirect support to families, with recognition of the importance of cultural values and family-centered care on decision-making within families. Opportunities are needed for accessible, virtual social support platforms to increase parental feelings of culturally mediated peer support from parents who share similar experiences.

Pediatric Kidney Transplantation-Living or Deceased Donor?

BACKGROUND

Kidney transplantation is ideal for children and adolescents with chronic end-stage renal disease because it offers better growth, development, and quality of life. Donor choice is vitally important in this age group, given the long life expectancy of these patients.

METHODS

A retrospective analysis of pediatric patients (<18 years) who underwent kidney transplantation from January 1999 to December/2018 was performed. Short- and long-term outcomes were compared between living and deceased donor transplants.

RESULTS

We included 59 pediatric kidney transplant recipients, 12 from a living donor and 47 from a deceased donor. Thirty-six (61.0%) patients were boys, and 5 (8.5%) had a retransplant. There were no differences between groups on sex, race, and weight of the recipient and donor, as well as the age and the etiology of the recipient's primary disease. Most recipients received induction immunosuppression with basiliximab and maintenance with triple therapy, with no differences between groups. Living donor transplants were mostly pre-emptive (58.3% vs 4.3%, P < .001) and had fewer HLA mismatches (≤3: 90.9% vs 13.0%, P < .001), older donors (38.4 vs 24.3 years, P < .001) and shorter hospital stays (8.8 vs 14.1 days, P = .004). There were no statistically significant differences regarding medical-surgical complications and graft or patient survival. However, we found that at 13 years post-transplant 91.7% of the living donor grafts were functioning vs 72.3% of the deceased donor grafts.

CONCLUSION

Our experience points out that a living donor graft in pediatric patients is associated with a higher probability of pre-emptive transplant, shorter hospital stay, greater HLA compatibility, and increased graft survival.

Influence of Knowledge and Beliefs of Housewives on Attitudes About Organ Donation

OBJECTIVES

Reluctance of families of deceased donors to provide approval for donation is a factor in low rates of deceased donor organ transplants. Decisions of women may be important for family approval. We investigated the influence of knowledge and beliefs of housewives on attitudes toward organ donation.

MATERIALS AND METHODS

This cross-sectional study was conducted with 212 housewives attending Directorate of Religious Affairs centers and public education centers in Adana province between May and June 2018. A structured questionnaire to assess sociode-mographic information, knowledge, and beliefs about organ donation, as well as the Attitudes Toward Organ Donation Scale, was applied through face-to-face interviews.

RESULTS

Mean age of participants was 42.9 ± 13.1 years, 68 (32.1%) had no formal education, and 125 women (59.0%) identified as low income. Of the women, 40 (18.9%) were single, 147 (69.3%) were married, 25 (11.8%) were divorced∕widowed, 104 (49.1%) were attending religious affairs centers, and 108 (50.9%) were attending public education centers. Mean score for the question "What is the religious drawback of donating organs?" was significantly higher in participants attending a Quran course (2.5 ± 1.4), and mean score of Attitudes Toward Organ Donation Scale decreased significantly as mean score for this question increased; the score for "Are you aware that the organ donation-related procedures are conducted within the law?" was 2.2 ± 1.2 (P < .001). Scores increased as knowledge level increased (r = 0.360, P < .001), and scores decreased as perception of organ donation as religiously objectionable increased (r = -0.258, P < .001).

CONCLUSIONS

Participants with sufficient knowledge about organ donation, without religious objection to organ donation, and with awareness of the lawful status of organ donation had positive attitudes toward organ donation. Efforts toward improvement of community knowledge could increase rates of deceased donor organ donation.