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Burroughs TE, Waterman AD, Hong BA. One Organ Donation, Three Perspectives: Experiences of Donors, Recipients, and Third Parties with Living Kidney Donation. Prog Transplant 2016; 13:142-50. [PMID: 12841522 DOI: 10.1177/152692480301300212] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although living kidney donors' experiences with donation have been studied, questions of potential bias in retrospective donor reports remain. This study examined the experience of living kidney donation from 3 perspectives: those of the donor, the recipient, and a third party involved with the donation (ie, a donor triad). Surveys were completed with 174 donor triads to examine triad members' perceptions of donors' concerns before transplantation, whether these concerns came true after transplantation, the donors' experiences with surgery and recovery, and whether they would make the same decision again today. Triad members all agreed that donors were highly satisfied with their donation experience and that the relationship between recipient and donor improved after transplantation. Although recipients and third parties correctly identified the donors' primary concerns, they underestimated the prevalence of 16 of 18 donor concerns, including the donors' willingness to make the same decision again. Recipients also overestimated how painful and difficult the surgery and recovery were for donors. The results suggest that retrospective studies of donors may not be marred by significant misreporting or memory biases and that better education about the donation experience for the entire donor triad might provide better social support for donors, reduce recipients' guilt about donors' pain, and increase donation rates overall.
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Pradel FG, Mullins CD, Bartlett ST. Exploring Donors' and Recipients' Attitudes about Living Donor Kidney Transplantation. Prog Transplant 2016; 13:203-10. [PMID: 14558635 DOI: 10.1177/152692480301300307] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Context There is a growing interest in living donor kidney transplantation because of its potential to reduce the current kidney shortage. Objective To explore the experience of potential recipients, recipients, potential donors, and donors with regard to living donor kidney transplantation and laparoscopic living donor nephrectomy. Method Twenty-five patients participated in a series of focus group interviews. The interviews were tape-recorded and a content analysis was performed. Results All participants had a positive attitude toward living donor kidney transplantation and laparoscopic living donor nephrectomy, though this procedure was not a factor that influenced potential donors' decision to donate a kidney. None of the potential donors and donors felt coerced into giving a kidney; they were motivated by a desire to help a loved one who was suffering. The main perceived impediment to donate a kidney was the potential recipients' reluctance to accept the offer. Potential recipients and recipients found it difficult to ask for a kidney and worried about the consequences of a kidney removal on their donor's health. A potential barrier to living donor kidney transplantation was that recipients would never have accepted a kidney if their donor had to pay for the kidney removal. In addition, recipients believed that a kidney from a non–blood-related donor was not as a good a match as a kidney from a blood-related donor. Conclusion This exploratory study reveals that donors, potential donors, recipients, and potential recipients had an overall positive attitude toward living donor kidney transplantation and laparoscopic living donor nephrectomy. This study also sheds light on a number of barriers that have not been previously reported.
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Affiliation(s)
- Françoise G Pradel
- School of Pharmacy, Center on Drugs and Public Policy, University of Maryland, Baltimore, Md 21201, USA
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Serur D, Bretzlaff G, Christos P, Desrosiers F, Charlton M. Solicited kidney donors: Are they coerced? Nephrology (Carlton) 2015; 20:952-5. [PMID: 26511772 DOI: 10.1111/nep.12551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 12/21/2022]
Abstract
Most non-directed donors (NDDs) decide to donate on their own and contact the transplant centre directly. Some NDDs decide to donate in response to community solicitation such as newspaper ads or donor drives. We wished to explore whether subtle coercion might be occurring in such NDDs who are part of a larger community. One successful organization in a community in Brooklyn, NY, provides about 50 NDDs per year for recipients within that community. The donors answer ads in local papers and attend donor drives. Herein, we evaluated the physical and emotional outcomes of community-solicited NDDs in comparison to traditional NDDs who come from varied communities and are not responding to a specific call for donation. An assessment of coercion was used as well.
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Affiliation(s)
- David Serur
- Division of Nephrology and the Rogosin Institute, New York Presbyterian Weill Cornell, New York, NY, USA
| | - Gretchen Bretzlaff
- Kidney and Pancreas Transplant Program, New York Presbyterian Weill Cornell, New York, NY, USA
| | - Paul Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy and Research Weill Cornell Medical College, New York, NY, USA
| | - Farrah Desrosiers
- Kidney and Pancreas Transplant Program, New York Presbyterian Weill Cornell, New York, NY, USA
| | - Marian Charlton
- Kidney and Pancreas Transplant Program, New York Presbyterian Weill Cornell, New York, NY, USA
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The Expectations and Attitudes of Patients With Chronic Kidney Disease Toward Living Kidney Donor Transplantation. Transplantation 2015; 99:540-54. [DOI: 10.1097/tp.0000000000000433] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Serur D, Charlton M, Lawton M, Sinacore J, Gordon-Elliot J. Donors in chains: psychosocial outcomes of kidney donors in paired exchange. Prog Transplant 2014; 24:371-4. [PMID: 25488561 DOI: 10.7182/pit2014222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Kidney paired donation chains are initiated by nondirected donors and propagated by donors within the chain of transplants, or chain donors. OBJECTIVE To compare psychosocial and functional outcomes, and to test coercion, of chain donors in paired exchange versus traditional directed donors who have an established relationship with the recipient. METHODS Thirty chain donors from a transplant center who were part of the National Kidney Registry paired exchange program were compared with 34 traditional donors who donated around the same time. Participants completed online surveys: the postdonation section of the Living Donor Expectancies Questionnaire was used to assess psychosocial and functional outcomes 1 to 6 years after donation. A survey to assess coercion was used as well. RESULTS Chain donors and traditional donors were similar in terms of sex, race, age, and time after donation. The 2 groups had similar altruistic motives in donating their kidney, and both types of donors mentioned psychological benefits. No differences were found on questions regarding psychosocial outcomes save for the "quid pro quo scale" (P= .01), which suggested that the traditional donors felt more that the recipients are indebted to them. The 2 groups did not differ significantly in the coercion measure. Pressure to donate and stress of donation were not greater in chain donors than traditional donors (P= .60). CONCLUSION Kidney donors in kidney paired donation chains do as well as traditional donors psychosocially without any increased tendency toward experiencing coercion.
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Affiliation(s)
- David Serur
- New York Presbyterian-Weill Cornell, New York, New York
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Cooper M, Kramer A, Barth R, Phelan M. Living kidney donor relationship in Caucasian and African American populations and implications for targeted donor education programs. Clin Transplant 2012; 27:32-6. [PMID: 22775242 DOI: 10.1111/j.1399-0012.2012.01685.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE The opportunities for living kidney donation vary greatly among socioeconomic and racial groups. We reviewed our series of living donors to evaluate donor relationships in various groups. MATERIALS AND METHODS Donor and recipient records for 1000 patients were reviewed. An additional 857 records of potential recipients presenting with a donor were analyzed. We compared the relationship of the recipient to initial donor and individual who underwent nephrectomy. RESULTS There were 693 CC and 263 AA live kidney donors. In the AA population donors were first-degree 71%, second-degree 10%, and unrelated 19%. In the CC population donors were first-degree 57%, second-degree 6%, and unrelated 37% (p < 0.0001 for unrelated CC vs. AA). Spousal donation is more common in CC donors (13%) than AA donors (6%), p = 0.001. Donation from child to parent is more common in AA (33%) than CC donors (15%), p < 0.0001. AA recipients predominantly identified a child as a donor in 63% and 48% were cleared for donation. In contrast, 69% of CC recipients identified a spouse as a donor yet only 23% became donors, p < 0.001 and p < 0.001. CONCLUSIONS There is a higher incidence of unrelated donors in the caucasian population, vs. first degree relatives often being living donors in the AA population.
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Affiliation(s)
- Matthew Cooper
- Division of Transplantation, University of Maryland Medical System, Baltimore, MD, USA.
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Kranenburg LW, Richards M, Zuidema WC, Weimar W, Hilhorst MT, IJzermans JNM, Passchier J, Busschbach JJV. Avoiding the issue: patients' (non)communication with potential living kidney donors. PATIENT EDUCATION AND COUNSELING 2009; 74:39-44. [PMID: 18752913 DOI: 10.1016/j.pec.2008.07.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Kidney transplantation with a living donor has proved to be an effective solution for kidney patients on the waiting list for transplantation. Nevertheless, it may be difficult to find a living kidney donor. The purpose of this explorative study is to investigate how kidney transplant candidates may, or may not, find a living donor in the Netherlands. METHODS We compared a group of 42 patients who did not find a living donor with a group of 42 patients who did, using semi-structured interviews. RESULTS We found that, although almost all patients recognized the advantages of living kidney donation and were willing to accept the offer of a living kidney donor, many found it very difficult to ask a potential donor directly. This was true for both groups. CONCLUSION Patients may gain from professional support to deal with this situation in ways that balance their medical needs and their personal relationships. PRACTICE IMPLICATIONS Support programs should be developed to assist patients in developing strategies for discussing living kidney donation with potential donors.
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Affiliation(s)
- Leonieke W Kranenburg
- Erasmus University Medical Centre, Department of Medical Psychology & Psychotherapy, Rotterdam, The Netherlands.
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Abstract
BACKGROUND This is the first large-scale interview study carried out in patients and potential donors who seem unwilling or unable to pursue living kidney donation. By investigating these groups, we explored whether further expansion of the living kidney donation program is feasible. METHODS We interviewed 91 patients on the waiting list for a kidney transplant who did not pursue living kidney donation and their potential donors (n=53). We also included a comparison group. All respondents underwent an in-depth interview by a psychologist about topics that could influence their willingness to pursue living kidney donation. RESULTS A total of 78% of the patients on the waiting list were willing to accept the offer of a living donor. The main reason for not pursuing living kidney donation was reluctance to discuss the issue with the potential donors. This was also found in the comparison group. Both groups indicated that if there was no donor offer, they tended to interpret this as a refusal to donate. This interpretation not always holds: more than one third (19 of 53) of the potential donors were open to consider themselves as a potential donor. On the other hand, a comparably sized group of potential donors (21 of 53) was reluctant about donation. The main reason for donor reluctance was fear for their health after donation. CONCLUSION The majority of patients on the waiting list are willing to accept a living kidney donor, but adopt an awaiting attitude towards their potential donors. Offering those patients professional assistance should be considered.
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Pradel FG, Bartlett ST. Does a home-based education program improve rates of living donor kidney transplantation? NATURE CLINICAL PRACTICE. NEPHROLOGY 2007; 3:366-7. [PMID: 17489090 DOI: 10.1038/ncpneph0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 04/03/2007] [Indexed: 05/15/2023]
Affiliation(s)
- Françoise G Pradel
- University of Maryland, School of Pharmacy, Baltimore, MD 21201-1563, USA.
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Martínez-Alarcón L, Ríos A, Conesa C, Alcaraz J, González MJ, Montoya M, Fernández OM, Pons JA, Ramírez P, Parrilla P. Attitude Toward Living Related Donation of Patients on the Waiting List for a Deceased Donor Solid Organ Transplant. Transplant Proc 2005; 37:3614-7. [PMID: 16386484 DOI: 10.1016/j.transproceed.2005.08.059] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Spain is the country with the highest rate of donation from deceased individuals. However, given the deficit in organs, living donation is being encouraged. Our objective was to analyze attitudes toward living donation among patients on the waiting list for a transplant. MATERIALS AND METHODS Patients on the waiting list for a kidney or liver transplant (n = 96; 46 kidney and 50 liver) in the last year had their attitudes toward living donation evaluated through a psychosocial survey performed in a direct interview with an independent health professional from the transplant unit and analyzed by Student t test and the chi-square test. RESULTS Ninety-one percent were in favor of donating their organs when they die, 6% had doubts, and the remaining 3% were against it. Twenty percent would accept living donation from a family member (32% in liver vs 7% in kidney; P < .05), despite 89% of them accepting that there would be a risk to the family member. Twenty percent reported that a family member had suggested donating, but the patient was opposed. Finally, only 6% considered living donation to be their first choice, 42% did not consider this option. Up to 96% would donate an organ to a family member if they were requested to do so. CONCLUSION Patients on the waiting list are not favorable to living related donation for themselves, although members of their family have proposed it to them. However, the liver patient is more prepared to accept it, possibly because that patient has no other alternative as do kidney patients have dialysis. Even so, they are favorable toward donating a living organ if a family member were to request one. In general, living donation is not being proposed to these patients as a real option, partly because of their doctors.
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Pradel FG, Mullins CD, Bartlett ST. Exploring donors' and recipients' attitudes about living donor kidney transplantation. Prog Transplant 2003. [PMID: 14558635 DOI: 10.7182/prtr.13.3.277l0581808643g8] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
CONTEXT There is a growing interest in living donor kidney transplantation because of its potential to reduce the current kidney shortage. OBJECTIVE To explore the experience of potential recipients, recipients, potential donors, and donors with regard to living donor kidney transplantation and laparoscopic living donor nephrectomy. METHOD Twenty-five patients participated in a series of focus group interviews. The interviews were tape-recorded and a content analysis was performed. RESULTS All participants had a positive attitude toward living donor kidney transplantation and laparoscopic living donor nephrectomy, though this procedure was not a factor that influenced potential donors' decision to donate a kidney. None of the potential donors and donors felt coerced into giving a kidney; they were motivated by a desire to help a loved one who was suffering. The main perceived impediment to donate a kidney was the potential recipients' reluctance to accept the offer. Potential recipients and recipients found it difficult to ask for a kidney and worried about the consequences of a kidney removal on their donor's health. A potential barrier to living donor kidney transplantation was that recipients would never have accepted a kidney if their donor had to pay for the kidney removal. In addition, recipients believed that a kidney from a non-blood-related donor was not as a good a match as a kidney from a blood-related donor. CONCLUSION This exploratory study reveals that donors, potential donors, recipients, and potential recipients had an overall positive attitude toward living donor kidney transplantation and laparoscopic living donor nephrectomy. This study also sheds light on a number of barriers that have not been previously reported.
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Affiliation(s)
- Françoise G Pradel
- School of Pharmacy, Center on Drugs and Public Policy, University of Maryland, Baltimore, Md 21201, USA
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Burroughs TE, Waterman AD, Hong BA. One organ donation, three perspectives: experiences of donors, recipients, and third parties with living kidney donation. Prog Transplant 2003. [PMID: 12841522 DOI: 10.7182/prtr.13.2.71t8xj210l18mx25] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although living kidney donors' experiences with donation have been studied, questions of potential bias in retrospective donor reports remain. This study examined the experience of living kidney donation from 3 perspectives: those of the donor, the recipient, and a third party involved with the donation (ie, a donor triad). Surveys were completed with 174 donor triads to examine triad members' perceptions of donors' concerns before transplantation, whether these concerns came true after transplantation, the donors' experiences with surgery and recovery, and whether they would make the same decision again today. Triad members all agreed that donors were highly satisfied with their donation experience and that the relationship between recipient and donor improved after transplantation. Although recipients and third parties correctly identified the donors' primary concerns, they underestimated the prevalence of 16 of 18 donor concerns, including the donors' willingness to make the same decision again. Recipients also overestimated how painful and difficult the surgery and recovery were for donors. The results suggest that retrospective studies of donors may not be marred by significant misreporting or memory biases and that better education about the donation experience for the entire donor triad might provide better social supportfor donors, reduce recipients' guilt about donors' pain, and increase donation rates overall.
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Pradel FG, Limcangco MR, Mullins CD, Bartlett ST. Patients' attitudes about living donor transplantation and living donor nephrectomy. Am J Kidney Dis 2003; 41:849-58. [PMID: 12666072 DOI: 10.1016/s0272-6386(03)00033-7] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The growing shortage of organs available for transplantation has resulted in an increased use of living donors for kidney transplantation. The laparoscopic nephrectomy is a new procedure used to remove kidneys from donors. The study objective was to explore the attitudes of recipients and donors toward living donor kidney transplantation and the impact of the laparoscopic donor nephrectomy on donors' and recipients' acceptance of living donor kidney transplantation. METHODS Tailored self-administered questionnaires were mailed to kidney donors, potential donors, recipients and potential recipients who visited the University of Maryland School of Medicine Division of Transplantation between January 1998 and May 2001. RESULTS The laparoscopic donor nephrectomy helped recipients and potential recipients with their decision to accept a kidney from a living donor (recipients: 53% strongly agreed, 36% agreed; potential recipients: 42% strongly agreed, 46% agreed). To a lesser extent, the laparoscopic donor nephrectomy assisted donors and potential donors with their decision to donate (donors: 19% strongly agreed, 20% agreed; potential donors: 20% strongly agreed, 20% agreed). Potential recipients and recipients identified 2 barriers to accepting living donor kidney transplantation: they were unwilling to accept a kidney if it meant this would financially burden their donors, and they worried that their donors might succumb to a future kidney problem. CONCLUSION Overall, the study found a positive attitude toward living donor kidney transplantation and laparoscopic donor nephrectomy. This new surgical procedure seemed to positively influence recipients and potential recipients to accept a kidney. In contrast, it had less impact on donors' and potential donors' willingness to give their kidney.
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Affiliation(s)
- Françoise G Pradel
- Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore, MD 21201, USA.
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Goldman LS. Liver transplantation using living donors. Preliminary donor psychiatric outcomes. PSYCHOSOMATICS 1993; 34:235-40. [PMID: 8493305 DOI: 10.1016/s0033-3182(93)71885-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Twenty liver transplantations to sick infants from living-donor relatives were performed over a 16-month period. Before the operation, donors were screened psychiatrically by interview and psychological testing. Donor outcomes were assessed postoperatively to evaluate adverse psychiatric outcomes and to attempt a correlation with preoperative findings. There were three significant donor problems in the immediate postoperative period, two marital dissolutions and one adjustment disorder, as well as several other minor problems. These results are examined in light of past observations about living-donor renal transplantations and pediatric transplantation in general.
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Affiliation(s)
- L S Goldman
- Consultation-Liaison Service, University of Chicago Pritzker School of Medicine, IL 60637
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Lewis M. Kidney donation by a 7-year-old identical twin child: psychological, legal, and ethical considerations. JOURNAL OF THE AMERICAN ACADEMY OF CHILD PSYCHIATRY 1974; 13:221-45. [PMID: 4596778 DOI: 10.1016/s0002-7138(09)61313-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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