A qualitative systematic review of anonymous/unspecified living kidney and liver donors' perspectives

Living Kidney Donation: A Narrative Review of Mid- and Long-term Psychosocial Outcomes

Living kidney donors make a significant contribution to alleviating the organ shortage. The aim of this article is to provide an overview of mid- and long-term (≥12 mo) living donor psychosocial outcomes and highlight areas that have been understudied and should be immediately addressed in both research and clinical practice. We conducted a narrative review by searching 3 databases. A total of 206 articles were included. Living donors can be divided into those who donate to an emotionally or genetically related person, the so-called directed donors, or to an emotionally or genetically unrelated recipient, the so-called nondirected donors. The most commonly investigated (bio)psychosocial outcome after living donation was health-related quality of life. Other generic (bio)psychological outcomes include specific aspects of mental health such as depression, and fatigue and pain. Social outcomes include financial and employment burdens and problems with insurance. Donation-specific psychosocial outcomes include regret, satisfaction, feelings of abandonment and unmet needs, and benefits of living kidney donation. The experience of living donation is complex and multifaceted, reflected in the co-occurrence of both benefits and burden after donation. Noticeably, no interventions have been developed to improve mid- or long-term psychosocial outcomes among living donors. We highlight areas for methodological improvement and identified 3 areas requiring immediate attention from the transplant community in both research and clinical care: (1) recognizing and providing care for the minority of donors who have poorer long-term psychosocial outcomes after donation, (2) minimizing donation-related financial burden, and (3) studying interventions to minimize long-term psychosocial problems.

The lived experience of living liver donors: A meta-synthesis of qualitative studies

BACKGROUND

Living liver donors are frequently used for liver transplantation, but they experience many physical changes and psychological challenges. A better understanding of the experiences of liver donors can provide them with comprehensive and individualized patient-centred support and health care. Thus, this study sought to identify and synthesize existing qualitative studies to develop an in-depth understanding of the lived experiences of living liver donors.

METHOD

A meta-synthesis was conducted and reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research statement. Seven databases were systematically searched from inception to March, 2024, using a combination of Medical Subject Headings with keywords. The results were integrated using the three-step thematic synthesis method suggested by Thomas and Harden.

RESULTS

Nine studies met the inclusion criteria and were included in this meta-synthesis. Four themes emerged from the meta-synthesis: (1) facing a life-changing situation, (2) experiencing changes in interpersonal relationships, (3) coping with changes, and (4) achieving personal growth.

CONCLUSIONS

Living liver donors experienced physical, psychological, and social changes after surgery, striving to manage these challenges, highlighting the importance of coping strategies and ultimately achieving personal growth. Future nursing research should focus on psychological interventions, supportive measures, and the positive aspects of living liver donors to help them achieve the optimal quality of life.

TRIAL REGISTRATION

PROSPERO CRD42022328947.

Altruistic kidney donation following the death of a loved one-a coincidence or a post-traumatic growth?

The aim of this study was to examine the case of altruistic kidney donation (AKD) following loss, in light of PTG theory. Loss may facilitate trauma alongside post-traumatic growth (PTG). Although much is known about the motivation for AKD in general, less is known about the motives of bereaved individuals who chose to altruistically donate their kidney post-loss. Employing a narrative approach, 10 bereaved individuals who altruistically donated a kidney were interviewed about their perceptions of the connection between the loss and their decision to donate a kidney post-loss. Content analysis revealed three types of bereaved AKD's perceived connection between the loss and the donation: explicitly direct, indirect, and implicit. Donation post-loss was characterized by aspects of PTG in three domains: self, other and worldviews. The findings are discussed in light of PTG theory and highlight the possible role of AKD in processes of coping and growth following grief.

The incidence of adverse outcome in donors after living donor liver transplantation: A meta-analysis of 60,829 donors

The scarcity of liver grafts has prompted developments in living donor liver transplantations (LDLT), with previous literature illustrating similar outcomes in recipients compared to deceased donor transplants. However, significant concerns regarding living donor morbidity and mortality have yet to be examined comprehensively. This study aims to provide estimates of the incidence of various outcomes in living liver donors. In this meta-analysis, Medline and Embase were searched from inception to July 2022 for articles assessing the incidence of outcomes in LDLT donors. Complications in the included studies were classified into respective organ systems. Analysis of incidence was conducted using a generalized linear mixed model with Clopper-Pearson intervals. Eighty-seven articles involving 60,829 living liver donors were included. The overall pooled incidence of complications in LDLT donors was 24.7% (CI: 21.6%-28.1%). The incidence of minor complications was 17.3% (CI: 14.7%-20.3%), while the incidence of major complications was lower at 5.5% (CI: 4.5%-6.7%). The overall incidence of donor mortality was 0.06% (CI: 0.0%-0.1%) in 49,027 individuals. Psychological complications (7.6%, CI: 4.9%-11.5%) were the most common among LDLT donors, followed by wound-related (5.2%, CI: 4.4%-6.2%) and respiratory complications (4.9%, CI: 3.8%-6.3%). Conversely, cardiovascular complications had the lowest incidence among the subgroups at 0.8% (CI: 0.4%-1.3%). This study presents the incidence of post-LDLT outcomes in living liver donors, illustrating significant psychological, wound-related, and respiratory complications. While significant advancements in recent decades have contributed towards decreased morbidity in living donors, our findings call for targeted measures and continued efforts to ensure the safety and quality of life of liver donors post-LDLT.

Exploring Staff Attitudes Towards Unspecified Kidney Donors in the United Kingdom: Results From the BOUnD Study

Unspecified kidney donation (UKD) has made substantial contributions to the UK living donor programme. Nevertheless, some transplant professionals are uncomfortable with these individuals undergoing surgery. This study aimed to qualitatively explore the attitudes of UK healthcare professionals towards UKD. An opportunistic sample was recruited through the Barriers and Outcomes in Unspecified Donation (BOUnD) study covering six UK transplant centres: three high volume and three low volume centres. Interview transcripts were analysed using inductive thematic analysis. The study provided comprehensive coverage of the UK transplant community, involving 59 transplant professionals. We identified five themes: staff's conception of the ethics of UKD; presence of the known recipient in the donor-recipient dyad; need for better management of patient expectations; managing visceral reactions about the "typical" unspecified kidney donor; complex attitudes toward a promising new practice. This is the first in-depth qualitative study of attitudes of transplant professionals towards UKD. The data uncovered findings with strong clinical implications for the UKD programme, including the need for a uniform approach towards younger candidates that is adhered to by all transplant centres, the need to equally extend the rigorous assessment to both specified and unspecified donors, and a new approach to managing donor expectations.