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Zuchowski M, Mamode N, Draper H, Gogalniceanu P, Norton S, Chilcot J, Auburn T, Clarke A, Williams L, Burnapp L, McCrone P, Maple H. Exploring Staff Attitudes Towards Unspecified Kidney Donors in the United Kingdom: Results From the BOUnD Study. Transpl Int 2023; 36:11258. [PMID: 37359823 PMCID: PMC10285071 DOI: 10.3389/ti.2023.11258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/23/2023] [Indexed: 06/28/2023]
Abstract
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.
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Affiliation(s)
- Mira Zuchowski
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Nizam Mamode
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Peter Gogalniceanu
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sam Norton
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Joseph Chilcot
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, King’s College London, London, United Kingdom
| | - Timothy Auburn
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Alexis Clarke
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Lynsey Williams
- School of Psychology, University of Plymouth, Plymouth, United Kingdom
| | - Lisa Burnapp
- Directorate of Organ and Tissue Donation and Transplantation, NHS Blood and Transplant, Watford, United Kingdom
| | - Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, United Kingdom
| | - Hannah Maple
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
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Maple H, Gogalniceanu P, Gare R, Burnapp L, Draper H, Chilcot J, Norton S, Mamode N. Donating a Kidney to a Stranger: Are Healthcare Professionals Facilitating the Journey? Results From the BOUnD Study. Transpl Int 2023; 36:11257. [PMID: 37324220 PMCID: PMC10261699 DOI: 10.3389/ti.2023.11257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/11/2023] [Indexed: 06/17/2023]
Abstract
Unspecified kidney donors (UKDs) are approached cautiously by some transplant professionals. The aim of this study was to interrogate the views of UK transplant professionals towards UKDs and identify potential barriers. A purposely designed questionnaire was validated, piloted and distributed amongst transplant professionals at each of the 23 UK transplant centres. Data captured included personal experiences, attitudes towards organ donation, and specific concerns about UKD. 153 responses were obtained, with representation from all UK centres and professional groups. The majority reported a positive experience with UKDs (81.7%; p < 0.001) and were comfortable with UKDs undergoing major surgery (85.7%; p < 0.001). 43.8% reported UKDs to be more time consuming and 52% felt that a mental health assessment should take place before any medical tests. 77% indicated the need for a lower age limit. The suggested age range was broad (16-50 years). Adjusted mean acceptance scores did not differ by profession (p = 0.68) but higher volume centres were more accepting (46.2 vs. 52.9; p < 0.001). This is the first quantitative study of acceptance by transplant professionals to a large national UKD programme. Support is broad, however potential barriers to donation have been identified, including lack of training. Unified national guidance is needed to address these.
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Affiliation(s)
- Hannah Maple
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Petrut Gogalniceanu
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Rebecca Gare
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lisa Burnapp
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
- UK and NHS Blood and Transplant, Bristol, United Kingdom
| | - Heather Draper
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Joseph Chilcot
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Sam Norton
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Nizam Mamode
- Department of Transplantation, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Marcus K, Berner D, Hadaya K, Hurst S. Anonymity in Kidney Paired Donation: A Systematic Review of Reasons. Transpl Int 2023; 36:10913. [PMID: 36819123 PMCID: PMC9931741 DOI: 10.3389/ti.2023.10913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
The objective of this study was to investigate reasons for or against anonymity that are pertinent to kidney paired donations (KPD). We conducted a systematic review of reasons using PubMed and Google Scholar until May 2022 and through snowballing. Inclusion criteria were publications that: 1) discussed organ donation anonymity; 2) was peer-reviewed; 3) presented at least one reason on anonymity. Exclusion criteria: 1) not published in a scientific journal; 2) grey literature and dissertations. Four researchers independently reviewed and selected papers based on the criteria, extracted text passages and coded them into narrow and broad reason types, selected reasons that were valid for kidney paired donations. 50 articles were included, 62 narrow reasons (n = 24 for; n = 38 against) and 13 broad reasons were coded. Broad reasons were: protection against harm, general benefits, gratitude, curiosity, unrealistic to implement, fundamental rights, respect people's wishes, professional neutrality, timing is important, information disclosure, altruism, reciprocity and donation pool. We did not find reasons that justify legal prohibition of donor-recipient interactions for KPD, if they consented to meet. Professional counselling, follow-up and careful evaluations to prevent potential harm.
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Affiliation(s)
- Kailing Marcus
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Delphine Berner
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karine Hadaya
- Service of Nephrology and Hypertension, Geneva University Hospitals and Clinique des Grangettes-Hirslanden, Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Ghent E, Robertson T, Young K, DeAngelis M, Fecteau A, Grant D, Ng V, Anthony SJ. The experiences of parents and caregiver(s) whose child received an organ from a living anonymous liver donor. Clin Transplant 2019; 33:e13667. [PMID: 31310681 DOI: 10.1111/ctr.13667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 06/19/2019] [Accepted: 07/06/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anonymous living donor transplantation is a potential strategy to address the shortage of available organs for transplant. A living anonymous donor (LAD) is a donor with no biological connection and whose identity is unknown to the recipient. This study captured the lived experiences of pediatric liver transplant recipient families whose child received an organ from a LAD. METHODS Qualitative data collection and analysis were guided by a theoretical framework of phenomenology. Data analysis highlighted themes through an inductive process of reviewing transcript paragraphs to code for significant statements that represented key concepts and captured depth of experience. RESULTS A total of nine interviews were conducted with 10 participants. Data analysis yielded themes of emotional turbulence through their transplant journey. Pre-transplant experiences were characterized by feelings of helplessness and desperation. Receiving a LAD transplant prompted shock, relief, and acceptance of the donation. Post-transplant experiences were characterized by altered life-perspectives and varied levels of connectedness to the donor, marked by gratitude and concern for donor well-being. CONCLUSION Anonymous donation in liver transplantation is perceived by recipient families as a remarkable gift and a viable donor option. Our preliminary findings can be used to inform strategy development regarding future delivery of care.
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Affiliation(s)
- Emily Ghent
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Taylor Robertson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Katarina Young
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Maria DeAngelis
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Annie Fecteau
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - David Grant
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Vicky Ng
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samantha J Anthony
- Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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Balliet W, Kazley AS, Johnson E, Holland-Carter L, Maurer S, Correll J, Marlow N, Chavin K, Baliga P. The non-directed living kidney donor: Why donate to strangers? J Ren Care 2019; 45:102-110. [PMID: 30868762 DOI: 10.1111/jorc.12267] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Kidney transplantation improves survival and quality of life for patients with end-stage kidney disease (ESKD). However, there is a shortage of donated organs, resulting in long wait times and the potential for death before a donor is found. Non-directed (also called altruistic) living kidney donation is a growing type of donation; however, few studies have examined the values and motivation of individuals evaluated to be a non-directed donor. OBJECTIVES This qualitative study explores the motivations and values of individuals evaluated for non-directed donation. DESIGN Focus groups were conducted with individuals who had been evaluated for non-directed living kidney donation. Grounded theory method guided the data analysis. PARTICIPANTS Participants (N = 11) were individuals who completed the evaluation for a non-directed living kidney donation. FINDINGS Qualitative analyses revealed eight major themes participants considered in making their decision to donate to a non-related person: (i) motivation to donate; (ii) minimise perceived risk; (iii) ideal selected recipient; (iv) change in lifestyle; (v) source of donation knowledge; (vi) history of altruistic acts; (vii) donation chain and (viii) others' response. CONCLUSIONS Results suggest that non-directed living kidney donors think deeply about their decision and have a resolve to help others that is aligned with their values. As organ availability remains at a critical shortage, unwillingness to consider non-directed living donors (NDD) due to beliefs of ill motivations appears unsupported. Future directions call for the need of standard practice of care in kidney donation evaluations across transplant centers.
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Affiliation(s)
- Wendy Balliet
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Abby S Kazley
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Emily Johnson
- Department of Health Care Leadership and Management, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lauren Holland-Carter
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stacey Maurer
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jennifer Correll
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole Marlow
- Department of Health Services Research, Management, and Policy, University of Florida Health Science Center, Gainesville, Florida, USA
| | - Kenneth Chavin
- Department of Surgery-Transplant, UH Cleveland Medical Center, Cleveland, Ohio, USA
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Gare R, Gogalniceanu P, Maple H, Burnapp L, Clarke A, Williams L, Norton S, Chilcot J, Gibbs P, Mitchell A, McCrone P, Draper H, Mamode N. Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professional's and patient's perspectives: research protocol for a national multicentre mixed-methods prospective cohort study. BMJ Open 2017; 7:e015971. [PMID: 28939572 PMCID: PMC5623565 DOI: 10.1136/bmjopen-2017-015971] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Living donation accounts for over one-third of all kidney transplants taking place in the UK. 1 The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney donation (UKD)) remains uncomfortable for some clinicians, principally due to concerns about the motivations and long-term physical and psychological outcomes in this donor group. AIMS The research programme aims to provide a comprehensive assessment of the unspecified donor programme in the UK. It aims to identify reasons for variations in practice across centres, explore outcomes for donors and ascertain barriers and facilitators to UKD, as well as assess the economic implications of unspecified donation. METHODS The research programme will adopt a mixed-methods approach to assessing UKD nationally using focus groups, interviews and questionnaires. Two study populations will be investigated. The first will include transplant professionals involved in unspecified kidney donation. The second will include a 5-year prospective cohort of individuals who present to any of the 23 UK transplant centres as a potential unspecified living kidney donor. Physical and psychological outcomes will be followed up to 1 year following donation or withdrawal from the donation process. A matched sample of specified donors (those donating to someone they know) will be recruited as a control group. Further qualitative work consisting of interviews will be performed on a purposive sample of unspecified donors from both groups (those who do and do not donate). DISSEMINATION The findings will be reported to NHS Blood and Transplant and the British Transplant Society with a view to developing national guidelines and a protocol for the management of those presenting for unspecified donation. TRIAL REGISTRATION NUMBER ISRCTN23895878, Pre-results.
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Affiliation(s)
- Rebecca Gare
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
| | - Petrut Gogalniceanu
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
| | - Hannah Maple
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
| | - Lisa Burnapp
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
- NHS Blood and Transplant, London, UK
| | | | | | - Sam Norton
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Joseph Chilcot
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Paul Gibbs
- Renal Transplant Department, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Paul McCrone
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Heather Draper
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Nizam Mamode
- Department of Renal Transplantation, Guy’s and St. Thomas’ NHS Foundation Trust/King’s College London, London, UK
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Gewarges M, Poole J, De Luca E, Shildrick M, Abbey S, Mauthner O, Ross H. Canadian Society of Transplantation Members' Views on Anonymity in Organ Donation and Transplantation. Transplant Proc 2016; 47:2799-804. [PMID: 26707291 DOI: 10.1016/j.transproceed.2015.09.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anonymity has been central to medical, psychosocial, and societal practices in organ donation and transplantation. The purpose of this investigation was to explore transplant professionals' views on anonymity in the context of organ transplantation. METHODS The study consisted of an electronic 18-item survey distributed to the Canadian Society of Transplantation membership, asking about anonymity vs open communication/contact between organ recipients and donor families. RESULTS Of the 541 members surveyed, 106 replied. Among respondents, 71% felt that organ recipients and donor families should only communicate anonymously, yet 47% felt that identifying information could be included in correspondence between consenting recipients and donor families. When asked whether organ recipients and donor families should be allowed to meet, 53% of respondents agreed, 27% disagreed, and 20% neither agreed nor disagreed. With social media facilitating communication and eliminating the ability to maintain donor/recipient anonymity, 38% of respondents felt that a reexamination of current policies and practices pertaining to anonymity was necessary. CONCLUSION In conclusion, there was no dominant position on the issue of anonymity/communication between donor families and transplant recipients. Further research and discussion concerning the views of healthcare professionals, organ recipients, and donor families on the mandate of anonymity is needed and may influence future policy.
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Affiliation(s)
- M Gewarges
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - J Poole
- School of Social Work, Faculty of Community Services, Ryerson University, Toronto, Ontario, Canada
| | - E De Luca
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - M Shildrick
- Tema Genus, Linköping University, Linköping, Sweden
| | - S Abbey
- Department of Psychiatry, Toronto General Hospital, Toronto, Ontario, Canada
| | - O Mauthner
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada
| | - H Ross
- Division of Cardiology and Transplantation, Toronto General Hospital, Toronto, Ontario, Canada.
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Maple H, Chilcot J, Burnapp L, Gibbs P, Santhouse A, Norton S, Weinman J, Mamode N. Motivations, outcomes, and characteristics of unspecified (nondirected altruistic) kidney donors in the United Kingdom. Transplantation. 2014;98:1182-1189. [PMID: 25099701 DOI: 10.1097/tp.0000000000000340] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Unspecified (nondirected altruistic) kidney donation is becoming increasingly common in the United Kingdom. Questions regarding motivation and characteristics of these donors persist, alongside concerns about regret and long-term psychosocial outcomes. The aims of this study were to compare psychosocial and physical outcomes in unspecified kidney donors (UKDs) versus specified kidney donors (SKDs). METHODS We performed a cross-sectional study, in which a detailed assessment of psychosocial outcomes was made using validated questionnaires. Additional questions specific to donation were also asked, including questions regarding motivation, regret, and anonymity. RESULTS One hundred ninety responses were received from 296 participants studied (110 UKDs [74.3%] vs. 80 SKDs [54.1%], P<0.001). Unspecified kidney donors were older (54 years vs. 44 years; P<0.001), predominantly white (99.1% vs. 78.5%; P<0.001), and donated more recently (1.3 years vs. 2.6 years; P<0.001). There was no difference in psychiatric history or personality type, or current depression, anxiety, stress, self-esteem, or well-being between the groups (P>0.05). Unspecified kidney donors were more engaged in other altruistic behaviours (P<0.001). There was no difference in physical outcomes, although UKDs recovered quicker (P<0.001). Regret was low (3.7% UKDs vs. 7.5% SKDs; P=0.078). CONCLUSION This study has demonstrated that UKDs have comparable physical and psychosocial outcomes to SKDs. These favorable outcomes may be, in part, because of the rigorous evaluation process which currently includes a mental health assessment. We conclude that the program can continue to expand safely across the United Kingdom.
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Abstract
Living donation to strangers is a complex issue that has caused some transplant centers to ban the practice altogether. Most prominent of the troublesome issues is the common source of these donors; namely, the Internet. These "stranger donors," however, are critical to both paired kidney transplants and chain kidney transplants. This article presents the ethical complexities of donors in these transplant arrangements and offers 2 case examples from our facility. Rigorous donor screening and informed consent processes are crucial, and together they help make transplant pairs and chains ethically feasible.
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Affiliation(s)
- Christopher G Veys
- California Pacific Medical Center, San Francisco, California 94115, USA.
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10
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Abstract
Living donation to strangers is a complex issue that has caused some transplant centers to ban the practice altogether. Most prominent of the troublesome issues is the common source of these donors; namely, the Internet. These “stranger donors,” however, are critical to both paired kidney transplants and chain kidney transplants. This article presents the ethical complexities of donors in these transplant arrangements and offers 2 case examples from our facility. Rigorous donor screening and informed consent processes are crucial, and together they help make transplant pairs and chains ethically feasible.
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Fortin MC, Dion-Labrie M, Hébert MJ, Doucet H. The enigmatic nature of altruism in organ transplantation: a cross-cultural study of transplant physicians' views on altruism. BMC Res Notes 2010; 3:216. [PMID: 20673349 PMCID: PMC3161367 DOI: 10.1186/1756-0500-3-216] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Accepted: 07/30/2010] [Indexed: 11/15/2022] Open
Abstract
Background Although altruism is a key principle in our current organ donation and transplantation system, the meanings and implications of the term have been widely debated. Recently, a new type of living organ donation--anonymous and non-directed, also called living altruistic donation (LAD)--has brought the issue into sharper focus. Transplant physicians' views on altruism might influence their attitudes and actions toward living altruistic donors. This study aimed to explore such views among transplant physicians in France and Quebec. Findings A total of 27 French and 19 Quebec transplant physicians participated in individual, semi-structured interviews between October 2004 and December 2005. The majority of these participants associated altruism with gratuitousness and saw altruistic acts as multiple and varied, ranging from showing consideration to saving a person's life. Conclusions The transplant physicians' discourses on altruism were quite diverse, leading us to question the relevance of the concept in organ transplantation and the appropriateness of the term "living altruistic donation."
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Affiliation(s)
- Marie-Chantal Fortin
- Nephrology and Transplantation Division, Centre Hospitalier de l'Université de Montréal, 1560 Sherbrooke East Street, Montreal, Quebec, H2L 4M1, Canada.
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Massey EK, Kranenburg LW, Zuidema WC, Hak G, Erdman RAM, Hilhorst M, Ijzermans JNM, Busschbach JJ, Weimar W. Encouraging psychological outcomes after altruistic donation to a stranger. Am J Transplant 2010; 10:1445-52. [PMID: 20486913 DOI: 10.1111/j.1600-6143.2010.03115.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In a growing number of transplant centers worldwide, altruistic donors are accepted to anonymously donate a kidney to a stranger. An important hesitation to expand these transplantation programs is the fear of evoking psychological distress in the altruistic donor after donation. To what extent this fear is justified has not yet been systematically investigated. In this study, 24 altruistic donors were interviewed on average 2 years after donation. Lifetime mental health history, current psychological complaints, satisfaction with and impact of the donation on well-being, motives for donation, communication with recipient and donation experience were assessed. Altruistic donors report a considerable positive impact of donation on psychological well-being, whereas negative impact was limited. Satisfaction with donation was very high. Although a history of a psychiatric diagnosis was ascertained in almost half of the donors, psychological complaints before and after donation were comparable to national average norm scores. Motives for donation were genuine and the experience of donation generally conformed to their expectations. In conclusion, living kidney donation to a stranger does not appear to exacerbate psychological complaints. Moreover, altruistic donors report considerable satisfaction and personal benefit. The exceptional gift of altruistic donors can contribute toward solving the current organ shortage issue.
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Affiliation(s)
- E K Massey
- Department of Internal Medicine, Erasmus MC, Postbus 2040, 3000 CA Rotterdam, The Netherlands.
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