The Expectations and Attitudes of Patients With Chronic Kidney Disease Toward Living Kidney Donor Transplantation: A Thematic Synthesis of Qualitative Studies. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: Hanson, Camilla S.; Chadban, Steve J.; Chapman, Jeremy R.; Craig, Jonathan C.; Wong, Germaine; Ralph, Angelique F.; Tong, Allison
• Is Part Of: Transplantation. Volume 99:Issue 3(2015)
• Publication Date: 2015-03
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/TP.0000000000000433
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Background: Living kidney donation offers superior outcomes over deceased organ donation, but incurs psychosocial and ethical challenges for recipients because of the risks imposed on their donor. We aimed to describe the beliefs, attitudes, and expectations of patients with chronic kidney disease toward receiving a living kidney donor transplant. Methods: We conducted a systematic review of qualitative studies of patients' attitudes toward living kidney donation using a comprehensive literature search of electronic databases to February 2013. The findings were analyzed using thematic synthesis. Results: Thirty-nine studies (n≥1791 participants) were included. We identified six themes: prioritizing own health (better graft survival, accepting risk, and desperate aversion to dialysis), guilt and responsibility (jeopardizing donor health, anticipating donor regret, and causing donor inconvenience), ambivalence and uncertainty (doubting transplant urgency, insufficient information, confronted by unfamiliarity, and prognostic uncertainty), seeking decisional validation (a familial obligation, alleviating family burden, reciprocal benefits for donors, respecting donor autonomy, external reassurance, and religious approval), needing social support (avoiding family conflict, unrelenting indebtedness, and emotional isolation), and cautious donor recruitment (self-advocacy, lacking self-confidence, avoiding donor coercion, emotional vulnerability, respecting cultural, and religious taboos). Conclusion: Enhanced education and psychosocial support may help clarify, validate, and address patients' concerns regarding donor outcomes, guilt, relationship tensions, and donor recruitment. This may encourage informed decision-making, increase access to living kidney donation, and improve psychosocial adjustment for transplant recipients. Abstract : A systematic review of studies of patients' attitudes toward living kidney donation reveals 6 themes that serve to define potential barriers to living donation and identify areas for research and intervention. Supplemental digital content is available in the text.