Clinicians' attitudes and approaches to evaluating the potential living kidney donor‐recipient relationship: An interview study. Issue 2 (29th January 2019)

• Record Type: Journal Article
• Authors: Ralph, Angelique F.; Butow, Phyllis; Craig, Jonathan C.; Chapman, Jeremy R.; Gill, John S.; Kanellis, John; Tong, Allison
• Is Part Of: Nephrology. Volume 24:Issue 2(2019)
• Page Start: 252
• Page End: 262
• Publication Date: 2019-01-29
• Subjects: donor‐recipient relationship -- living donor transplantation -- qualitative research; Nephrology -- Periodicals; Kidneys -- Diseases -- Periodicals; Nephrologists -- Periodicals; 616.61; 616.61
• DOI: 10.1111/nep.13238
• Languages: English
• ISSNs: 1320-5358

Abstract

ABSTRACT: Aim: Careful assessment of the potential donor‐recipient relationship is recommended by guidelines to prevent undue coercion, and to ensure realistic expectations and genuine motivations. However, relationships are complex, nuanced and value‐laden, and can be challenging to evaluate in living kidney donation. We aimed to describe the attitudes and approaches of transplant clinicians towards assessing the relationship between potential living kidney donors and their recipients. Methods: Semi‐structured interviews were conducted with 54 transplant clinicians (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists) from 32 transplant centres across nine countries including Australia, United States, Canada and New Zealand. Transcripts were analyzed thematically. Results: Four themes were identified: protecting against vulnerability and premature decisions (ensuring genuine motivation, uncovering precarious dynamics and pre‐empting conflict, shared accountability, relying on specialty psychosocial expertise, trusting intimate bonds, tempering emotional impulsivity); safeguarding against coercion (discerning power imbalance, justified inquiry, awareness of impression management); minimizing potential threat to relationships (preserving the bond, giving equitable attention to donors and recipients, ensuring realistic expectations); and ambiguities in making judgments (adjudicating appropriateness and authenticity of relationships, questioning professional intervening, uncertainties in subjective and emotional assessments). Conclusions: Clinicians felt ethically compelled to minimize the risk of undue coercion and to protect donors and recipients when evaluating the donor‐recipient relationship. However, disentangling voluntariness and altruism from potential undisclosed pressures to enact societal and family duty, making decisions within this complex, multi‐stakeholder context, and avoiding the imposition of undue paternalism and donor autonomy, were challenging. Multidisciplinary expertise and practical strategies for managing uncertainties are required. Summary at a Glance: This qualitative research examines the attitudes and perspectives of health care workers in the evaluation of potential donor‐recipient relationships. The risk of coercion, detecting potential vulnerabilities in potential donor/recipient relationships and a multidisciplinary team approach were identified as key components in the assessment of live‐donor kidney transplantation.