Living Donation Decision Making: Recipients' Concerns and Educational Needs

Abstract

Kidney recipients reported that they might not pursue living donation because they felt guilty and indebted to the donor, did not want to harm or inconvenience the donor, did not want to accept a kidney that a family member might need later, and did not want to disappoint the donor if the kidney failed. Recipients were generally unaware that donors could personally benefit from donating and would rather wait for donor volunteers than ask anyone directly. Both donors and recipients thought that training on how to make the donation request and education about living donors' motivations for donation and transplant experience could help more renal patients pursue living donation.

Sex Differences and Attitudes toward Living Donor Kidney Transplantation among Urban Black Patients on Hemodialysis

“…Lack of strong social support may explain why the widowed patients (all of whom were women) were less likely to want LDKT in the multivariate analysis. This finding also suggests that, in addition to educating patients about health and quality of life benefits, the availability or lack of social support should be factored into the design of interventions (8,(42)(43)(44)(45)(46)(47)(48)(49)(50)(51). It is also important to note that black women are also more likely to be excluded from living kidney donation for medical reasons (52).…”

Recruitment of Live Donors by Candidates for Kidney Transplantation

“…Minimal published literature exists on how transplant candidates interact with donors. Although some transplant candidates seek altruistic donors through the media, the majority of donors are recruited through the personal relationships that comprise a candidate's social support network (14,17,34,35). Because these interactions are usually private, transplant professionals interested in donor recruitment need to rely on the self-report of candidates and donors to identify possible methods to increase live donation overall.…”

“…The creation of successful programs that maximize live donor transplantation would require a more detailed understanding of the barriers confronted by individual candidates when attempting to find donors. Proposed barriers include limited knowledge of the benefits of live donor transplantation, concern about donor harm, cultural, or religious beliefs, poor ability to cope with chronic kidney disease, and lack of social support (9,(13)(14)(15)(16)(17)(18) Attempted donor recruitment is an important step toward live donor transplantation and a plausible surrogate endpoint in understanding factors that limit overall access to live donor transplantation. The purpose of this cross-sectional study was to identify characteristics of transplant candidates that are associated with attempts to recruit potential live kidney donors.…”

A Survey of Nephrologists’ Views on Preemptive Transplantation

“…According to participants, the reasons most frequently raised by patients to delay preemptive transplantation were their reluctance to talk with family or friends about donating a kidney, their concerns about the health consequences of a kidney removal on their donor, and their concerns about financial costs related to transplantation and kidney removal. These barriers are similar to the barriers reported by hemodialysis patients when considering live donor kidney transplantation (22,26). Needing time to adjust to the idea of preemptive transplantation and still feeling healthy, although not as widely reported, might need further attention.…”

“…Patients might encounter psychologic and attitudinal barriers when seeking a donor, similar to those experienced by patients on dialysis. Patients may be reluctant to ask relatives for a kidney and express concerns about the long-term consequences of donating a kidney (22)(23)(24)(25)(26). Patients with CKD who feel relatively well and are not burdened with dialysis may have less sense of urgency to pursue transplantation than those who are already established on dialysis (27).…”