Living Kidney Donor Assessment: Challenges, Uncertainties and Controversies Among Transplant Nephrologists and Surgeons

Abstract

The assessment of living kidney donors presents unique ethical challenges and complex psychosocial implications. This study aimed to ascertain the perspectives of transplant nephrologists and surgeons on living kidney donor assessment. Semi‐structured, face‐to‐face interviews were conducted with 110 transplant nephrologists and surgeons from 43 transplant units in 12 countries from Europe, Australasia and North America. The challenge of defining acceptable risk to the donor was central to five themes identified: burden of responsibility (personal accountability, policing morality, democratic decision making, meeting legal obligations, optimizing outcomes and innovation, relinquished control); medical protectiveness (prognostic uncertainty, skepticism of donor risk perception, avoidance of undue coercion, concerns for dubious motivations and coercion, safeguard donor well‐being, ethical information disclosure); respecting donor autonomy (facilitate informed‐decision making, concede to donor risk acceptance, benefit of the doubt, donor mandate to maintain health, acceptable altruism); driving ideologies (preserving equity, championing living donation, cognizance of anti‐paternalism) and contextual pressures (evolving donor demographic, resource limitations). Living kidney donor assessment involves complex interactions between safeguarding the donors' welfare and respecting their autonomy. In our opinion, authoritative and well‐described transplant unit, hospital and public policy positions that make explicit the considerations that are often implicit may reduce the uncertainty within which living donors are assessed today.

Early Postoperative Pain and its Predictors in the Adult to Adult Living Donor Liver Transplantation Cohort Study

“…20,21 This may represent a response that is highly influenced by the psychological benefits of donation. 22,23 The finding illustrates the important interplay between patient characteristics and individual domains of pain perception. This observation argues against opinion that the only way to improve pain management is the strict use of protocols for monitoring and administering analgesics.…”

Psychosocial wellbeing after living kidney donation - a longitudinal, prospective study

“…The qualitative literature has addressed donor psychosocial outcomes in considerable detail, due to the very nature of how these studies are conducted and the types of data they generate. Studies have focussed on many different aspects, such as decision‐making, expectations and the opinions of transplant professionals . They have also identified concerns regarding donor mental health and whether the benefits of donation outweigh the risks .…”

To tell or not to tell: attitudes of transplant surgeons and transplant nephrologists regarding the disclosure of recipient information to living kidney donors

“…Surprisingly, there is not much research on attitudinal differences between nephrologists and surgeons (30). Rather, most studies focus on variability between renal transplant programs and offered little insight into similarities and differences between surgeon respondents and nephrologist respondents (12,31,32). We found that surgeons and nephrologists had strikingly similar views.…”