Understanding family dynamics in adult-to-adult living donor liver transplantation decision-making in Taiwan: Motivation, communication, and ambivalence

Abstract

This study investigated how multiple family members co‐construct the ethical significance of living donor liver transplantation (LDLT) and how the family structure and dynamics of donor–recipient–caregiver relationships shape the communication and decision‐making process within the sociocultural context of Taiwan. We conducted in‐depth interviews with 36 participants from 13 families at the Chang Gung Memorial Hospital from February to December 2019. Interviews were audio recorded, transcribed, and translated from Mandarin to English and analyzed utilizing grounded theory and thematic analysis. Our findings revealed that LDLT in Taiwan is not merely a personal choice of either donor or recipient but essentially a collaborative process of family‐centered medical decision‐making, intertwined with socioeconomic conditions, cultural and social norms, gender roles, and the division of labor in the household. The notion of reciprocity and indebtedness for family members is a central theme underlying the entire process of motivation, deliberation, and decision‐making, thereby reinforcing the naturalness of LDLT. However, our study highlighted that donors from families with traditional gender hierarchy and power imbalance may experience psychological and social vulnerabilities. Conclusively, we suggest that healthcare professionals should be sensitive to the contextual and relational factors involved in family dynamics and provide appropriate support to the ambivalent donors.

A Qualitative Study in Family Units on Organ Donation: Attitude, Influencing Factors and Communication Patterns

“…Previous studies often simply described the decision-making model as family centered ( 35 ). Ya-Ping Lin had constructed 3 patterns of communication and decision-making processes in living donor liver transplantation among Tawanese ( 26 ). However, we established three family communication patterns that apply to the public in China mainland based on varying family structures, relationships, personal attitude and traditional beliefs.…”

“…Previous research focused on family’s attitude toward donation ( 22 ), family bereavement ( 23 ), influencing factors ( 24 ), ethical exploration ( 25 ) and motivation to donate ( 26 ). Many of these studies were conducted in the United States, Australia, Canada and the United Kingdom.…”

Perception Regarding Live Kidney Donation in the General Population of South Korea

“…[19][20][21][22] Apart from this, familial common good and mutual obligation are also strongly emphasized in many Asian countries; therefore, the number of living donor kidney transplants is signi cantly higher than that in other countries when considering the total number of transplantations, even without any special encouragement. [22] In this study, the willingness to donate a kidney was about half, and the targets of donations mainly were family members. There seems to be no great reluctance to donate a kidney to family members, probably because this may have originated from the aforementioned Asian culture that values family relations.…”

“…[19,20] Additionally, the reasons why deceased donor transplantation has not been performed in Korea are as follows: 1) the leading cause of brain death, such as death from head trauma caused by tra c or cerebrovascular accident, is high; and 2) the rapid transition to an aging society has led to an increase in the number of brain deaths in elderly patients with various underlying diseases, so organs that can be donated are often limited. [19][20][21][22] Apart from this, familial common good and mutual obligation are also strongly emphasized in many Asian countries; therefore, the number of living donor kidney transplants is signi cantly higher than that in other countries when considering the total number of transplantations, even without any special encouragement. [22] In this study, the willingness to donate a kidney was about half, and the targets of donations mainly were family members.…”

Perception Regarding Live Kidney Donation in the General Population of South Korea

“…[19][20][21][22] Apart from this, familial common good and mutual obligation are also strongly emphasized in many Asian countries; therefore, the number of living donor kidney transplants are signi cantly higher than that in other countries when considering the total number of transplantations, even without any special encouragement. [22] In this study, the willingness to donate a kidney was found to be about half, and the targets of donations were mostly family members. There seems to be no great reluctance to donate a kidney to family members, probably because this may have originated from the aforementioned Asian culture that values family relations.…”