Patients' attitudes towards living kidney donation: Systematic review and thematic synthesis of qualitative research

• Published in: Transplantation Vol. 96; p. 421
• Main Authors: Hanson, Camila S, Chadban, Steven, Chapman, Jeremy R, Craig, Jonathan C, Wong, Germaine, Tong, Allison
• Format: Journal Article
• Language: English
• Published: 27-11-2013
• ISSN: 0041-1337

Living donor kidney transplantation can offer optimal clinical outcomes for recipients compared with dialysis or deceased donor transplants. However, decision-making can be complex for patients, given the medical and psychosocial risks to donors. This study aimed to describe the beliefs, attitudes, and expectations of patients with chronic kidney disease (CKD) towards living kidney donation. We conducted a systematic review of qualitative studies of patients' attitudes towards living kidney donation using a comprehensive literature search to February 2013. Thematic synthesis was used to analyse the findings. Thirty-seven studies involving 1732 patients with CKD (stages 1-5) were included. We identified five major themes: prioritising health (better graft survival, urgency and desperation, resuming normal life, accepting risk, active self-advocacy); burden of responsibility (jeopardising donor health, anticipated donor regret, fear of graft failure, donor inconvenience); sensitive and cautious communication (donor initiation, respectful communication, decisional pressure, donor unsuitability, lacking self-efficacy, emotional vulnerability); shifting relationship dynamics (strengthened bonds, tension and conflict, unrelenting indebtedness, maintaining self-reliance, renegotiating relationship roles); and support structures (religious altruism, family loyalty, limited professional support). Patients believed a living kidney donation could offer a lifesaving treatment with minimal medical risk to themselves or donors. However, patients felt accountable for potential adverse outcomes like graft failure and donor health complications, and feared their donor would regret their decision to donate. Initiating discussions with potential donors was emotionally challenging for patients. Clarifying, validating and addressing these concerns, coupled with education and psychosocial support can empower patients to make informed decisions about living kidney donation.