Bone marrow donation in childhood: one donor's perspective

The Meaning of Being a Living Kidney, Liver, or Stem Cell Donor-A Meta-Ethnography

BACKGROUND

Studies on living donors from the donors' perspective show that the donation process involves both positive and negative feelings involving vulnerability. Qualitative studies of living kidney, liver, and allogeneic hematopoietic stem cell donors have not previously been merged in the same analysis. Therefore, our aim was to synthesize current knowledge of these donors' experiences to deepen understanding of the meaning of being a living donor for the purpose of saving or extending someone's life.

METHODS

The meta-ethnography steps presented by Noblit and Hare in 1988 were used.

RESULTS

Forty-one qualitative studies from 1968 to 2016 that fulfilled the inclusion criteria were analyzed. The studies comprised experiences of over 670 donors. The time since donation varied from 2 days to 29 years. A majority of the studies, 25 of 41, were on living kidney donors. The synthesis revealed that the essential meaning of being a donor is doing what one feels one has to do, involving 6 themes; A sense of responsibility, loneliness and abandonment, suffering, pride and gratitude, a sense of togetherness, and a life changing event.

CONCLUSIONS

The main issue is that one donates irrespective of what one donates. The relationship to the recipient determines the motives for donation. The deeper insight into the donors' experiences provides implications for their psychological care.

Data mining of mental health issues of non-bone marrow donor siblings

Background

Allogenic hematopoietic stem cell transplantation is a curative treatment for patients with advanced hematologic malignancies. However, the long-term mental health issues of siblings who were not selected as donors (non-donor siblings, NDS) in the transplantation have not been well assessed. Data mining is useful in discovering new findings from a large, multidisciplinary data set and the Scenario Map analysis is a novel approach which allows extracting keywords linking different conditions/events from text data of interviews even when the keywords appeared infrequently. The aim of this study is to assess mental health issues on NDSs and to find helpful keywords for the clinical follow-up using a Scenario Map analysis.

Findings

A 47-year-old woman whose younger sister had undergone allogenic hematopoietic stem cell transplantation 20 years earlier was interviewed as a NDS. The text data from the interview transcriptions was analyzed using Scenario Mapping. Four clusters of words and six keywords were identified. Upon review of the word clusters and keywords, both the subject and researchers noticed that the subject has had mental health issues since the disease onset to date with being a NDS. The issues have been alleviated by her family.

Conclusions

This single subject study suggested the advantages of data mining in clinical follow-up for mental health issues of patients and/or their families.

Supporting Siblings Through the Pediatric Bone Marrow Transplant Trajectory

When a child undergoes bone marrow transplant (BMT), the entire family is affected by the demands of the transitions encountered throughout the BMT experience. Although there is a growing body of knowledge on how healthy siblings adjust to the BMT experience, there is still much to be learned. Part of a larger study aimed at detailing healthy siblings' lived experiences of BMT, this article presents findings specific to one of the study's objectives that focused on understanding siblings' perspectives of how nurses and other health professionals can best support siblings throughout the BMT trajectory. A qualitative research study guided by the philosophy of hermeneutic phenomenology was conducted. Eight siblings of pediatric BMT recipients were recruited. Semistructured, open-ended interviews, demographic data, and field notes were the primary sources of data. Interview transcripts were analyzed and interpreted using van Manen's approach. Seven themes emerged: (1) include me in the definition of "family," (2) be caring, (3) share information with me, (4) give me choices, (5) help me share my feelings, (6) provide opportunities for me to meet my peers, and (7) create a healthy hospital environment. Findings showed that siblings have definite thoughts about how nurses and other health professionals should support them, but their support needs are not being met.

An Interruption in Family Life: Siblings' Lived Experience as They Transition Through the Pediatric Bone Marrow Transplant Trajectory

PURPOSE/OBJECTIVES

To arrive at an understanding of the lived experience of healthy donor and nondonor siblings as they transition through the bone marrow transplantation (BMT) trajectory.

RESEARCH APPROACH

Qualitative study guided by the philosophy of hermeneutic phenomenology.

SETTING

Participants' homes or the investigator's university or hospital office.

PARTICIPANTS

Eight siblings of pediatric BMT recipients were recruited based on their knowledge of the experience of transitioning through the BMT trajectory.

METHODOLOGIC APPROACH

Data were collected by semistructured, open-ended interviews; demographic forms; and field notes during a period of six months. Data analysis occurred concurrently with data collection. Thematic statements were isolated using Van Manen's selective highlighting approach. Interviews were reviewed repeatedly for significant statements.

MAIN RESEARCH VARIABLE

Siblings' lived experience of the BMT trajectory.

FINDINGS

Interruption in family life emerged as the essence of siblings' lived experience. Four themes supported this essence: life goes on, feeling more or less a part of a family, faith in God that things will be okay, and feelings around families.

CONCLUSIONS

Hermeneutic phenomenologic research increases understanding of what being a sibling of a pediatric BMT recipient means. This study is one of the few that have afforded siblings the opportunity to speak about what is important to them.

INTERPRETATION

Findings from this study provide insight into how siblings live and cope throughout the BMT trajectory and will guide nurses as they seek to provide more sensitive and comprehensive care.

Living donor transplantation between twins: guidance for Donor Advocate Teams

Using a clinical case, this paper explores the ethical complexities of assessing potential living organ donors when the proposed donor-recipient pair consists of monozygotic (identical) or dizygotic (fraternal) twins. While all donor-recipient pairs can present various ethical and psychosocial challenges, the challenges of twin pairs are unique and especially complex. Donor Advocate Teams need to be aware of these unique issues and address them during their assessment process.