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Lee Y, Park H, Jee HJ, Lee HJ, Gwon JG, Min H, Jung CW, Kim MG, Cho CH. Psychological characteristics and associations between living kidney transplantation recipients and biologically related or unrelated donors. BMC Nephrol 2020; 21:355. [PMID: 32819286 PMCID: PMC7441633 DOI: 10.1186/s12882-020-02017-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/12/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although recipients and donors in living kidney transplantation experience psychological distress-including depression and anxiety-during the pre-operative period, very few studies have evaluated the related psychological reactions. This study aimed to determine the characteristics and correlations of the mood states and personality of recipients and donors (genetically related and unrelated) of living kidney transplantations. METHODS A total of 66 pairs of living donors and recipients were enrolled from April 2008 to June 2019 in this study, of whom 53 eligible pairs of living donors and recipients were included in the retrospective analysis of their psychological assessments in the pre-transplantation states. While participants' personality patterns were assessed using the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), mood states were evaluated via both the State-Trait Anxiety Inventory (STAI) and The Center for Epidemiologic Studies Depression Scale (CES-D). Statistical analysis was performed using paired t-tests and Spearman's correlation analyses. RESULTS The recipient group showed significantly higher scores for Hypochondriasis (t = - 4.49, p = .0001), Depression (t = - 3.36, p = .0015), and Hysteria (t = - 3.30, p = .0018) of MMPI-2 and CES-D (t = - 3.93, p = .0003) than the donor group. The biologically unrelated recipient group reported higher scores of Hypochondriasis (t = - 3.37, p = .003) and Depression (t = - 2.86, p = 0.0098) than the unrelated donor group. Higher scores for Hypochondriasis (t = - 3.00, p = 0.0054) and CES-D (t = - 3.53, p = .0014) were found in the related recipient group. A positive association was found for Hypomania (r = .40, p = .003) of MMPI-2, STAI-S (r = .36, p = .009), and CES-D (r = .36, p = .008) between the recipient and donor groups. CONCLUSIONS Recipients suffered from a higher level of depression and somatic concerns than donors before living kidney transplantation. Psychological problems like depression and anxiety can occur in both living kidney transplantation donors and recipients. This study suggests that clinicians must pay attention to mood states not only in recipients but also in donors because of emotional contagion.
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Affiliation(s)
- Yujin Lee
- Department of Psychiatry, Seoul Metropolitan Eunpyeong Hospital, Seoul, South Korea
| | - Hyewon Park
- Department of Psychiatry, Samsung Biomedical Research Institute, Seoul, South Korea
| | - Hee-Jung Jee
- Department of Biostatistics, Korea University College of Medicine, Seoul, South Korea
| | - Heon-Jeong Lee
- Department of Psychiatry, Korea University College of Medicine, Seoul, South Korea
| | - Jun Gyo Gwon
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Hyeonjin Min
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Cheol Woong Jung
- Department of Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Myung-Gyu Kim
- Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Chul-Hyun Cho
- Department of Psychiatry, Chungnam National University Sejong Hospital, Sejong, South Korea.
- Department of Psychiatry, College of Medicine, Chungnam National University, 82 Munhwa-ro, Jung-gu, Daejeon, 35015, South Korea.
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Beier K, Wöhlke S. An ethical comparison of living kidney donation and surrogacy: understanding the relational dimension. Philos Ethics Humanit Med 2019; 14:13. [PMID: 31533778 PMCID: PMC6749634 DOI: 10.1186/s13010-019-0080-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 08/29/2019] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND The bioethical debates concerning living donation and surrogacy revolve around similar ethical questions and moral concepts. Nevertheless, the ethical discourses in both fields grew largely isolated from each other. METHODS Based on a review of ethical, sociological and anthropological research this paper aims to link the ethical discourses on living kidney donation and surrogacy by providing a comparative analysis of the two practices' relational dimension with regard to three aspects, i.e. the normative role of relational dynamics, social norms and gender roles, and reciprocity. Based on this analysis, we derive conclusions for the framing of living organ donation and surrogacy in ethical theory and practice. RESULTS First, our analysis emphasizes the relevance of acknowledging the complex relational implications of living kidney donation and surrogacy. Underestimating this relational dimension may not only lead to individual crises but endanger existing as well as newly emerging familial relationships. Second, we point out differences in the normative assessment of social norms and gender roles in the ethical debates about living kidney donation and surrogacy. In particular, we show how different evaluations of altruism affect the understanding of autonomy in both contexts. In addition, we sensitize for biased perceptions of gender roles. Finally, we argue that challenges resulting from unresolved reciprocity are an issue in living kidney donation and surrogacy independent of whether the exchange of body parts or bodily services is framed as a gift or commercial exchange. By pointing out the limits of financial compensation, we stress the relevance of non-material, relational rewards as potential remedy.
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Affiliation(s)
- Katharina Beier
- Department of Medical Ethics and History of Medicine, University Medical Center, 37073 Göttingen, Germany
| | - Sabine Wöhlke
- Department of Medical Ethics and History of Medicine, University Medical Center, 37073 Göttingen, Germany
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Ralph AF, Butow P, Craig JC, Wong G, Chadban SJ, Luxton G, Gutman T, Hanson CS, Ju A, Tong A. Living kidney donor and recipient perspectives on their relationship: longitudinal semi-structured interviews. BMJ Open 2019; 9:e026629. [PMID: 30948607 PMCID: PMC6500358 DOI: 10.1136/bmjopen-2018-026629] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Many donors and recipients report an improved bond posttransplantation; however, unexpected conflicts and tension may also occur. Insights into the lived experiences of the donor-recipient relationship can inform strategies for interventions and support. We aimed to describe donor and recipient expectations and experiences of their relationship before and after living kidney donor transplantation. DESIGN, SETTING AND PARTICIPANTS Semistructured interviews were conducted with 16 donor-recipient pairs before the transplant and 11-14 months post-transplant. Transcripts were analysed thematically. RESULTS We identified seven themes (with respective subthemes): donation as enacting familial responsibility for care; analytical decision making to mitigate regret (avoiding anticipated regret and maintaining control, removing emotional impulsivity); strengthened interpersonal ties (gaining a deeper appreciation among family members, stronger empathy for each other, improving social participation); instability of relational impacts (anger and aggression threatening dynamics, unanticipated stress and emotional lability, triggering familial tension); renegotiating social roles (unexpected continuation of caregiving responsibilities, inability to relinquish the caregiving role, disappointment with unfulfilled renewal of intimacy, dissatisfaction over discrepant energy levels); guilt over unmet expectations and inevitability of the gift relationship (vague and transient indebtedness, expectation of reciprocity, transferring kidney ownership). CONCLUSIONS Donor-recipient relationships may be improved through increased empathy, appreciation, and ability to participate in life together; however, unfulfilled expectations and behavioural and emotional changes in recipients (a side effect related to immunosuppression) remain unresolved consequences of living kidney donor transplantation. Education and counselling to help donors and recipients adjust to potential changes in relationship dynamics may help protect and foster relational stability postdonation.
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Affiliation(s)
- Angelique F Ralph
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, New South Wales, Australia
- Psycho-oncology Co-operative Research Group, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Medical Psychology and Evidence-Based Decision-Making, The University of Sydney, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Germaine Wong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Steve J Chadban
- Central Clinical School, University of Sydney, Camperdown, New South Wales, Australia
- Transplantation Services, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Grant Luxton
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Talia Gutman
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Camilla S Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Angela Ju
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
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Noda T, Kobayashi S, Sawamura J, Oshibuchi H, Nishimura K. Withdrawal of the Decision to Donate Kidney by Living Related Donors: A Single-center Study in Japan. Transplant Proc 2018; 50:3045-3052. [PMID: 30577164 DOI: 10.1016/j.transproceed.2018.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In Japan, 90% of kidney transplantations involve living related donors. A third-party interview is conducted during latter stages of preparation for transplantation to ensure the donor's voluntary decision-making. In this study, we investigated the factors responsible for withdrawal of decision for kidney donation by related living donors after third-party interview. METHODS Related living donor candidates were divided into 2 groups based on their final decision: those who finally donated the kidney (FDG; n = 435); and those who withdrew their decision after third-party interview (WG; n = 11). The psychosocial and medical variables were compared and the reasons for withdrawal were investigated. RESULTS Multiple logistic regression analysis revealed that none of the variables were significantly related to WG. Six categories of reasons for withdrawal were identified: "avoiding pregnancy risk"; "selecting alternative treatment"; "avoiding physical burden for donor"; "recipients' intemperance"; "need to take more time for decision-making"; and "psychological pressure." CONCLUSION A certain number of donor candidates withdrew their decision for different reasons, even in the latter stages of the transplant preparation. Careful verification of the donor candidates' individual situation and provision of adequate information and time are important to protect the donor's right to refuse.
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Affiliation(s)
- T Noda
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - S Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
| | - J Sawamura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - H Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - K Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
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Ross LF, Thistlethwaite JR. Developing an ethics framework for living donor transplantation. JOURNAL OF MEDICAL ETHICS 2018; 44:843-850. [PMID: 29973389 DOI: 10.1136/medethics-2018-104762] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 06/08/2023]
Abstract
Both living donor transplantation and human subjects research expose one set of individuals to clinical risks for the clinical benefits of others. In the Belmont Report, the National Commission for the Protection of Human Subjects of Biomedical and Behavior Research (National Commission) articulated three principles to serve as the basis for a research ethics framework: respect for persons, beneficence and justice. In contrast, living donor transplantation lacks a framework. In this manuscript, we adapt the three principles articulated in the Belmont Report to serve as the foundation for an ethics framework for living donor transplantation which we supplement with the principles of vulnerability and responsibility. The National Commission supported additional protections for vulnerable groups of potential research participants. In 2001, Kenneth Kipnis effectively argued that the concept of vulnerable groups failed to explore in what ways particular groups of people were vulnerable, thereby risking unnecessary protections for some and inadequate protections for others. He proposed a taxonomy that explored different types of vulnerabilities that all research participants may experience to provide a more robust framework for human subjects protections, which we adapt to living donors. Robert Goodin claims that health professionals, who stand in special relationship with patients, are responsible for promoting and protecting their well-being. In living donor transplantation, the donor transplant team is responsible for empowering prospective donors to address their vulnerabilities and/or for protecting those who cannot by disqualifying them from donation.
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Affiliation(s)
- Lainie F Ross
- Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
| | - J Richard Thistlethwaite
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
- MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois, USA
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Pérez-San-Gregorio MÁ, Martín-Rodríguez A, Luque-Budia A, Conrad R. Concerns, Mental Health, and Quality of Life in Living Kidney Donation-Parent Donor Candidates Worry Less about Themselves. Front Psychol 2017; 8:564. [PMID: 28443056 PMCID: PMC5387064 DOI: 10.3389/fpsyg.2017.00564] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/27/2017] [Indexed: 01/10/2023] Open
Abstract
Even though the majority of living kidney donor candidates appear in good mental health and show few concerns little is known concerning the influence of the type of donor-recipient relationship on donor candidates' specific concerns with regard to kidney donation. 136 donor candidates at Virgen del Rocío University Hospital of Seville filled in the Scale of Concerns Regarding Living Kidney Donation of whom 105 donor candidates and their corresponding recipients (105 patients with End-Stage Renal Disease) were further evaluated with regard to mental health (Hospital Anxiety and Depression Scale, Beck Depression Inventory-II) and quality of life (SF-36 Health Survey). As hypothesized recipients scored higher on depression and lower on quality of life. Donor candidates intending to donate to their children were significantly less concerned about risks of donation for themselves compared to donor candidates donating to siblings. Our findings highlight the importance of the type of donor-recipient relationship to understand specific concerns of donor candidates and optimize psychosocial assessment and support. From an evolutionary perspective parents lack of concern about their own well-being can be seen as an altruistic behavior to increase children's fitness at the (potential) expense of their own fitness.
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Affiliation(s)
| | - Agustín Martín-Rodríguez
- Department of Personality, Assessment, and Psychological Treatment, University of SevilleSeville, Spain
| | - Asunción Luque-Budia
- Liaison Mental Health Services, University Hospital Virgen del RocíoSeville, Spain
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University of BonnBonn, Germany
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7
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Ralph AF, Butow P, Hanson CS, Chadban SJ, Chapman JR, Craig JC, Kanellis J, Luxton G, Tong A. Donor and Recipient Views on Their Relationship in Living Kidney Donation: Thematic Synthesis of Qualitative Studies. Am J Kidney Dis 2016; 69:602-616. [PMID: 27889296 DOI: 10.1053/j.ajkd.2016.09.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/25/2016] [Indexed: 11/11/2022]
Abstract
BACKGROUND Many donors and recipients report an improved relationship after transplantation; however, tension, neglect, guilt, and proprietorial concern over the recipient can impede donor and recipient well-being and outcomes. We aimed to describe donor and recipient expectations and experiences of their relationship in the context of living kidney donation. STUDY DESIGN Thematic synthesis of qualitative studies. SETTING & POPULATION Living kidney donors and recipients. SEARCH STRATEGY & SOURCES Electronic databases were searched to October 2015. ANALYTICAL APPROACH Thematic synthesis. RESULTS From 40 studies involving 1,440 participants (889 donors and 551 recipients) from 13 countries, we identified 6 themes. "Burden of obligation" described the recipient's perpetual sense of duty to demonstrate gratitude to the donor. "Earning acceptance" was the expectation that donation would restore relationships. "Developing a unique connection" reflected the inexplicable bond that donor-recipient dyads developed postdonation. "Desiring attention" was expressed by donors who wanted recognition for the act of donation and were envious and resentful of the attention the recipient received. "Retaining kidney ownership" reflected the donor's inclination to ensure that the recipient protected "their" kidney. "Enhancing social participation" encompassed relieving both the caregiver from the constraints of dialysis and the recipient from increased involvement and contribution in family life. LIMITATIONS Non-English articles were excluded. CONCLUSIONS Living kidney donation can strengthen donor-recipient relationships but may trigger or exacerbate unresolved angst, tension, jealousy, and resentment. Facilitating access to pre- and posttransplantation psychological support that addresses potential relationship changes may help donors and recipients better adjust to changes in the relationship dynamics, which in turn may contribute to improved psychosocial and transplantation outcomes following living kidney donation.
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Affiliation(s)
- Angelique F Ralph
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; School of Psychology, The University of Sydney, Sydney, NSW, Australia.
| | - Phyllis Butow
- School of Psychology, The University of Sydney, Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group, The University of Sydney, Sydney, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, NSW, Australia
| | - Camilla S Hanson
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Steve J Chadban
- Central Clinical School, The University of Sydney, Sydney, NSW, Australia; Transplantation Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jeremy R Chapman
- Centre for Transplant and Renal Research, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Medicine, Monash University, Clayton, VIC, Australia
| | - Grant Luxton
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia
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8
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Voultsos P, Raikos N, Vasileiadis N, Spiliopoulou C, Tarlatzis B. Ethico-legal issues related to ovarian tissue transplantation. MEDICINE, SCIENCE, AND THE LAW 2016; 56:293-304. [PMID: 27381404 DOI: 10.1177/0025802416657685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Ovarian tissue transplantation (OTT) is a promising experimental method which may soon become well-established. In cases of minor oncology, where patients' fertility is seriously threatened by treatment, it may be applied as a unique fertility preservation option. OTT has a dual nature ('organ' and 'gamete'). Many stakeholders are involved, including donor, recipient, child, health-care providers and society at large. There is considerable uncertainty about the long-term consequences of the application of OTT and OT cryopreservation (OTC). Thus, application of OTT gives rise to a number of very different ethico-legal issues and dilemmas which are hard to solve coherently through a principlism-based bioethical approach. This study focuses on such dilemmas and attempts to review them. The role of virtue ethics, which may be combined with principlism, is essential to solve such dilemmas coherently and reasonably. Dealing with conflicts of ethical principles equivalent between them, or moral dilemmas without available answers and mind-sharing in a difficult interpersonal process of decision making, requires a virtue-based ethical approach. Besides, ethico-legal issues related to OTC/OTT are complex issues requiring a multidisciplinary approach (ethical considerations, medical, psychological and social evaluations etc.). We stress the crucial role of multidisciplinary Ethics Committee which is considered indispensable for each reproductive health-care unit practicing OTC/OTT.
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Affiliation(s)
- P Voultsos
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - N Raikos
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - N Vasileiadis
- 1 Department of Forensic Medicine and Toxicology, Faculty of Medicine, Aristotle University of Thessaloniki, Greece
| | - Ch Spiliopoulou
- 2 Department of Forensic Medicine and Toxicology, School of Medicine, National and Kapodistrian University of Athens, Greece
| | - B Tarlatzis
- 3 Infertility and IVF Center, Department of Obstetrics and Gynaecology, Medical School, Aristotle University of Thessaloniki, Greece
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9
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Sirois F. Perspectives sur l’expérience psychique de la transplantation et de l’implantation. EVOLUTION PSYCHIATRIQUE 2016. [DOI: 10.1016/j.evopsy.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Ummel D, Achille M. Transplant Trajectory and Relational Experience Within Living Kidney Dyads. QUALITATIVE HEALTH RESEARCH 2016; 26:194-203. [PMID: 25700284 DOI: 10.1177/1049732315570128] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Living kidney donation is considered common practice across most Westernized countries. While extensive research has documented the experience of living donors, few studies have addressed the perspective of recipients, and even fewer have examined the experience of donor and recipient as an interactive dyad. In this study, our aim was to examine the reciprocal influence between donors and recipients across the transplantation process. We recruited a homogeneous sample of 10 donors and recipients, who were interviewed individually. Data were analyzed using interpretative phenomenological analysis. The presentation of results follows the stages of the transplantation process: the disease experience, the experience of offering and accepting a kidney, the screening period, the surgery, and the post-transplantation period. Results are discussed within the framework of Mauss's gift exchange theory, social roles, and altruism. This comprehensive description of the dyadic experience provides a way to frame and understand psychosocial aspects and relational implications of living renal transplantation.
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Affiliation(s)
- Deborah Ummel
- Department of psychology, Université de Montréal, Montréal, Québec, Canada
| | - Marie Achille
- Department of psychology, Université de Montréal, Montréal, Québec, Canada
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11
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Agerskov H, Ludvigsen MS, Bistrup C, Pedersen BD. From donation to everyday life: Living kidney donors' experiences three months after donation. J Ren Care 2015; 42:43-52. [PMID: 26463844 DOI: 10.1111/jorc.12137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND As the number of patients with end stage kidney disease continues to rise internationally, living kidney donation remains a favourable treatment option. Long waiting times on dialysis can be avoided and short and long-term outcomes are better, when compared with deceased donor transplantation. Living kidney donation is a safe procedure for healthy individuals who have completed a rigorous screening programme. Significant experiences can occur during the recovery period. OBJECTIVE To investigate donors' experiences of donation and their recovery period, in the first three months after donation. MATERIALS AND METHODS The study took a phenomenological-hermeneutic approach. Open interviews were conducted three months after donation. Data were interpreted and discussed in accordance with Ricoeur's text interpretation theory on three levels: naïve reading, structural analysis and critical interpretation and discussion. FINDINGS The donation process was experienced as an 'expedition', including preparations, the operation, recovery and everyday life. Positive feelings were challenging to describe; however health troubles and vulnerability were evident. A closer relationship and a need to follow the recipient's progress implied that patient and donor felt they were a part of each other. Support from relatives was important but could also be a burden. CONCLUSION The kidney donation process is experienced as being like on an expedition, involving positive feelings, vulnerability, a closer patient-donor relationship and challenges around family relationships. It is essential that nurses are aware of the complexity of the situation and focus on the impact of the process, to support and facilitate donors' needs.
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Affiliation(s)
- Hanne Agerskov
- Research Unit of Nursing, University of Southern Denmark Department of Nephrology, Odense University Hospital, Odense, Denmark
| | | | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Birthe D Pedersen
- Research Unit of Nursing, University of Southern Denmark, Funen, Denmark
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12
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Serur D, Charlton M, Bretzlaff G, Sinacore J, Christos P, Gordon-Elliott J. Is donating a kidney to a friend bad for your marriage? Nephrology (Carlton) 2015; 20:434-6. [PMID: 25900385 DOI: 10.1111/nep.12426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Studies have shown that kidney donation to a spouse has a positive impact on marriage. This study was done to evaluate the impact on marriage when donation occurs to someone other than the spouse. Two groups of donors from our centre who donated around the same period were studied: donation to a spouse (spouse donor (SD)) or to someone other than the spouse (non-spouse donor (ND)). A survey, the Revised Dyadic Adjustment Scale, was used to evaluate the effect of donation on the marriage. This tool consists of 14 questions that measure how satisfying and stable the relationship is. The results showed equal or better marriage scores in the ND group compared with the SD group. The NDs scored higher on two questions, one regarding agreement or disagreement on career choices (P = 0.05) and the other regarding the frequency of having stimulating exchanges of ideas with one's spouse (P = 0.02). With the highest possible total score of 69, NDs scored 53.4 and SDs scored 47.7 (P = 0.16). Scores of 47 and below indicate marital distress. In one final additional question, 97% of NDs reported 'no change or good effect' on the marriage, similar to 91% for SDs (P = 0.46). This is the first study to evaluate the effect of kidney donation on the state of marriage when the spouse is not the recipient. It appears that marriage is not impacted negatively when kidney donation occurs to someone other than the spouse.
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Affiliation(s)
- David Serur
- Division of Nephrology and the Rogosin Institute, New York Presbyterian Weill Cornell, New York, USA
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13
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De Pasquale C, Veroux M, Indelicato L, Sinagra N, Giaquinta A, Fornaro M, Veroux P, Pistorio ML. Psychopathological aspects of kidney transplantation: Efficacy of a multidisciplinary team. World J Transplant 2014; 4:267-75. [PMID: 25540735 PMCID: PMC4274596 DOI: 10.5500/wjt.v4.i4.267] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/02/2014] [Accepted: 05/29/2014] [Indexed: 02/05/2023] Open
Abstract
Renal transplantation is a well established treatment for end-stage renal disease, allowing most patients to return to a satisfactory quality of life. Studies have identified many problems that may affect adaptation to the transplanted condition and post-operative compliance. The psychological implications of transplantation have important consequences even on strictly physical aspects. Organ transplantation is very challenging for the patient and acts as an intense stressor stimulus to which the patient reacts with neurotransmitter and endocrine-metabolic changes. Transplantation can result in a psychosomatic crisis that requires the patient to mobilize all bio-psycho-social resources during the process of adaptation to the new foreign organ which may result in an alteration in self-representation and identity, with possible psychopathologic repercussions. These reactions are feasible in mental disorders, e.g., post-traumatic stress disorder, adjustment disorder, and psychosomatic disorders. In organ transplantation, the fruitful collaboration between professionals with diverse scientific expertise, calls for both a guarantee for mental health and greater effectiveness in challenging treatments for a viable association between patients, family members and doctors. Integrated and multidisciplinary care should include uniform criteria and procedures for standard assessments, for patient autonomy, adherence to therapy, new coping strategies and the adoption of more appropriate lifestyles.
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Kisch A, Bolmsjö I, Lenhoff S, Bengtsson M. Having a sibling as donor: Patients' experiences immediately before allogeneic hematopoietic stem cell transplantation. Eur J Oncol Nurs 2014; 18:436-42. [DOI: 10.1016/j.ejon.2014.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 03/06/2014] [Accepted: 03/13/2014] [Indexed: 11/29/2022]
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Quintin J. Organ transplantation and meaning of life: the quest for self fulfilment. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:565-574. [PMID: 23014955 PMCID: PMC3696169 DOI: 10.1007/s11019-012-9439-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Today, the frequency and the rate of success resulting from advances in medicine have made organ transplantations an everyday occurrence. Still, organ transplantations and donations modify the subjective experience of human beings as regards the image they have of themselves, of body, of life and of death. If the concern of the quality of life and the survival of the patients is a completely human phenomenon, the fact remains that the possibility of organ transplantation and its justification depend a great deal on the culture in which we live. The exploration of the philosophical tradition allows for a reconsideration of organ transplantation. If we listen to people who have experienced the decline of one of their organs and their own rebirth through the organ of someone else, we arrive at the conclusion that they went through an extreme experience in which nothing appeared as before. All those experiences intensify philosophical questionings on the meaning of life with respect to self fulfilment. The concept of nature as the experience of others can be an authentic source from which to nourish our thoughts about organ transplantation. However, and this is our hypothesis, we need something more if we are to decide something about our own life. We need a hermeneutical stance in relation to ourselves and to our world. Philosophical counselling, as a long established tradition originating with Pythagoras and later reframed by the German philosopher Achenbach could be useful in inspiring a reflection on the good life, chiefly as it takes the form of a Socratic dialogue.
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Affiliation(s)
- Jacques Quintin
- Université de Sherbrooke, 97 Heneker, Sherbrooke, QC J1J 3G2, Canada.
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Kisu I, Banno K, Mihara M, Suganuma N, Aoki D. Current status of uterus transplantation in primates and issues for clinical application. Fertil Steril 2013; 100:280-94. [DOI: 10.1016/j.fertnstert.2013.03.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 03/02/2013] [Accepted: 03/06/2013] [Indexed: 01/14/2023]
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Smith SW, Hitt R, Nazione S, Lauckner C, Park HS, Sung R, Leichtman A. Comparison of communication and personal characteristics of living kidney donors and a matched quota sample. Clin Transplant 2012; 27:104-12. [PMID: 23072546 DOI: 10.1111/ctr.12026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2012] [Indexed: 11/29/2022]
Abstract
Deceased organ donation does not meet the need for kidney transplants. Thus, it is important to examine topics relevant to kidney donors such as communication leading to the donation decision and donor characteristics. This study reports personal characteristics and communication leading to the decision to donate among living kidney donors and a demographically matched quota sample. Donors had higher scores for compassion, while non-donors reported more volunteerism. Donors and non-donors did not differ in conversation or conformity orientations of family communication styles. Only 4.7% of donors reported being asked to donate directly. Matched respondents reported feeling more comfortable than unsettled with the idea of being asked directly and indicated a preference to learn of the need directly or indirectly, giving them the option to volunteer. The majority of donors were giving to family members and friends, and the matched sample indicated greater willingness to donate to immediate family members, followed by friends. Practical implications of the findings are offered.
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Affiliation(s)
- Sandi W Smith
- Department of Communication, Michigan State University, East Lansing, MI 48824, USA.
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18
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de Groot IB, Schipper K, van Dijk S, van der Boog PJM, Stiggelbout AM, Baranski AG, Marang-van de Mheen PJ. Decision making around living and deceased donor kidney transplantation: a qualitative study exploring the importance of expected relationship changes. BMC Nephrol 2012; 13:103. [PMID: 22958636 PMCID: PMC3493312 DOI: 10.1186/1471-2369-13-103] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 09/07/2012] [Indexed: 12/28/2022] Open
Abstract
Background Limited data exist on the impact of living kidney donation on the donor-recipient relationship. Purpose of this study was to explore motivations to donate or accept a (living donor) kidney, whether expected relationship changes influence decision making and whether relationship changes are actually experienced. Methods We conducted 6 focus groups in 47 of 114 invited individuals (41%), asking retrospectively about motivations and decision making around transplantation. We used qualitative and quantitative methods to analyze the focus group transcripts. Results Most deceased donor kidney recipients had a potential living donor available which they refused or did not want. They mostly waited for a deceased donor because of concern for the donor’s health (75%). They more often expected negative relationship changes than living donor kidney recipients (75% vs. 27%, p = 0.01) who also expected positive changes. Living donor kidney recipients mostly accepted the kidney to improve their own quality of life (47%). Donors mostly donated a kidney because transplantation would make the recipient less dependent (25%). After transplantation both positive and negative relationship changes are experienced. Conclusion Expected relationship changes and concerns about the donor’s health lead some kidney patients to wait for a deceased donor, despite having a potential living donor available. Further research is needed to assess whether this concerns a selected group.
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Affiliation(s)
- Ingrid B de Groot
- Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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Kadioglu Z, Kacar S, Eroglu A, Guven B, Tilif S. Dyadic Adjustment and Psychological Concordance of Kidney Transplant Recipients and Donors after Spousal Transplantation. Transplant Proc 2012; 44:1608-13. [DOI: 10.1016/j.transproceed.2012.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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[The influence of relationship dynamics on the psychosocial outcome of genetically related and unrelated living kidney donor-recipient pairs]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2012; 58:84-91. [PMID: 22427127 DOI: 10.13109/zptm.2012.58.1.84] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Renal diseases and their treatment can cause distress and psychosocial problems for both patients and relatives. METHODS Relationship dynamics and parameters of quality of life were assessed in 10 genetically related (brothers) and 14 genetically unrelated donor-recipient pairs (spouses) involved in living kidney donation (LKD). RESULTS LKDs were described by related donors and recipients as fundamentally positive and in many cases led to an intensification of the relationship between donor and recipient. LKDs between unrelated donors and recipients appeared to achieve the same results as donations between related donors and recipients. Particularly the general desire to help determined the decision-making process of donors. CONCLUSION In addition to general clinical parameters, especially motivational and relationship dynamics should be evaluated in the pre- and postoperative clinical psychological assessment of potential donors and recipients of LKD.
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Lefkowitz A, Edwards M, Balayla J. The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Transpl Int 2012; 25:439-47. [DOI: 10.1111/j.1432-2277.2012.01438.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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22
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Aujoulat I, Schwering KL, Reding R. Living-related donation: a challenge to adolescent transplant recipients who transit from parental care to self-managed care. Child Care Health Dev 2012; 38:146-8. [PMID: 21902712 DOI: 10.1111/j.1365-2214.2011.01309.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Abstract
In the literature, varying terminology for living organ donation can be found. However, there seems to be a need for a new classification to avoid confusion. Therefore, we assessed existing terminology in the light of current living organ donation practices and suggest a more straightforward classification. We propose to concentrate on the degree of specificity with which donors identify intended recipients and to subsequently verify whether the donation to these recipients occurs directly or indirectly. According to this approach, one could distinguish between "specified" and "unspecified" donation. Within specified donation, a distinction can be made between "direct" and "indirect" donation.
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Kaptein AA, van Dijk S, Broadbent E, Falzon L, Thong M, Dekker FW. Behavioural research in patients with end-stage renal disease: a review and research agenda. PATIENT EDUCATION AND COUNSELING 2010; 81:23-29. [PMID: 19954916 DOI: 10.1016/j.pec.2009.10.031] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 09/03/2009] [Accepted: 10/25/2009] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To suggest a behavioural research agenda for patients with end-stage renal disease (ESRD) based on a concise review of seven stages of psychosocial research, a literature review, and current behavioural research in other chronic somatic diseases. METHODS Historical behavioural ESRD research was classified. The specialized register of the Cochrane Behavioral Medicine Field was also checked, and additional papers were selected by screening reference lists and related behavioural science journals, to identify promising areas for future research. RESULTS The top-five topics identified via the literature search pertain to (1) psychological aspects and interventions, (2) adaptation, coping, and depression, (3) exercise, (4) counseling and education, and (5) compliance. 'Illness and treatment beliefs', 'sexuality', 'suicide', 'family support', and 'self-management interventions', were identified on the basis of research in other chronic illnesses as topics for future research. Regarding theory, the Common-Sense Model (CSM) was judged to offer useful theoretical perspectives; regarding methods, qualitative methods can be a valuable addition to quantitative research methods. CONCLUSION Illness beliefs, treatment beliefs, and self-management behaviours are promising concepts in the assessment and clinical care of ESRD-patients. Cognitive-behavioural treatments appear to have potential and should be specified and elaborated for specific categories and problems of ESRD-patients. PRACTICE IMPLICATIONS This research agenda is in line with moves towards patient-centred disease-management to improve the quality of medical care for ESRD-patients.
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Affiliation(s)
- Ad A Kaptein
- Unit of Psychology, LUMC, Leiden, The Netherlands.
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26
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Langenbach M, Stippel A, Stippel D. Kidney Donors' Quality of Life and Subjective Evaluation at 2 Years After Donation. Transplant Proc 2009; 41:2512-4. [DOI: 10.1016/j.transproceed.2009.06.122] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Current world literature. Curr Opin Organ Transplant 2009; 14:211-7. [PMID: 19307967 DOI: 10.1097/mot.0b013e32832ad721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abraham EC, Wilson AC, Goebel J. Current kidney allocation rules and their impact on a pediatric transplant center. Am J Transplant 2009; 9:404-8. [PMID: 19178416 DOI: 10.1111/j.1600-6143.2008.02504.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In 2005, kidney allocation rules in the United States were updated to enhance access to kidneys from young adult deceased donors (DDs) for pediatric recipients. We studied how this rule change affected transplant activity at our pediatric center. We retrospectively compared kidney transplant activity at our center since the rule change (until December 31, 2007) to before the change (n = 36 each), focusing on those recipients directly affected by it, that is, younger than 18 years. There were no significant differences in recipients' age, gender or ethnicity before versus after the rule change. Percentages of preemptive transplants and retransplants were similar in both groups, as was the percentage of sensitized patients. There was a significant decrease in overall, but not DD, mean donor age. Mean wait time for DD kidneys decreased for pediatric recipients. Increases were found in percentage of DD transplants and in mean HLA mismatches after the rule change. Patient and short-term graft survival were not significantly different. These data suggest that the allocation rule change was not only followed by improvement in overall access to kidney transplantation for children, but also by decreases in living donor transplants and HLA matching. Larger studies are needed to evaluate the long-term impact of the change.
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Affiliation(s)
- E C Abraham
- Department of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
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Kranenburg LW, Richards M, Zuidema WC, Weimar W, Hilhorst MT, IJzermans JNM, Passchier J, Busschbach JJV. Avoiding the issue: patients' (non)communication with potential living kidney donors. PATIENT EDUCATION AND COUNSELING 2009; 74:39-44. [PMID: 18752913 DOI: 10.1016/j.pec.2008.07.028] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Revised: 07/09/2008] [Accepted: 07/10/2008] [Indexed: 05/16/2023]
Abstract
OBJECTIVE Kidney transplantation with a living donor has proved to be an effective solution for kidney patients on the waiting list for transplantation. Nevertheless, it may be difficult to find a living kidney donor. The purpose of this explorative study is to investigate how kidney transplant candidates may, or may not, find a living donor in the Netherlands. METHODS We compared a group of 42 patients who did not find a living donor with a group of 42 patients who did, using semi-structured interviews. RESULTS We found that, although almost all patients recognized the advantages of living kidney donation and were willing to accept the offer of a living kidney donor, many found it very difficult to ask a potential donor directly. This was true for both groups. CONCLUSION Patients may gain from professional support to deal with this situation in ways that balance their medical needs and their personal relationships. PRACTICE IMPLICATIONS Support programs should be developed to assist patients in developing strategies for discussing living kidney donation with potential donors.
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Affiliation(s)
- Leonieke W Kranenburg
- Erasmus University Medical Centre, Department of Medical Psychology & Psychotherapy, Rotterdam, The Netherlands.
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The dynamics of kidney donation: viewpoints from the donor, the recipients, and the transplant team. Kidney Int 2008; 73:1108-10. [PMID: 18449178 DOI: 10.1038/ki.2008.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Living kidney transplantation has become increasingly widespread to reduce organ shortage. Very few studies have prospectively investigated the donor's long-term risks. Living donation is a complex medical decision in which different actors are involved. This therapeutic option needs educational programs for potential donors, recipients, and transplant professionals to make them aware of the possible risks and benefits. It is important to fully exploit living-donor kidney transplantation.
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