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Martinelli V, Lumer ELL, Chiappedi M, Politi P, Gregorini M, Rampino T, Peri A, Pietrabissa A, Fusar-Poli L. Ethical Issues in Living Donor Kidney Transplantation: An Update from a Psychosocial Perspective. Healthcare (Basel) 2024; 12:1832. [PMID: 39337173 PMCID: PMC11431117 DOI: 10.3390/healthcare12181832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 09/05/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
Living donor kidney transplantation (LDKT) currently represents the treatment of choice for patients with end-stage renal failure. LDKT is a serious event with profound psychological, interpersonal, familial, and social implications. Over the last few years, there has been an exponential growth in living donation programs involving genetically and emotionally related donors, as well as people who donate to an unrelated and unknown subject. The implementation of paired exchange programs, Samaritan donation, and preemptive transplantation raise further ethical issues, which are inextricably linked to the unique psychosocial context of both the donor and the recipient. The present narrative review aims to provide an update on the main ethical challenges related to LDKT. We conducted a comprehensive literature search in PubMed/Medline. The results of the most relevant studies were narratively synthesized from a psychosocial perspective around the four principles of biomedical ethics: autonomy, beneficence, non-maleficence, and justice. Finally, we discussed the potential future directions to provide an effective, patient-centered, and ethical psychosocial assessment and follow-up of living donors and recipients that underwent LDKT.
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Affiliation(s)
- Valentina Martinelli
- General Surgery Unit 2, IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.P.); (A.P.)
- Harvey Medical Course, Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Estella L. L. Lumer
- Harvey Medical Course, Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Matteo Chiappedi
- Child Neurology and Psychiatry Unit, ASST Pavia, 27029 Vigevano, Italy;
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (P.P.); (L.F.-P.)
| | - Marilena Gregorini
- Nephrology, Dialysis and Transplant Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.G.); (T.R.)
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Teresa Rampino
- Nephrology, Dialysis and Transplant Unit, IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (M.G.); (T.R.)
- Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy
| | - Andrea Peri
- General Surgery Unit 2, IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.P.); (A.P.)
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Andrea Pietrabissa
- General Surgery Unit 2, IRCCS Policlinico San Matteo, 27100 Pavia, Italy; (A.P.); (A.P.)
- Department of Clinical-Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Laura Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (P.P.); (L.F.-P.)
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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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Thys K, Schwering KL, Siebelink M, Dobbels F, Borry P, Schotsmans P, Aujoulat I. Psychosocial impact of pediatric living-donor kidney and liver transplantation on recipients, donors, and the family: a systematic review. Transpl Int 2014; 28:270-80. [PMID: 25363518 DOI: 10.1111/tri.12481] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 08/18/2014] [Accepted: 10/24/2014] [Indexed: 11/27/2022]
Abstract
Living-donor kidney and liver transplantation intend to improve pediatric recipients' psychosocial well-being, but psychosocial impact in recipients strongly depends upon the impact on the donor and the quality of family relations. We systematically reviewed quantitative and qualitative studies addressing the psychosocial impact of pediatric living-donor kidney and liver transplantation in recipients, donors, and the family. In accordance with the PRISMA guidelines, we systematically searched the databases Medline, Web of Knowledge, Cinahl, Embase, ERIC, and Google Scholar. We identified 23 studies that satisfied our inclusion criteria. Recipients had improved coping skills and satisfactory peer relationships, but also reported anxiety and depressive symptoms, worried about the future, and had a negative body image. Similarly, donors experienced increased self-esteem, empowerment, and community awareness, but also complained of postoperative pain and a lack of emotional support. With respect to family impact, transplantation generated a special bond between the donor and the recipient, characterized by gratitude and admiration, but also raised new expectations concerning the recipient's lifestyle. As psychological problems in recipients were sometimes induced by feelings of guilt and indebtedness toward the donor, we recommend more research on how gift exchange dynamics function within donor-recipient relationships, enrolling donors and recipients within the same study.
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Affiliation(s)
- Kristof Thys
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Thys K, Van Assche K, Nobile H, Siebelink M, Aujoulat I, Schotsmans P, Dobbels F, Borry P. Could minors be living kidney donors? A systematic review of guidelines, position papers and reports. Transpl Int 2013; 26:949-60. [DOI: 10.1111/tri.12097] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/05/2013] [Accepted: 03/10/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Kristof Thys
- Centre for Biomedical Ethics and Law; University of Leuven; Belgium
| | - Kristof Van Assche
- Research Group on Law, Science, Technology and Society; Vrije Universiteit Brussel; Belgium
| | - Hélène Nobile
- Centre for Biomedical Ethics and Law; University of Leuven; Belgium
- German Institute of Human Nutrition (DIfE); Potsdam-Rehbrücke Germany
| | - Marion Siebelink
- University of Groningen; University Medical Centre Groningen; The Netherlands
| | - Isabelle Aujoulat
- Institute of Health & Society; Université Catholique de Louvain; Belgium
| | - Paul Schotsmans
- Centre for Biomedical Ethics and Law; University of Leuven; Belgium
| | - Fabienne Dobbels
- Centre for Health Services and Nursing Research; University of Leuven; Belgium
| | - Pascal Borry
- Centre for Biomedical Ethics and Law; University of Leuven; Belgium
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