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Loban K, El Wazze S, Milland T, Hales L, Slominska A, Sandal S. Experiences of living kidney donors: A synthesis of unsolicited patient narratives. Transplant Rev (Orlando) 2024; 38:100855. [PMID: 38657495 DOI: 10.1016/j.trre.2024.100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Despite the lauded benefits of living kidney donation, there is growing evidence of the challenges that living kidney donors (LKD) encounter in their donation trajectory and gaps in healthcare service provision. However, most of the evidence is derived from research conducted by clinicians or academic investigators. Significantly less attention has been devoted to analyzing unsolicited accounts of LKDs' experiences. METHODS We conducted a review and synthesis of published unsolicited first-person narratives of LKDs and aimed to synthesize their experiences and identify care needs. Four electronic databases were searched and 27 LKD narratives were included in our final analysis. Thematic synthesis was used to generate themes inductively. RESULTS Although the majority of LKDs reported the act of donation to be a fulfilling experience, almost 48% reported encountering challenges in the care that they received. Also, 29% of LKDs reported experiencing an adverse clinical event. Five distinct themes emerged surrounding the donation experience and healthcare needs: 1) Educational needs due to perceived lack of transparency and compensating for knowledge gaps; 2) Respect for donor autonomy due to coercive influences from family or healthcare providers, lack of respect for donor preferences and loopholes in the consent process; 3) Unmet care needs related to poor communication with healthcare providers, coordination issues and inconsistent and inadequate long-term care; 4) Unanticipated outcomes due to economic costs and the emotional burden of donation; and 5) Contributing beyond the donation event by advocating for a balanced view of donation and generating support mechanisms. CONCLUSION In this synthesis of LKDs narratives, important care gaps and the need to advocate for a balanced perspective on living kidney donation were highlighted. Our review underscores the value of patients' own stories as critical evidence that can inform improvement in healthcare service delivery.
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Affiliation(s)
- Katya Loban
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Saly El Wazze
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Théa Milland
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Lindsay Hales
- Library Services, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Anita Slominska
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
| | - Shaifali Sandal
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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Loban K, Milland T, Hales L, Lam NN, Dipchand C, Sandal S. Understanding the Healthcare Needs of Living Kidney Donors Using the Picker Principles of Patient-centered Care: A Scoping Review. Transplantation 2024:00007890-990000000-00770. [PMID: 38773835 DOI: 10.1097/tp.0000000000005080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
Living kidney donors (LKDs) undertake a complex and multifaceted journey when pursuing donation and have several unmet healthcare needs. A comprehensive understanding of these needs across their entire donation trajectory can help develop a patient-centered care model. We conducted a scoping review to synthesize empirical evidence, published since 2000, on LKDs' experiences with healthcare from when they decided to pursue donation to postdonation care, and what they reported as their care needs. We categorized them according to the 8 Picker principles of patient-centered care. Of the 4514 articles screened, 47 were included. Ample literature highlighted the need for (1) holistic, adaptable, and linguistically appropriate approaches to education and information; (2) systematic, consistent, and proactive coordination and integration of care; and (3) self-management and preparation to optimize perioperative physical comfort. Some literature highlighted the need for (4) better continuity and transition of care postdonation. Two key unmet needs were the lack of (5) a holistic psychosocial evaluation predonation and predischarge to provide emotional support and alleviation of fear and anxiety; and (6) access to specialty and psychosocial services postdonation especially when adverse events occurred. Limited literature explored the principles of (7) respect for patients' values, preferences, and expressed needs; and (8) involvement of family and friends as caregivers. We summarize several unmet healthcare needs of LKDs throughout their donation journey and highlight knowledge gaps. Addressing them can improve their well-being and experiences, and potentially address inequities in living kidney donation and increase living donor kidney transplantation.
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Affiliation(s)
- Katya Loban
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Thea Milland
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Lindsay Hales
- Library Services, McGill University Health Centre, Montreal, QC, Canada
| | - Ngan N Lam
- Division of Nephrology, Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Christine Dipchand
- Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Shaifali Sandal
- MEDIC, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
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Loban K, Fadel E, Nugus P, Przybylak-Brouillard A, Badenoch H, Robert JT, Bugeja A, Gill J, Fortin MC, Rodriguez C, Sandal S. Living kidney donors' health care needs, experiences, and perspectives across their entire donation trajectory: a semistructured, in-depth interview study. Kidney Int 2024; 105:251-258. [PMID: 38008162 DOI: 10.1016/j.kint.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/27/2023] [Accepted: 11/10/2023] [Indexed: 11/28/2023]
Affiliation(s)
- Katya Loban
- Metabolic Disorders and Complications Program (MEDIC), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Elie Fadel
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Peter Nugus
- Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Antoine Przybylak-Brouillard
- Metabolic Disorders and Complications Program (MEDIC), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Institute of Health Sciences Education, McGill University, Montreal, Quebec, Canada
| | - Heather Badenoch
- Patient Partner, Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Jorane-Tiana Robert
- Metabolic Disorders and Complications Program (MEDIC), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Ann Bugeja
- Division of Nephrology, Department of Medicine, the Ottawa Hospital, Ottawa, Ontario, Canada; Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Justin Gill
- Division of Nephrology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Charo Rodriguez
- Patient Partner, Canadian Donation and Transplantation Research Program, Edmonton, Alberta, Canada
| | - Shaifali Sandal
- Metabolic Disorders and Complications Program (MEDIC), Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada; Division of Experimental Medicine, Department of Medicine, McGill University, Montreal, Quebec, Canada; Division of Nephrology, Department of Medicine, McGill University, Montreal, Quebec, Canada.
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Loban K, Alam A, Sandal S. The need for better donor engagement and outreach with legacy living kidney donors. Clin Kidney J 2024; 17:sfad271. [PMID: 38186875 PMCID: PMC10768765 DOI: 10.1093/ckj/sfad271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
- Katya Loban
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec
- Research Institute of the McGill University Health Centre, Montreal, Quebec
| | - Ahsan Alam
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec
- Research Institute of the McGill University Health Centre, Montreal, Quebec
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec
| | - Shaifali Sandal
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec
- Research Institute of the McGill University Health Centre, Montreal, Quebec
- Division of Experimental Medicine, Department of Medicine, McGill University Health Centre, Montreal, Quebec
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