Narrative Review
The Dynamics of Recipient-Donor Relationships in Living Kidney Transplantation

https://doi.org/10.1053/j.ajkd.2007.07.029Get rights and content

Psychosocial issues in kidney transplant donors and recipients are a cause for concern. We reviewed studies that investigated psychosocial issues in donors and recipients of living kidney transplants. A variety of instruments were used for this purpose. However, there was a lack of consensus regarding the structure and method of psychosocial assessment in living kidney donors. We found that only a few centers currently carry out a systematic psychosocial follow-up of recipients and their donors. The majority of psychosocial studies were of living kidney donors, indicating a preference of researchers to study psychosocial issues in live kidney donors. We believe living kidney transplant recipients are also an important group, and more studies should be done to better understand the psychosocial issues in this group. The majority of studies were retrospective in nature. We also discuss relationships, interactions, and communication patterns that characterize living kidney donation. We place emphasis on understanding the relational history of donors and recipients to provide supportive intervention and enable the potential donor make an informed decision about surgery. We recommend comprehensive psychosocial screening before and after transplantation and donation. This may decrease psychological problems and increase satisfaction with the transplantation process. Furthermore, the transplant community will need to address the type of instruments, duration of follow-up, and funding sources to carry out our recommendations.

Section snippets

Social Support for Living Kidney Transplantation

A number of health studies placed a significant amount of emphasis on the extent of social support afforded to patients both as an indicator of their ability to endure some form of treatment intervention and to generate security and confidence.3, 4, 5, 6 However, that social support can cause stress, as well as allay it, receives less attention. It is not safe to assume that a patient has sufficient social support just because he or she is married. Social support also can be conditional on the

Characteristics of Relationships in Living Kidney Transplantations

A mutually acceptable pattern of attachment entails complementary thought processes, interpersonal behaviors, and corresponding moods.7 Within the context of the donor-recipient relationship, there would be a need to identify episodes of interaction with attention to whether both parties believed they were understood by the other and the appropriateness of the time frame and manner of response. We also need to understand the nature of response, counterresponses from the other party, and

Review of the Literature

We searched MEDLINE, the Cochrane Library, EMBASE, Cinhahl, World Wide Web, Royal College of Nursing journals, PsychINFO, and ASSIA by using the key words “psychosocial issues in donors of live kidney transplant” and “psychosocial issues in recipients of live kidney transplant.” Only articles in English were included. Priority was given to studies that were prospective and articles in the last 20 years. We avoided case reports or reports in abstract form, incomplete information, and duplicate

Critique of the Literature

We found 35 studies of psychosocial issues in live kidney donors and 13 studies of psychosocial issues in live kidney recipients, indicating a preference of researches to study psychosocial issues in live kidney donors. We believe living kidney transplant recipients are also an important group, and more studies should be done to better understand the psychosocial issues in this group. It also was interesting that the majority of studies were retrospective. We believe more prospective studies

Discussion

The reasoning behind living organ donation is often complex and varies from one individual to another. However, the main motivating factors appear to be the stress and anxiety of subjecting a loved one to prolonged dialysis therapy and the emotional and physical deterioration equated with long-term dialysis therapy. The key to gaining insight into the nature of a patient’s relationship with the donor in the present, along with their ability to form and retain attachments, lies in their past

Conclusion

It is already becoming apparent that the issue of living kidney donation is more complex than merely the need to determine whether a patient is being coerced.5 Physicians routinely address this issue privately with donors and offer them the opportunity of a pseudo-medical exclusion if they so wish.6 They need to be clear that the act of donation is a collaborative interaction that presents the recipient with a chance of a better quality of life.

We suggest that transplant centers carry out

Acknowledgements

Support: None.

Financial Disclosure: None.

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    Originally published online as doi:10.1053/j.ajkd.2007.07.029 on October 3, 2007.

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