The Motivations and Experiences of Living Kidney Donors: A Thematic Synthesis

Tong, Allison; Chapman, Jeremy R.; Wong, Germaine; Kanellis, John; McCarthy, Grace; Craig, Jonathan C.

doi:10.1053/j.ajkd.2011.11.043

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The Motivations and Experiences of Living Kidney Donors: A Thematic Synthesis

Allison Tong, PhD
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Address correspondence to Allison Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW 2145, Sydney, Australia
Jeremy R. Chapman, FRCP
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
Germaine Wong, PhD
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia
- Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
John Kanellis, PhD
- Department of Medicine, Monash University, Clayton, VIC, Australia
- Department of Nephrology, Monash Medical Centre, Clayton, VIC, Australia
Grace McCarthy, BSc
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
Jonathan C. Craig, PhD
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
- Sydney School of Public Health, University of Sydney, Sydney, Australia

Received 2 September 2011; accepted 30 November 2011. published online 10 February 2012.
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Background

Living kidney donation is associated with better recipient outcomes compared with deceased kidney donation, but living kidney donors face the risk of physical and psychological complications. The aim of this study was to synthesize published qualitative studies of the experiences and perspectives of living kidney donors.

Methods

We conducted a systematic review and thematic synthesis of qualitative studies of motivations to donate and experiences after donation of living kidney donors. MEDLINE, Embase, PsycINFO, CINAHL, and reference lists of articles were searched to April 2011.

Results

26 studies involving 478 donors were included. We identified 6 themes about the decision to donate: compelled altruism, inherent responsibility, accepting risks, family expectation, personal benefit, and spiritual confirmation. Three themes dominated the impact of donation and postdonation: renegotiating identity (including subthemes of fear and vulnerability, sense of loss, depression and guilt, new appreciation of life, and personal growth and self-worth), renegotiating roles (including subthemes of multiplicity of roles, unable to resume previous activities, and hero status), and renegotiating relationships (including subthemes of neglect, proprietorial concern, strengthened family and recipient bonds, and avoidance of recipient indebtedness).

Conclusions

Kidney donation has a profound and multifaceted impact on the lives of donors and requires them to renegotiate their identity, roles, and relationships. Strategies to safeguard against unwarranted coercion, and to maximize donor resilience, capacity to negotiate their multiple roles as a patient and carer, emotional fortitude, and ability to have balanced expectations and relationships with the recipient and the family are needed to ultimately protect the safety and well-being of living kidney donors.

Index words: Kidney donation , kidney transplantation , living donation , qualitative research , systematic review , quality of life