Clinicians’ attitudes and approaches to evaluating the potential living kidney donor-recipient relationship: An interview study

Angelique F. Ralph, Phyllis Butow, Jonathan C. Craig, Jeremy R. Chapman, John S. Gill, John Kanellis, Allison Tong

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Aim: Careful assessment of the potential donor-recipient relationship is recommended by guidelines to prevent undue coercion, and to ensure realistic expectations and genuine motivations. However, relationships are complex, nuanced and value-laden, and can be challenging to evaluate in living kidney donation. We aimed to describe the attitudes and approaches of transplant clinicians towards assessing the relationship between potential living kidney donors and their recipients. Methods: Semi-structured interviews were conducted with 54 transplant clinicians (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists) from 32 transplant centres across nine countries including Australia, United States, Canada and New Zealand. Transcripts were analyzed thematically. Results: Four themes were identified: protecting against vulnerability and premature decisions (ensuring genuine motivation, uncovering precarious dynamics and pre-empting conflict, shared accountability, relying on specialty psychosocial expertise, trusting intimate bonds, tempering emotional impulsivity); safeguarding against coercion (discerning power imbalance, justified inquiry, awareness of impression management); minimizing potential threat to relationships (preserving the bond, giving equitable attention to donors and recipients, ensuring realistic expectations); and ambiguities in making judgments (adjudicating appropriateness and authenticity of relationships, questioning professional intervening, uncertainties in subjective and emotional assessments). Conclusions: Clinicians felt ethically compelled to minimize the risk of undue coercion and to protect donors and recipients when evaluating the donor-recipient relationship. However, disentangling voluntariness and altruism from potential undisclosed pressures to enact societal and family duty, making decisions within this complex, multi-stakeholder context, and avoiding the imposition of undue paternalism and donor autonomy, were challenging. Multidisciplinary expertise and practical strategies for managing uncertainties are required.

Original languageEnglish
Pages (from-to)252-262
Number of pages11
JournalNephrology
Volume24
Issue number2
DOIs
Publication statusPublished - 1 Feb 2019

Keywords

  • donor-recipient relationship
  • living donor transplantation
  • qualitative research

Cite this

Ralph, Angelique F. ; Butow, Phyllis ; Craig, Jonathan C. ; Chapman, Jeremy R. ; Gill, John S. ; Kanellis, John ; Tong, Allison. / Clinicians’ attitudes and approaches to evaluating the potential living kidney donor-recipient relationship : An interview study. In: Nephrology. 2019 ; Vol. 24, No. 2. pp. 252-262.
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title = "Clinicians’ attitudes and approaches to evaluating the potential living kidney donor-recipient relationship: An interview study",
abstract = "Aim: Careful assessment of the potential donor-recipient relationship is recommended by guidelines to prevent undue coercion, and to ensure realistic expectations and genuine motivations. However, relationships are complex, nuanced and value-laden, and can be challenging to evaluate in living kidney donation. We aimed to describe the attitudes and approaches of transplant clinicians towards assessing the relationship between potential living kidney donors and their recipients. Methods: Semi-structured interviews were conducted with 54 transplant clinicians (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists) from 32 transplant centres across nine countries including Australia, United States, Canada and New Zealand. Transcripts were analyzed thematically. Results: Four themes were identified: protecting against vulnerability and premature decisions (ensuring genuine motivation, uncovering precarious dynamics and pre-empting conflict, shared accountability, relying on specialty psychosocial expertise, trusting intimate bonds, tempering emotional impulsivity); safeguarding against coercion (discerning power imbalance, justified inquiry, awareness of impression management); minimizing potential threat to relationships (preserving the bond, giving equitable attention to donors and recipients, ensuring realistic expectations); and ambiguities in making judgments (adjudicating appropriateness and authenticity of relationships, questioning professional intervening, uncertainties in subjective and emotional assessments). Conclusions: Clinicians felt ethically compelled to minimize the risk of undue coercion and to protect donors and recipients when evaluating the donor-recipient relationship. However, disentangling voluntariness and altruism from potential undisclosed pressures to enact societal and family duty, making decisions within this complex, multi-stakeholder context, and avoiding the imposition of undue paternalism and donor autonomy, were challenging. Multidisciplinary expertise and practical strategies for managing uncertainties are required.",
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Clinicians’ attitudes and approaches to evaluating the potential living kidney donor-recipient relationship : An interview study. / Ralph, Angelique F.; Butow, Phyllis; Craig, Jonathan C.; Chapman, Jeremy R.; Gill, John S.; Kanellis, John; Tong, Allison.

In: Nephrology, Vol. 24, No. 2, 01.02.2019, p. 252-262.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Clinicians’ attitudes and approaches to evaluating the potential living kidney donor-recipient relationship

T2 - An interview study

AU - Ralph, Angelique F.

AU - Butow, Phyllis

AU - Craig, Jonathan C.

AU - Chapman, Jeremy R.

AU - Gill, John S.

AU - Kanellis, John

AU - Tong, Allison

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Aim: Careful assessment of the potential donor-recipient relationship is recommended by guidelines to prevent undue coercion, and to ensure realistic expectations and genuine motivations. However, relationships are complex, nuanced and value-laden, and can be challenging to evaluate in living kidney donation. We aimed to describe the attitudes and approaches of transplant clinicians towards assessing the relationship between potential living kidney donors and their recipients. Methods: Semi-structured interviews were conducted with 54 transplant clinicians (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists) from 32 transplant centres across nine countries including Australia, United States, Canada and New Zealand. Transcripts were analyzed thematically. Results: Four themes were identified: protecting against vulnerability and premature decisions (ensuring genuine motivation, uncovering precarious dynamics and pre-empting conflict, shared accountability, relying on specialty psychosocial expertise, trusting intimate bonds, tempering emotional impulsivity); safeguarding against coercion (discerning power imbalance, justified inquiry, awareness of impression management); minimizing potential threat to relationships (preserving the bond, giving equitable attention to donors and recipients, ensuring realistic expectations); and ambiguities in making judgments (adjudicating appropriateness and authenticity of relationships, questioning professional intervening, uncertainties in subjective and emotional assessments). Conclusions: Clinicians felt ethically compelled to minimize the risk of undue coercion and to protect donors and recipients when evaluating the donor-recipient relationship. However, disentangling voluntariness and altruism from potential undisclosed pressures to enact societal and family duty, making decisions within this complex, multi-stakeholder context, and avoiding the imposition of undue paternalism and donor autonomy, were challenging. Multidisciplinary expertise and practical strategies for managing uncertainties are required.

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KW - living donor transplantation

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U2 - 10.1111/nep.13238

DO - 10.1111/nep.13238

M3 - Article

VL - 24

SP - 252

EP - 262

JO - Nephrology

JF - Nephrology

SN - 1320-5358

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