Strengthening Relationship And Psychosocial Outcomes In Living Kidney Donation: Perspectives Of Donors, Recipients And Clinicians

The unmet demand for organ donation has necessitated widespread acceptance of living kidney donation which is associated with better survival and quality of life for most recipients compared with deceased donor transplantation and dialysis. More than 60% of living kidney donations in the United States, Canada, Australia and New Zealand are from spousal and biologically related donors. Many of these donors are willing to accept the risks of donating a kidney to improve outcomes for their recipient. However, donors and recipients must navigate potential changes to interpersonal dynamics, roles, and responsibilities during and after the donation process. Donor-recipient relationships are complex, nuanced and value laden and can be challenging to evaluate during the transplant work-up and can present unexpected challenges for donor and recipients. Also, potential conflicts and tensions may remain unaddressed and unresolved after the transplant. Further, while the literature on the risks of donation are expanding, there are no data describing experiences of individuals who were deemed ineligible for donation. Such individuals disappear from view from the transplant centre and there is ambiguity surrounding their status as patients. This is a thesis by publication containing published and submitted work. The aims of the studies included in this thesis are: 1) to describe the donor and recipient perspectives on the donor-recipient relationship in living kidney donation, across different populations and healthcare contexts. 2) to describe donor and recipient expectations and views of their relationship before and after living kidney transplantation. 3) to describe the attitudes and approaches of transplant clinicians to evaluating the donor-recipient relationship.4) to describe the perspectives of potential donors on their experience and consequences of being deemed ineligible as a living kidney donor