The essence of living kidney donation

Abstract

Aim Nephrectomy performed on healthy individuals for the purpose of transplantation is an exceptional activity. It confers great responsibilities to the medical staff involved. Potential donors must be carefully informed and assessed with respect to medical and psychosocial aspects. This thesis focuses on information, motives for donation, setting medical limits and the experience of undergoing nephrectomy.Materials and MethodsThe contents of written information from transplant units in 14 countries were investigated. Interviews were conducted with potential donors, and analysed using a phenomenological approach (n=12). Categories of motives were identified. Questionnaires were sent to potential donors in Sweden and Norway, asking respondents to mark on a Visual Analogue Scale the importance of several motives and concerns (n=154). The outcome of transplantation was evaluated with respect to several risk factors, including a low glomerular filtration rate of the living donor (n=344). From medical records and in interviews performed 4 weeks post donation, the degree of pain, fatigue and physical activity were evaluated and compared between donors who underwent open and laparoscopic nephrectomy (n= 55 and 45, respectively).ResultsThe contents of the information brochures varied greatly, and many lacked important aspects. The decision to donate was mainly emotionally based. Seven major motives for donation were identified - a desire to help, a logic motive, pressure, identification, increased self-esteem, self-benefit and moral duty. A desire to help, identification and self-benefit were the strongest motives. In contrast, pressure, guilt and religion were weak incentives. A glomerular filtration rate below 80 ml/min was shown to be an independent risk factor for graft loss. The laparoscopic nephrectomy technique conferred less pain than the open procedure. Irrespective of surgical method, most donors had not recovered physically or mentally after 4 weeks.ConclusionsTo inform potential donors is of paramount importance, but difficult because the decision to donate is rarely based on actual facts. Most potential live kidney donors have a combination of motives for donation and mixed feelings about it. A lower limit for donor GFR should be set. Regardless of surgical technique, living kidney donation is more demanding, mentally and physically, than commonly recognised. These are important aspects of the pre-donation evaluation.