A. A. Shaffer1, E. A. King1, J. P. Kahn2, L. H. Erby3, D. L. Segev1 1Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 2Johns Hopkins School Of Public Health,Berman Institute Of Bioethics,Baltimore, MD, USA 3Johns Hopkins School Of Public Health,Department Of Health And Behavior Sciences,Baltimore, MD, USA
Introduction:
As the shortage of donor organs remains an obstacle, transplantation with living donors is increasing. Live donor kidney transplantation yields improved graft survival and recipient longevity, compared with deceased donors. However, one concern with living donation is the potential risk of coercion or pressure on individuals to donate when approached by a transplant candidate. Currently, there is no widely used, standard test to measure donor pressure in a clinical setting. The purpose of this study was to use a novel assessment to evaluate pressure experienced by live donor candidates, determine primary motivations for considering donation, and identify demographic factors associated with increased pressure.
Methods:
We modified a psychological questionnaire of perceived coercion to generate a novel pressure assessment for potential kidney donors. This assessment is composed of six questions. Each of the first four questions collects information on one element of the decision, including the idea, influence, choice, and freedom. These are answered on a Likert scale from “Strongly Agree” to “Strongly Disagree,” which we convert to a numerical scale from 1 to 5. The fifth question asks the respondent to self-report perceived pressure on a scale from 1 (least pressure) to 5 (most pressure). Results of the first five questions were averaged to compute a pressure score. The sixth question qualitatively ascertains the candidate’s primary motivation for donation. This question requires the respondent to rank her or his reason for donating, in order of importance, from three options. From November 25, 2013, data were prospectively collected on every individual calling our center for live donor evaluation.
Results:
Our study population included 400 potential live donors with a mean age of 41.8 years (SD=13.3). Of the participants, 58.8% were female, 72.3% were Caucasian, and 20.4% were African American. The mean pressure score was 1.1 (SD=0.3) and ranged from 1 to 4.2. Of the respondents, 79.2% had a total pressure score of 1, indicating that they had answered each of the scaled questions with the lowest pressure measurement. There was no difference in mean pressure score by age, sex, race, or recipient/ donor relationship type. The primary ranked motivation for donation was 86.3% “I wanted to help my recipient,” 11.3% “I wanted to give meaning to my life,” and 2.4% “My family or friends expected me to donate.”
Conclusion:
Most candidates (79.2%) for living kidney donation feel little pressure from others when making the decision to donate, but some (19.2%) report higher than minimal pressure. Our data show that there is no clearly identifiable demographic profile for those who experience pressure. This pressure assessment can be used to identify donor candidates facing pressure to donate early in the evaluation process so that these concerns can be fully addressed prior to donation.