The motivations and experiences of living kidney donors: A thematic synthesis.

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 on the experiences and perspectives of living kidney donors. Method(s): We conducted a systematic review and thematic synthesis of qualitative studies on motivations to donate and experiences after donation of living kidney donors. MEDLINE, Embase, PsycINFO, CINAHL, references lists of articles were searched to April 2011. Result(s): Twenty-six studies involving 478 donors were included. We identified six 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 post-donation: renegotiating identity (including sub-themes of fear and vulnerability, sense of loss, depression and guilt, new appreciation of life, personal growth and self-worth), renegotiating roles (including sub-themes of multiplicity of roles, unable to resume previous activities, hero status) and renegotiating relationships (including sub-themes of neglect, proprietorial concern, strengthened family and recipient bonds, and avoidance of recipient indebtedness). Conclusion(s): Kidney donation has a profound and multi-faceted impact on the lives of donors, and requires them to renegotiate their identity, roles and relationships. Strategies to safeguard against unwarranted coercion, and to maximise donor resilience, capacity to negotiate their multiple roles as a patient and carer, emotional fortitude, and ability to have balanced expectations and relationships with their recipient and the family, are needed to ultimately protect the safety and well-being of living kidney donors.