title: Living kidney donor advocacy program: a quality improvement project.
abstract: OBJECTIVE
  : In 2007, the Centers for Medicare & Medicaid Services mandated that kidney transplant programs establish a living donor advocate program to ensure safe care and support for living organ donors. This quality improvement project assessed the impact of establishing a living donor advocate program and identified the ethical commitments and threats living kidney donors perceive throughout the donation process.
  
  
  METHODS
  : This quality improvement project reflects a mixed-methods methodology. Qualitative as well as quantitative data were generated through the donor-advocate consultation sessions and the written Living Donor Satisfaction Survey. Thirteen living donors participated.
  
  
  RESULTS
  : No threats to donor rights were identified by either the donor or the advocate. Nonrelated donors were motivated by altruism, whereas related donors were motivated by a sense of family. A majority of donors reported being changed emotionally and spiritually by the act of serving as a living donor. The living kidney donors were overwhelmingly extremely satisfied with their decision to donate and perceived the living donor advocacy program as being very good.
  
  
  CONCLUSIONS
  : Questions have been raised about what role the donor's spouse should have during the informed consent process. Further research is needed to better understand the role and power of an advocate when threats to the donor's rights are noted.
authors.affiliation: Department of Nursing, University of Vermont, Burlington, VT 05405, USA. marcia.bosek@uvm.edu
authors.forename: Marcia Sue Dewolf
authors.initials: MS
authors.lastname: Bosek
authors.forename: Isabelle L
authors.initials: IL
authors.lastname: Sargeant
mesh_terms: D006801:Humans; D016030:Kidney Transplantation / Q000941:ethics* / Q000523:psychology*; D019520:Living Donors / Q000941:ethics* / Q000523:psychology*; D010344:Patient Advocacy / Q000592:standards*; D058996:Quality Improvement; D014481:United States