title: The expectations and attitudes of patients with chronic kidney disease toward living kidney donor transplantation: a thematic synthesis of qualitative studies.
abstract: BACKGROUND
  Living kidney donation offers superior outcomes over deceased organ donation, but incurs psychosocial and ethical challenges for recipients because of the risks imposed on their donor. We aimed to describe the beliefs, attitudes, and expectations of patients with chronic kidney disease toward receiving a living kidney donor transplant.
  
  
  METHODS
  We conducted a systematic review of qualitative studies of patients' attitudes toward living kidney donation using a comprehensive literature search of electronic databases to February 2013. The findings were analyzed using thematic synthesis.
  
  
  RESULTS
  Thirty-nine studies (n ≥ 1791 participants) were included. We identified six themes: prioritizing own health (better graft survival, accepting risk, and desperate aversion to dialysis), guilt and responsibility (jeopardizing donor health, anticipating donor regret, and causing donor inconvenience), ambivalence and uncertainty (doubting transplant urgency, insufficient information, confronted by unfamiliarity, and prognostic uncertainty), seeking decisional validation (a familial obligation, alleviating family burden, reciprocal benefits for donors, respecting donor autonomy, external reassurance, and religious approval), needing social support (avoiding family conflict, unrelenting indebtedness, and emotional isolation), and cautious donor recruitment (self-advocacy, lacking self-confidence, avoiding donor coercion, emotional vulnerability, respecting cultural, and religious taboos).
  
  
  CONCLUSIONS
  Enhanced education and psychosocial support may help clarify, validate, and address patients' concerns regarding donor outcomes, guilt, relationship tensions, and donor recruitment. This may encourage informed decision-making, increase access to living kidney donation, and improve psychosocial adjustment for transplant recipients.
authors.affiliation: 1 Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. 2 Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia. 3 Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, NSW, Australia. 4 Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 5 Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Camilla S
authors.initials: CS
authors.lastname: Hanson
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Chadban
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.forename: Germaine
authors.initials: G
authors.lastname: Wong
authors.forename: Angelique F
authors.initials: AF
authors.lastname: Ralph
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
mesh_terms: D000223:Adaptation, Psychological; D000533:Altruism; D001294:Attitude to Health; D003469:Culture; D003657:Decision Making; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology*; D019520:Living Donors / Q000523:psychology; D009042:Motivation; D009392:Nephrectomy; D036301:Qualitative Research; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000523:psychology* / Q000601:surgery*; D012306:Risk; D012649:Self Concept; D012944:Social Support