title: Donors in chains: psychosocial outcomes of kidney donors in paired exchange.
abstract: BACKGROUND
  Kidney paired donation chains are initiated by nondirected donors and propagated by donors within the chain of transplants, or chain donors.
  
  
  OBJECTIVE
  To compare psychosocial and functional outcomes, and to test coercion, of chain donors in paired exchange versus traditional directed donors who have an established relationship with the recipient.
  
  
  METHODS
  Thirty chain donors from a transplant center who were part of the National Kidney Registry paired exchange program were compared with 34 traditional donors who donated around the same time. Participants completed online surveys: the postdonation section of the Living Donor Expectancies Questionnaire was used to assess psychosocial and functional outcomes 1 to 6 years after donation. A survey to assess coercion was used as well.
  
  
  RESULTS
  Chain donors and traditional donors were similar in terms of sex, race, age, and time after donation. The 2 groups had similar altruistic motives in donating their kidney, and both types of donors mentioned psychological benefits. No differences were found on questions regarding psychosocial outcomes save for the "quid pro quo scale" (P= .01), which suggested that the traditional donors felt more that the recipients are indebted to them. The 2 groups did not differ significantly in the coercion measure. Pressure to donate and stress of donation were not greater in chain donors than traditional donors (P= .60).
  
  
  CONCLUSIONS
  Kidney donors in kidney paired donation chains do as well as traditional donors psychosocially without any increased tendency toward experiencing coercion.
authors.affiliation: New York Presbyterian-Weill Cornell, New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: Serur
authors.affiliation: New York Presbyterian-Weill Cornell, New York, New York.
authors.forename: Marian
authors.initials: M
authors.lastname: Charlton
authors.affiliation: New York Presbyterian-Weill Cornell, New York, New York.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lawton
authors.affiliation: National Kidney Registry, Babylon, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sinacore
authors.affiliation: New York Presbyterian-Weill Cornell, New York, New York.
authors.forename: Janna
authors.initials: J
authors.lastname: Gordon-Elliot
mesh_terms: D000328:Adult; D000533:Altruism; D003068:Coercion; D046148:Donor Selection; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology*; D019520:Living Donors / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009519:New York City; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement