Perspectives of Transplant Professionals on the Values, Ethics, and Challenges of Living Kidney Donor Evaluation in Asia.
BACKGROUND
Deceased donor rates in Asia are among the lowest in the world. This has necessitated a reliance on living kidney donation, which has given rise to concerns about donor motivation and assessment in this region. We aimed to describe transplant professional perspectives on living kidney donor evaluation in Asia.


METHODS
Face-to-face, semistructured interviews were conducted with 53 transplant professionals (nephrologists [n = 21], surgeons/urologists [n = 17], coordinators [n = 7], social workers [n = 5], ethicists [n = 2], psychologist [n = 1]) from 20 centers in 10 countries. Transcripts were analyzed thematically to identify themes.


RESULTS
The theme of traversing vulnerability overarched 4 themes. Vigilance against exploitation of the vulnerable meant mitigating the threat of commercial transplantation, combating disparities, and verifying volunteerism. Maintaining clarity of professional roles encompassed the perceived necessity of legal safeguards to determine legitimacy of relationships, ensuring informed consent, demarcating responsibilities, minimizing conflict of interest, meeting community expectations, and resolving ambivalence regarding donor risk. Societal plight driving caution about living kidney donor assessment was emphasized in the context of poverty and desperation, higher risk of disease, and lack of social security. Navigating sociocultural barriers acknowledged the centrality of the family, economic priorities, distrust in modern medicine, generational traditions, and emotional opacity limiting their ability to gauge donor motivation.


CONCLUSIONS
Moral, professional, sociocultural and societal vulnerabilities contribute to the barriers and ethical quandaries in living kidney donation in Asia. Strategies are needed to address culturally based anxieties and disparities in living donation. Transplant professionals depend on strong legislation and policies to prevent exploitation of living donors.
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 Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia. 4 Department of Renal Medicine, Singapore General Hospital, Singapore. 5 Department of Medicine and Therapeutics, Prince of Wales Hospital, Randwick, NSW, Australia. 6 Department of Social Medicine, National Taiwan University, Taiwan.
Allison
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Tong
Jeremy R
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Chapman
Terence
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Kee
Philip K T
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Li
Daniel F C
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Tsai
Germaine
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Wong
Jonathan C
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Craig
D000328:Adult; D000368:Aged; D001208:Asia; D001291:Attitude of Health Personnel; D003466:Cultural Characteristics; D046148:Donor Selection / Q000941:ethics / Q000331:legislation & jurisprudence; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D054625:Healthcare Disparities; D006801:Humans; D007258:Informed Consent; D007407:Interviews as Topic; D016030:Kidney Transplantation / Q000009:adverse effects / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology; D019520:Living Donors / Q000941:ethics / Q000331:legislation & jurisprudence / Q000523:psychology / Q000600:supply & distribution; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D010465:Perception; D024382:Professional Role; D036301:Qualitative Research; D018570:Risk Assessment; D012307:Risk Factors; D012941:Social Responsibility; D012959:Socioeconomic Factors; D014836:Volition; D035862:Vulnerable Populations / Q000523:psychology; D055815:Young Adult