title: Donor and Recipient Views on Their Relationship in Living Kidney Donation: Thematic Synthesis of Qualitative Studies.
abstract: BACKGROUND
  Many donors and recipients report an improved relationship after transplantation; however, tension, neglect, guilt, and proprietorial concern over the recipient can impede donor and recipient well-being and outcomes. We aimed to describe donor and recipient expectations and experiences of their relationship in the context of living kidney donation.
  
  
  METHODS
  Thematic synthesis of qualitative studies.
  
  
  METHODS
  Living kidney donors and recipients.
  
  
  METHODS
  Electronic databases were searched to October 2015.
  
  
  METHODS
  Thematic synthesis.
  
  
  RESULTS
  From 40 studies involving 1,440 participants (889 donors and 551 recipients) from 13 countries, we identified 6 themes. "Burden of obligation" described the recipient's perpetual sense of duty to demonstrate gratitude to the donor. "Earning acceptance" was the expectation that donation would restore relationships. "Developing a unique connection" reflected the inexplicable bond that donor-recipient dyads developed postdonation. "Desiring attention" was expressed by donors who wanted recognition for the act of donation and were envious and resentful of the attention the recipient received. "Retaining kidney ownership" reflected the donor's inclination to ensure that the recipient protected "their" kidney. "Enhancing social participation" encompassed relieving both the caregiver from the constraints of dialysis and the recipient from increased involvement and contribution in family life.
  
  
  CONCLUSIONS
  Non-English articles were excluded.
  
  
  CONCLUSIONS
  Living kidney donation can strengthen donor-recipient relationships but may trigger or exacerbate unresolved angst, tension, jealousy, and resentment. Facilitating access to pre- and posttransplantation psychological support that addresses potential relationship changes may help donors and recipients better adjust to changes in the relationship dynamics, which in turn may contribute to improved psychosocial and transplantation outcomes following living kidney donation.
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia; School of Psychology, The University of Sydney, Sydney, NSW, Australia. Electronic address: angelique.ralph@sydney.edu.au.
authors.forename: Angelique F
authors.initials: AF
authors.lastname: Ralph
authors.affiliation: School of Psychology, The University of Sydney, Sydney, NSW, Australia; Psycho-oncology Co-operative Research Group, The University of Sydney, Sydney, NSW, Australia; Centre for Medical Psychology & Evidence-based Decision-making, The University of Sydney, Sydney, NSW, Australia.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: Camilla S
authors.initials: CS
authors.lastname: Hanson
authors.affiliation: Central Clinical School, The University of Sydney, Sydney, NSW, Australia; Transplantation Services, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
authors.forename: Steve J
authors.initials: SJ
authors.lastname: Chadban
authors.affiliation: Centre for Transplant and Renal Research, The University of Sydney, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
authors.affiliation: Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Monash University, Clayton, VIC, Australia; Department of Medicine, Monash University, Clayton, VIC, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Kanellis
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Luxton
authors.affiliation: Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
mesh_terms: D001290:Attitude; D006801:Humans; D007398:Interpersonal Relations; D016030:Kidney Transplantation; D019520:Living Donors; D036301:Qualitative Research; D066027:Transplant Recipients
keywords: Living kidney donation; donor-recipient relationship; emotional outcomes; interpersonal relationships; kidney donor; kidney transplant recipient; psychosocial issues; qualitative research; relationship processes; thematic synthesis