Centre for Kidney Research, The Children's Hospital at Westmead, NSW, Australia.
Am J Kidney Dis. 2012 Jul;60(1):15-26. doi: 10.1053/j.ajkd.2011.11.043. Epub 2012 Feb 4.
Living kidney donation is associated with better recipient outcomes compared with deceased kidney donation, but living kidney donors face the risk of physical and psychological complications. The aim of this study was to synthesize published qualitative studies of the experiences and perspectives of living kidney donors.
We conducted a systematic review and thematic synthesis of qualitative studies of motivations to donate and experiences after donation of living kidney donors. MEDLINE, Embase, PsycINFO, CINAHL, and reference lists of articles were searched to April 2011.
26 studies involving 478 donors were included. We identified 6 themes about the decision to donate: compelled altruism, inherent responsibility, accepting risks, family expectation, personal benefit, and spiritual confirmation. Three themes dominated the impact of donation and postdonation: renegotiating identity (including subthemes of fear and vulnerability, sense of loss, depression and guilt, new appreciation of life, and personal growth and self-worth), renegotiating roles (including subthemes of multiplicity of roles, unable to resume previous activities, and hero status), and renegotiating relationships (including subthemes of neglect, proprietorial concern, strengthened family and recipient bonds, and avoidance of recipient indebtedness).
Kidney donation has a profound and multifaceted impact on the lives of donors and requires them to renegotiate their identity, roles, and relationships. Strategies to safeguard against unwarranted coercion, and to maximize donor resilience, capacity to negotiate their multiple roles as a patient and carer, emotional fortitude, and ability to have balanced expectations and relationships with the recipient and the family are needed to ultimately protect the safety and well-being of living kidney donors.
与死后肾脏捐献相比，活体肾脏捐献与更好的受者结果相关，但活体肾脏捐献者面临身体和心理并发症的风险。本研究的目的是综合已发表的关于活体肾脏捐献者经历和观点的定性研究。
我们对活体肾脏捐献者捐献动机和捐献后经历的定性研究进行了系统评价和主题综合分析。检索了 MEDLINE、Embase、PsycINFO、CINAHL 和文章参考文献列表，检索时间截至 2011 年 4 月。
共纳入 26 项研究，涉及 478 名捐献者。我们确定了 6 个关于捐献决定的主题：强制利他主义、内在责任、接受风险、家庭期望、个人利益和精神确认。有 3 个主题主导了捐献和捐后影响：重新协商身份（包括恐惧和脆弱感、失落感、抑郁和内疚感、对生活新的欣赏和个人成长和自我价值感等子主题）、重新协商角色（包括角色多样性、无法恢复以前的活动、英雄地位等子主题）和重新协商关系（包括忽视、专有权关注、加强家庭和受者关系以及避免受者负债等子主题）。
肾脏捐献对捐献者的生活产生了深远而多方面的影响，需要他们重新协商自己的身份、角色和关系。需要采取策略来保护捐献者免受不必要的强制，并最大限度地提高其适应能力，使其能够协商作为患者和照顾者的多个角色，保持情感坚韧，以及平衡对受者和家庭的期望和关系，从而最终保护活体肾脏捐献者的安全和福祉。
