了解捐赠者更好？一项关于肾病患者对“利他性”活体肾移植看法的定性研究。

Better the donor you know? A qualitative study of renal patients' views on 'altruistic' live-donor kidney transplantation.

作者信息

Bailey Phillippa K, Ben-Shlomo Yoav, de Salis Isabel, Tomson Charles, Owen-Smith Amanda

机构信息

School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK.

出版信息

Soc Sci Med. 2016 Feb;150:104-11. doi: 10.1016/j.socscimed.2015.12.041. Epub 2015 Dec 28.

DOI:10.1016/j.socscimed.2015.12.041

PMID:26745864

Abstract

BACKGROUND

In the UK there is a short-fall between individuals requiring a renal transplant and kidneys available for transplantation. Non-directed 'altruistic' living kidney donation has emerged as a strategy for bridging this gap between supply and demand, with the number increasing each year.

OBJECTIVE

This study aimed to explore the views of potential recipients towards non-directed 'altruistic' live-donor kidney transplantation.

METHODS

Semi-structured interviews with 32 UK deceased-donor kidney transplant recipients were performed. Interviews explored willingness to consider directed and non-directed live-donor kidney transplants (LDKTs). Interviews were recorded, transcribed verbatim and transcripts were analysed using the constant comparison method described in Grounded Theory.

RESULTS

For those not willing to accept a non-directed 'altruistic' LDKT, the following themes were identified: i) Prioritising other recipients above self; ii) Fear of acquiring an unknown donor's characteristics, and iii) Concern for the donor - unnecessary risk. For those willing to accept a non-directed 'altruistic' LDKT the following themes were identified: iv) Prioritising known above unknown persons, v) Belief that they are as deserving as other potential recipients, and vi) Advantages of a LDKT.

CONCLUSIONS

Drawing on 'gift exchange theory', this study contributes to our understanding of the experience of the intended recipient of a gift. The anonymity of the donor-recipient appears to be seen as a benefit of non-directed 'altruistic' live-donor transplants, freeing recipients from the obligations of the gift. However, those who feel unworthy of the 'gifted transplant' are concerned about the donor and by the lack of opportunity for direct reciprocity. Highlighting the 'reciprocal benefits' reported by donors may allow individuals whose preference is a live-donor transplant to accept one if offered. These insights provide the transplant community with targets for intervention, through which the concerns of potential recipients might be addressed.

摘要

背景

在英国，需要肾移植的个体数量与可用于移植的肾脏数量之间存在缺口。非定向“利他性”活体肾捐赠已成为弥合供需差距的一种策略，且数量逐年增加。

目的

本研究旨在探讨潜在受者对非定向“利他性”活体供肾移植的看法。

方法

对32名英国已故供体肾移植受者进行了半结构化访谈。访谈探讨了考虑接受定向和非定向活体供肾移植（LDKT）的意愿。访谈进行了录音，逐字转录，并用扎根理论中描述的持续比较法对转录本进行分析。

结果

对于那些不愿意接受非定向“利他性”LDKT的受者，确定了以下主题：i）将其他受者置于自身之上；ii）担心获得未知供体的特征，以及iii）对供体的担忧——不必要的风险。对于那些愿意接受非定向“利他性”LDKT的受者，确定了以下主题：iv）将已知的人置于未知的人之上；v）认为他们与其他潜在受者一样应得；以及vi）LDKT的优势。

结论

借鉴“礼物交换理论”，本研究有助于我们理解礼物预期接受者的经历。供体与受体的匿名性似乎被视为非定向“利他性”活体供体移植的一个好处，使受者摆脱了礼物的义务。然而，那些觉得自己不配接受“赠与的移植”的人担心供体以及缺乏直接回报的机会。强调供体报告的“互惠利益”可能会让那些倾向于活体供体移植的个体在有机会时接受移植。这些见解为移植界提供了干预目标，通过这些目标可以解决潜在受者的担忧。