Assessing the impact of the living kidney donor transplant process on living donors’ relational closeness with family, friends, and acquaintances

Introduction: Around 6,000 Americans are living kidney donors (LKDs) each year. Previous studies examined the impact of the living donation process on the relationship between LKDs and their intended recipients. However, there is minimal data on how this process affects LKDs’ relational closeness with others, such as family and friends.
Method: We conducted a longitudinal, prospective, mixed-methods study at 3 high-volume US transplant centers to evaluate LKDs’ relational closeness with individuals other than their intended recipient. English-speaking adults who presented for in-person donor evaluation were eligible. Participants completed semi-structured interviews at: (T1) in-person evaluation, (T2) donor eligibility decision, and (T3) 6 months post-eligibility decision. This study reports responses to: “Do you think the living kidney donor evaluation process affected your relationship with other individuals?” Using grounded theory, we identified themes regarding participants’ reasons for reporting that their relational closeness improved, decreased, or stayed the same.
Results: 141 participants completed interviews at all time points. Most were female (57%), White (88%), non-Hispanic (94%), and employed (86%). 67% of participants were donors; 28% were ineligible to donate and 5% opted out of donation. Table 1 displays detailed participant demographics. Participants described the impact of the donor process on their relational closeness with their family (51%), their friends (26%), the intended recipient’s family (22%), or the intended recipient’s friends (1%).

At T3, 33% reported their relational closeness with others improved, 59% reported it stayed the same, and 8% reported a decrease. Participants most reported positive changes in their relational closeness with their friends or family compared to others related to the recipient. The most common themes associated with improved relational closeness with others were an improved bond with others and others’ enhanced perceptions of the donor. One participant reported, “People said, ‘Oh, you’re a hero. You saved somebody’s life.’”.
Relational closeness decreased when others didn’t understand the LKD’s reason to donate. One participant said, “I did have a boyfriend at the time and he broke up with me because he didn’t agree with what I was doing.” In addition, participants’ relationships with the intended recipients’ family or friends were more likely to get worse if the participant opted out or was ineligible to donate, with reasons being case specific.
No change occurred if the LKD didn’t share the process with others. The most reported themes are reported in Table 2.

Conclusion: Our results suggest that the donation process impacts LKDs’ relationships with others, often positively. Transplant centers should ensure that donors have access to psychosocial support for the minority of LKDs who experience a decrease in relational closeness with members of their or their intended recipient’s social networks.