Understanding risk in living donor nephrectomy

J Med Ethics. 2010 Mar;36(3):142-7. doi: 10.1136/jme.2009.031740.

Abstract

Objectives: To investigate risk perception relating to living kidney donation, to compare the risk donors would accept with current practice and identify influential factors.

Design: An observational study consisting of questionnaires completed by previous living donors and the general public. Participants selected the risk they would accept from a list of options, in various scenarios. Risk communication was investigated by randomly dividing the sample and presenting risk differently.

Setting: Primary care (two centres) and secondary care (one centre), London.

Participants: 175 questionnaires were sent to patients who had previously undergone living-donor nephrectomy and to members of the public consulting a general practitioner. The living-donor sample comprised 77 consecutive donors at Guy's Hospital from May 2003 to January 2005. The general-public sample was recruited from two London healthcare centres. Of the eventual 151 participants, 61 were living donors and 90 were from the general public.

Main outcome measure: The amount of risk a participant would accept to donate a kidney.

Results: 74% of participants were willing to accept a risk of death higher than 1/3000. The most commonly accepted risk was 1/2 (29%). Those presented with a 'chance of survival' accepted higher risks than those presented with a 'risk of death' (p<0.01). Greater risks were accepted when the recipient was closely related and, for some, when the recipient's prognosis was worse. No difference was observed between the living-donor and general-public groups.

Conclusions: Kidney donors will accept a higher risk of death than is currently quoted, especially if risks are presented in terms of chance of survival.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Attitude to Death
  • Family
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Kidney Transplantation / psychology*
  • Living Donors / psychology*
  • Male
  • Middle Aged
  • Nephrectomy / adverse effects
  • Nephrectomy / psychology*
  • Risk Assessment
  • Risk Factors
  • Statistics as Topic
  • Surveys and Questionnaires
  • Tissue and Organ Procurement / organization & administration*