Is There More Stress or Coercion To Donate in KPD Donors?

[Clark]

http://www.atcmeetingabstracts.com/abstract/is-there-more-stress-or-coercion-to-donate-in-kpd-donors/

Is There More Stress or Coercion To Donate in KPD Donors?
D. Serur, M. Charlton, M. Lawton, J. Sinacore, C. Li, J. Gordon-Elliott

BACKGROUND:

Kidney paired donation (KPD) is growing fast. The donors in KPD, or chain donors (Ch-D), have never before been studied from a psychosocial aspect or compared to traditional donors. There has been a concern that chain donors are under extra pressure and coercion as their backing out of the donation will result in more than just one person not getting transplanted and they do not have the option of backing out by invoking ABO incompatibility. This is the first study that evaluated the psychosocial and functional outcomes of Ch-Ds in paired exchange in comparison to traditional directed donors (Tr-D) who have an established relationship with the recipient. An assessment of coercion was utilized as well.

METHODS:

Chain donors (n=40) from our center that were part of the National Kidney Registry paired exchange program were evaluated and compared to traditional donors (n=38). Participants completed online surveys: The post-donation section of the Living Donor Expectancies Questionnaire (LDEQ) was used for psychosocial and functional outcomes 6-36 months after donation. The MacArthur Admission Experience Survey-Short Form 1 (MacArthur AES) was used to evaluate coercion.

RESULTS:

Chain donors and traditional donors in this study were similar in terms of gender, race, age, and time after donation (p-value range 0.3 to 0.. The two groups had similar altruistic motives in donating their kidney and psychological benefits were mentioned by both type of donors. There were no differences in questions about interpersonal benefit, personal growth, spiritual benefit, or health consequences after donation (p values 0.2 to 0.5). There only difference between the two groups was that traditional donors scored higher on the quid pro quo scale of the survey (p value .015), a sense that the recipient is indebted to them. The two groups did not differ significantly in the coercion tool (MacArthur AES). Pressure to donate and stress of donation was not greater in Ch-Ds (P value 0.6).

CONCLUSION:

Our study is the first ever to indicate that donors in KPD chains fare comparably with traditional donors, deriving the same psychosocial benefits and same level of functioning post-donation. There was no tendency towards experiencing greater coercion in the KPD donors.

[Clark]

I suggest that this study did not measure coercive stress in either group. This must be measured among all donor candidates prior to donation, and follow up done with all who do not become donors, for whatever reason. I also submit that the relative magnitude of coercive stress among different categories of relationship between donor candidate and would be recipient is less the point than a recognition that coercion may exist, and its character, while broadly describable by relationship category, will be idiosyncratic for each individual relationship.