Decisions around living kidney donation

Living donor Kidney transplantation (LDKT) is the optimal treatment for eligible people with
advanced chronic kidney disease (ACKD) with proven superiority to deceased donor
transplantation and dialysis treatments. Despite this, the uptake of LDKT is lower among
minority ethnic groups in the United Kingdom (UK), even though they are disproportionately
affected by kidney disease. This thesis explores how people make decisions about LDKT,
highlighting the decisional needs around this complex process with particular focus on minority
ethnic groups.
Two qualitative studies that were conducted in two kidney units in West Yorkshire region of
the UK. Interviews with 30 people with ACKD were conducted for Study 1. Nineteen kidney
healthcare professionals (HCPs) who provide LDKT decision making support- were included
in Study 2. Thematic analysis was conducted to generate themes representing decisional needs
around LDKT. Themes were occurred at three levels: (A) People with ACKD: Themes included
information needs, family concerns and psychosocial matters, and deliberation and validation,
(B) HCPs: Themes included language barriers in clinical interactions, cultural awareness, staff
diversity and trusted personnel and, (C) Patient information resources: Themes included timing
and setting of LDKT education and, suitability of patient facing information.
This research highlights the multifaceted nature of LDKT decision making. Several themes
were influenced by the intersection of ethnicity, social disadvantage, and language barriers. To
address LDKT decision making needs, interventions should move away from a “one size fits
all” approach and aim to provide tailored support that addresses and adapt to individual
contexts.