Stressors and coping mechanisms in live-related renal transplantation

Aim: To explore donor and recipient experiences of stressors and coping mechanisms associated with live-related renal transplantation.

Background: Live-related renal transplantation is an effective and efficient treatment for end-stage kidney disease, but is also associated with a variety of stressors.

Design: Longitudinal, phenomenological study.

Methods: Eleven live kidney donors and their recipients (n = 22) were recruited from a regional renal transplant centre in South-West England. Data were collected through three recorded, semi-structured interviews, conducted pretransplant and at three and 10 months post-transplant. Interviews were transcribed verbatim, analysed using a process of thematic analysis and validated through a constructive process of inter-rater reliability.

Results: End-stage kidney disease, dialysis and live transplantation produced a variety of stressors for donors and recipients. Common stressors included the live transplantation decision-making process, the prospect of surgery and postoperative recovery, follow-up care for donors and, in particular, concern for each other, especially amongst recipients. The main stressor, however, was fear of transplant failure. Participants used a variety of problem- and emotion-focused coping mechanisms to deal with these stressors and donors and recipients actively supported each other through the transplantation process.

Conclusion: Renal transplantation remains the treatment of choice for most patients with end-stage kidney disease but is a source of considerable stress for donors and especially recipients and subsequently requires a range of coping mechanisms, including social support.

Relevance to clinical practice: Patients need to be adequately informed of the risks associated with transplantation and provided with appropriate emotional care and support throughout the transplantation process. Health professionals also need to be mindful of assessing the needs and managing realistic expectations of patients and their families.