Research on Psychosocial and Ethical Aspects of Living Donor Liver Transplantation

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Shortage of organs and advance of transplantation techniques have drawn international attention to living donor liver transplantation (LDLT), especially adult-to-adult right lobe hepatectomy. This study aims to construct a decision-making model of the psychological process leading up to donation in adult LDLT for a donor.Twenty-two donors (15 males and 7 females, an average age of 37.9±10.1 (SD)) were interviewed using a semi-structured format. Questions included how participants felt when they first learned of the need for transplantation, circumstances of conversation (s) with family about who should be the donor, and so forth. Interviews were conducted after the operation (mean 12.6±5.2 days), lasted 48 minutes on average and ranged in duration from 20 to 77 minutes. All interviews were tape-recorded, transcribed verbatim, and analyzed based on grounded theory.A decision-making model was developed consisting of five-stages : (1) recognition, (2) digestion, (3) decision-making, (4) reinforcement, and (5) resolution. The second and the third stages described donors' experiences of "reaching a decision;" the latter two described that of "facing transplantation." The central theme of this model was "having no choice," which consisted of four codes : (1) priority of life, (2) only LDLT, (3) for family, and (4) only me. Although the reality of having no choice existed as a psychological burden, it concurrently motivated each participant to donate throughout the process.The model of "having no choice" describes the psychological process of donors' decision-making in LDLT. This study's framework serves as an essential tool for healthcare professionals to understand a donor's experience and, based on that understanding, to provide sufficient support to the donor.