*Purpose: Anonymous living organ donation has recently become a more regular practice in select transplant programs, with donors coming forward voluntarily to give their organs to those in need. These donors may be directed or non-directed, and anonymity may be one-way or reciprocal. There is limited literature focusing on the psychosocial aspects of anonymity in living liver donors. Given the unique situation of these donors, we interviewed a sample of 26 anonymous live liver donors and explored their opinions surrounding the idea of anonymity and its implications in living liver donation.

*Methods:

Anonymous donors completed a semi-structured qualitative interview consisting of questions regarding their experiences as a donor. Donors were at least 18 years of age, fluent in English, and had donated at least 3 months prior to participating. Living donation surgeries had occurred between 2005 and 2016. Interviews were conducted over the telephone or in person by an experienced qualitative researcher during the time period September 2016 to April 2017. All interviews, ranging from 41 to 135 minutes in length, were audio-recorded, transcribed, and quality-checked. They were analyzed and categorized into common themes, specifically those pertaining to the donor’s perceptions and experiences with anonymity.

*Results: Of 40 eligible anonymous donors, 26 (65%) anonymous donors were interviewed. Out of the donors interviewed, 4/26 (15.4%) participated in a directed donation, meaning they had knowledge of the recipient’s identity. In these cases, anonymity was one-way. The remainder were non-directed (two-way anonymity). The views of the directed donors did not appear to have any significant differences from the views of non-directed donors. Five main themes related to anonymity were identified as follows: (1) Ethical issues related to coercion and recipient indebtedness; the majority expressed that the recipient should not feel like they owe the donor anything in return; (2) Wanting internal satisfaction rather than seeking accolades—donation was a purely altruistic act; (3) Not wanting to be emotionally attached to the outcome in the recipient, thus avoiding the guilt and responsibility if the recipient had a complication; (4) Concerns about negative perceptions amongst their own friends and family, such as being referred to as “selfish” for risking their life; (5) Feelings of ambivalence towards meeting the recipient; although most donors were not opposed to meeting the recipient, they would not seek them out themselves.

*Conclusions: These findings provide unique insight into living donor opinions on several aspects related to anonymity in the donation process. We identified five key drivers related to decisions surrounding anonymity. Knowledge of the donor’s mindset and attitudes on the topic will help improve awareness and provide the best possible mental and physical care for the anonymous donor.

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