Does Hope for a Better Future or Fear of Death Motivate Kidney Patients More? A Decisional Balance Exploration of Motivation to Pursue Living Donor Kidney Transplant

H. Rafiqzad¹, A. Wasim¹, A. Rezaeishahreza¹, J. Lam¹, A. Li¹, T. Mahiuddin¹, A. D. Waterman², M. Novak¹, I. Mucsi¹

¹University Health Network, Toronto, ON, Canada, ²University of California, Los Angeles, Los Angeles, CA

Meeting: 2020 American Transplant Congress

Abstract number: C-099

Keywords: Kidney transplantation, Outcome, Patient education, Psychosocial

Session Information

Session Name: Poster Session C: Kidney Psychosocial

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: We assessed whether the importance attributed to “living a longer life with transplant” versus “fear of death during transplant surgery” by kidney transplant (KT) candidates were associated with readiness to pursue living donor kidney transplant (LDKT).

*Methods: A cross-sectional sample of adults on dialysis in Toronto completed standard, validated questionnaires. Patients rated the importance of potential positive and negative outcomes to their decision about transplant on a scale ranging from 1 to 5 (‘not important’ to ‘extremely important’). LDKT and deceased donor KT (DDKT) pro and con scores were calculated by summing positive and negative item scores, respectively. Answers to the two items of interest (“I would live a longer life with a transplant”; “I could die during the transplant surgery”) were dichotomized (not/slightly/moderately vs very/extremely important) and their association with the outcome variable was analyzed in multivariable logistic regression models. Readiness to pursue LDKT (outcome) was categorized into “taking actions to pursue LDKT” (advanced action stage) vs “considering/not considering LDKT” (early stage).

*Results: 576 participants were recruited (63% male, mean [SD] age 57 [13] years). 87% of participants considered the chance of living a longer life as highly important, while only 37% of participants considered the possibility of dying during surgery as highly important to their decision. In multivariable adjusted logistic regression models, individuals for whom “living a longer life after transplant” was of high importance were more likely to be taking actions to pursue LDKT (OR=2.61, CI=1.13-6.03, P=0.03). In a similar model, the importance of potential death during transplant surgery was not associated with LDKT readiness (OR=0.71, CI=0.45-1.13, P=0.15).

*Conclusions: In this study, individuals who were motivated by potential positive outcomes of LDKT, particularly living a longer life, were more likely to be taking actions to pursue LDKT. The potential negative consequences, including fear of death, were not associated with LDKT readiness. As predicted by the Transtheoretical Model, understanding LDKT readiness and emphasizing the potential positive outcomes after LDKT may motivate more patients to consider LDKT.

To cite this abstract in AMA style:

Rafiqzad H, Wasim A, Rezaeishahreza A, Lam J, Li A, Mahiuddin T, Waterman AD, Novak M, Mucsi I. Does Hope for a Better Future or Fear of Death Motivate Kidney Patients More? A Decisional Balance Exploration of Motivation to Pursue Living Donor Kidney Transplant [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/does-hope-for-a-better-future-or-fear-of-death-motivate-kidney-patients-more-a-decisional-balance-exploration-of-motivation-to-pursue-living-donor-kidney-transplant/. Accessed May 16, 2025.

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