Potential Living Kidney Donors (LKD) Concerns About Opting Out and Preferences for an 'Alibi'.
1Yale U, New Haven
2Northwestern U, Chicago
3U Pennyslvania, Philadelphia
Meeting: 2017 American Transplant Congress
Abstract number: D288
Keywords: Donation, Ethics, Kidney transplantation, Psychosocial
Session Information
Session Name: Poster Session D: Non-Organ Specific: Economics, Public Policy, Allocation, Ethics
Session Type: Poster Session
Date: Tuesday, May 2, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Purpose
To evaluate potential LKDs comfort discussing opting out with their intended recipient (IR) and preferences for alibis
Methods
We conducted a prospective, longitudinal study of potential LKDs at 3 US transplant centers. Each offers an alibi, a non-specific statement of ineligibility to those who opt out of donation. We report data from semi-structured interviews after LKDs were told if they could donate. Questions assessed LKDs comfort telling their IR if they opted out and preferences about alibi use. Inductive qualitative coding was performed in NVivo. Chi-squared tests assessed correlations between LKD characteristics and attitudes toward alibis.
Results
100 LKDs participated: 68% donors, 21% ineligibles, 5% who opted out, and 6% non-donors for other reasons.
36% would not feel comfortable telling their IR they opted out.
| Intended Recipient | % of Sample | Not comfortable telling intended recipient about opt-out decision (%) | Would want alibi (%) |
| Friend | 26 | 42 | 50 |
| Sibling | 22 | 45 | 50 |
| Spouse | 14 | 14 | 21 |
| Parent | 13 | 31 | 31 |
| Child | 11 | 45 | 9 |
| Other relative | 8 | 38 | 50 |
| Other | 6 | 17 | 17 |
| Overall | 100 | 36 | 37 |
LKDs were concerned about the IR's health (14%), negative effect on the LKD-IR relationship (11%), and emotional impact on the IR (9%). Comfort with this conversation arose from confidence that the IR would understand (33%), desire to be honest (22%), and close relationship to the IR (19%).
37% did not know the center offered an alibi, but 37% said they might use one if they opted out. Supporters believed the alibi reduces pressure on the LKD (17%), provides an easy way out (15%), and protects the LKD-IR relationship (9%). Others thought alibis were cowardly or a lie (32%), felt they could be honest (28%), or wanted to share the decision in their own words (17%).
LKD characteristics were not correlated with knowledge of or preference for alibi use.
Conclusion
One-third of LKDs would be uncomfortable sharing an opt-out decision with their IRs, and many did not know about alibis. Our results suggest that centers can enhance donor autonomy by increasing awareness of alibis and facilitating LKD-IR conversations about opting out.
CITATION INFORMATION: Yu K, Thiessen C, Li S, Dobosz D, Gannon J, Kennedy K, Gray D, Mussell A, Reese P, Kulkarni S, Gordon E. Potential Living Kidney Donors (LKD) Concerns About Opting Out and Preferences for an 'Alibi'. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Yu K, Thiessen C, Li S, Dobosz D, Gannon J, Kennedy K, Gray D, Mussell A, Reese P, Kulkarni S, Gordon E. Potential Living Kidney Donors (LKD) Concerns About Opting Out and Preferences for an 'Alibi'. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/potential-living-kidney-donors-lkd-concerns-about-opting-out-and-preferences-for-an-alibi/. Accessed May 15, 2025.« Back to 2017 American Transplant Congress