donation: a family and
Patricia M. Franklin and Alison K. Crombie
Living renal donation is increasing due to excellent graft survival rates, a lack of growth in cadaveric donation and an increase in those waiting for a renal transplant. Indeed, in the USA the number of transplants from living renal donors has recently overtaken the number of transplants from deceased donors. Living renal donation involves complicated decision-making for donors, recipients and health professionals and is underpinned by legal constraints, national guidelines (see Appendix 1) and individual ethical, moral and familial attitudes.
The discussions within this chapter explore this decision-making with recourse to national and international data and two qualitative research studies, undertaken by each of the authors, in two large transplant centres in the UK (Franklin and Crombie 2003). To provide further insights into important core aspects of decision-making from the viewpoint of recipients, donors, non-donors, pre- and postoperatively, as well as biomedical decisionmaking, Franklin concentrated on psychological parameters, while Crombie explored the sociocultural perspectives, through an anthropological approach. Franklin and Crombie's fieldwork consisted of interviews with family members, interviews with transplant professionals (consultants, counsellors, nurses and other health professionals) and observation in transplant clinics, wards, dialysis units, and meetings between senior medical and multiprofessional team members.
Since the first human kidney transplant in 1954, solid organ transplantation now encompasses most organs in the body: heart, lung, kidneys, liver, pancreas, small and large intestine. Developments in surgical techniques and