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Narratives: an essential tool for evaluating living kidney donations

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Abstract

Norway’s living kidney donation-rate is among the highest in the world (36 per million). According to questionnaire-results, donors enjoy better than average health, presumably due to the strict medical criteria for being allowed to donate and life long medical follow up. However, in recent years international studies have cast doubt on the predominantly positive picture of donors and recipients, particularly regarding psychological aspects of transplantation surgery and donor evalutation. Findings in this study derive from anthropological fieldwork lasting 36 months at three university hospitals in the Oslo-basin. 18 end stage kidney disease patients and their potential donors were recruited opportunistically and interviewed (separately) in three or more semi-structured conversations during the evaluation process and after transplantation. 3 cases are discussed in detail. Notes were transcribed and analysed according to narrative theory. Focus was to explore the content of donors’ and recipients’ pre- and post-transplantation narratives and to examine whether these accounts warrant a need for more comprehensive psychological assessment than is current practice in Norway. Donor- and recipient-narratives are well suited as a tool to improve living kidney donation-decisions. The material indicates a need to offer psychological care to LKD-partners, before and after transplantation.

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Abbreviations

LKD:

Living kidney donation

ESRD:

End stage renal disease

LD:

Living donation

PKD:

Pre-emptive kidney donation

DKD:

Deceased kidney donation

DD:

Deceased donation

PMP:

Per million population

NTU:

National Transplant Unit

PKT:

Pre-dialytic kidney transplantation

References

  • Afsar, B., and B. Akman. 2009. Depression and nonadherence are closely related in dialysis patients. Kidney International 76(6):679; author reply 679–680.

    Google Scholar 

  • Bakhtin, M., ed. 1981. The dialogic imagination, ed. M. Homquist. Austin: University of Texas Press.

  • Biller-Andorno, N., and H. Schauenburg. 2001. It’s only love? Some pitfalls in emotionally related organ donation. Journal of Medical Ethics 27(3): 162–164.

    Article  PubMed  CAS  Google Scholar 

  • Charon, R. 2004. Narrative and medicine. New England Journal of Medicine 350(9): 862–864.

    Article  PubMed  CAS  Google Scholar 

  • Douglas, M. 1992. Risk and blame: essays in cultural theory. London: Routledge.

  • Fagerli, R.A., M.E. Lien, and M. Wandel. 2005. Experience of dietary advice among Pakistani-born persons with type 2 diabetes in Oslo. Appetite 45(3): 295–304.

    Article  PubMed  Google Scholar 

  • Ferhman-Ekholm, I., C.-G. Elinder, M. Steinbeck, G. Tydén, and C.-G. Groth. 1997. Kidney donors live longer. Transplantation 64(7): 976–978.

    Article  Google Scholar 

  • Filocamo, M.T., M. Zanazzi, V. Li Marzi, G. Lombardi, G. Del Popolo, G. Mancini, M. Salvadori, and G. Nicita. 2009. Sexual dysfunction in women during dialysis and after renal transplantation. Journal of Sex Medicine 6(11): 3125–3131.

    Article  Google Scholar 

  • Frank, A.W. 1995. The wounded storyteller. Chicago and London: The University of Chicago Press.

  • Franklin, P.M., A.K. Crombie. 2003. Live related renal transplantation: psychological, social, and cultural issues. Transplantation 76(8): 1247–1252.

    Google Scholar 

  • Godbout, J.T. 1998. The moral of the gift. Journal of Socio-Economics 27(4): 557–570.

    Article  Google Scholar 

  • Godelier, M. 1999. The enigma of the gift. Cambridge, UK: Polity Press in association with Blackwell Publishers Ltd.

  • Gordon, E.J. 2001. They don't have to suffer for me: why dialysis patients refuse offers of living donor kidneys. Medical Anthropology Quarterly 15(2): 245–267

    Google Scholar 

  • Gregory, C.A. 1993. Exchange and reciprocity. In Companion Encylopedia of anthropology, ed. T. Ingold, 911–939. London, New York: Routldge.

  • Hartmann, A., P. Fauchald, L. Westlie, I.B. Brekke, and H. Holdaas. 2003. The risk of living kidney donation. Nephrology, Dialysis, Transplantation 18: 871–873.

    Article  PubMed  Google Scholar 

  • Helse- og omsorgsdepartementet. 1999. Law on patient rights. Pasientrettighetsloven 1999-07-02-63. Norway: HOD (Helse- og omsorgsdepartementet).

  • Hyde, L. 1979. The gift. Imagination and the erotic life of property. New York: Rndom House Inc.

    Google Scholar 

  • Jindal, R.M., R.T. Neff, K.C. Abbott, F.P. Hurst, E.A. Elster, E.M. Falta, P. Patel, and D. Cukor. 2009. Association between depression and nonadherence in recipients of kidney transplants: analysis of the United States renal data system. Transplant Proceedings 41(9): 3662–3666.

    Article  CAS  Google Scholar 

  • Kierans, C. 2005. Narrating kidney disease: the significance of sensation and time in the emplotment of patient experience. Culture, Medicine and Psychiatry 29(3): 341–359.

    Article  PubMed  Google Scholar 

  • Labov, W. 1969. The logic of nonstandard english. In Language, social context: Selected readings, ed. P.P. Giglioli. Harmondsworth: Penguin.

    Google Scholar 

  • Langewitz, W., M. Denz, and A. Keller. 2002. Spontaneous talking time at start of consultation in outpatient clinic: Cohort study. BMJ 325: 682–683

    Google Scholar 

  • Leivestad, T. 2009. Annual Report The Norwegian Renal Registry (Norsk Nefrologiregister). Oslo.

  • Lopes, A., I.C. Frade, L. Teixeira, C. Oliveira, M. Almeida, L. Dias, and A.C. Henriques. 2011. Depression and anxiety in living kidney donation: Evaluation of donors and recipients. Transplantation Proceedings 43(1): 131–136.

    Article  PubMed  CAS  Google Scholar 

  • Lyengar, S. 2010. The art of choosing. UK: Little Brown.

  • Mattingly, C. 1998. Healing dramas and clinical plots. The narrative structure of experience. New York: Cambridge University Press.

    Google Scholar 

  • Mauss, M. 1969. The gift: The form and reason for exchange in archaic societies. London: Routledg & Kegan Paul Ltd.

    Google Scholar 

  • Mishler, E.G. 1986. Research interviewing: Context and narrative. Cambridge, MA: Harvard University Press.

    Google Scholar 

  • Mjøen, G., O. Øyen, H. Holdaas, K. Midtvedt, and P.D. Line. 2009. Morbidity and mortality in 1022 consecutive living donor nephrectomies: Benefits of a living donor registry. Transplantation 88(11): 1273–1279.

    Article  PubMed  Google Scholar 

  • Pascazio, L., I.B. Nardone, A. Clarici, G. Enzmann, M. Grignetti, G.O. Panzetta, and C. Vecchiet. 2010. Anxiety, depression and emotional profile in renal transplant recipients and healthy subjects: A comparative study. Transplantation Proceedings 42(9): 3586–3590.

    Article  PubMed  CAS  Google Scholar 

  • Reissman, C., ed. 2002. Analysis of personal narratives. In Handbook of interview research, vol. 30, ed. J. Gubrium and J. Holstein. Thousand Oaks California: Sage.

  • Sahlins, M. 1972. Stone age economics. London: Tavistock.

    Google Scholar 

  • Schneider, D.M. 1980. American kinship: A cultural account. Englewood Cliffs, NJ: University of Chicago Press.

    Google Scholar 

  • Squire, C. 2007. HIV in South Africa: Talking about the Big THing. London: Rouledge.

    Google Scholar 

  • Steiner, T., H. Wunderlich, and U. Ott. 2009. Sexuality after kidney transplantation. Urologe A 48(12): 1438–1442.

    Article  PubMed  CAS  Google Scholar 

  • Virzi, A., M.S. Signorelli, M. Veroux, G. Giammarresi, S. Maugeri, A. Nicoletti, and P. Veroux. 2007. Depression and quality of life in living related renal transplantation. Transplant Proceedings 39(6): 1791–1793.

    Article  CAS  Google Scholar 

  • Westlie, L., P. Fauchald, T. Talseth, A. Jakobsen, and A. Flatmark. 1993. Quality of life in Norwegian kidney donors. Nephrology, Dialysis, Transplantation 8: 1145–1150.

    Google Scholar 

  • Witczak, B.J., T. Leivestad, P.D. Line, and H. Holdaas. 2009. Experience from an active preemptive kidney transplantation program—809 cases revisited. Transplantation 88(5): 672–677.

    Article  PubMed  Google Scholar 

  • Zeiler, K., L. Guntram, and A. Lennerling. 2010. Moral tales of parental living kidney donation: a parenthood moral imperative and its relevance for decision making. Medicine, Health Care and Philosophy 13(3): 225–236.

    Article  Google Scholar 

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Acknowledgments

This study has been made possible by a 3-year scholarship from Extra Foundation (Oslo, Norway). My gratitude is specially directed to the informants in my fieldwork who generously shared their positive and sometimes sadder experiences of transplantation and donation with me. I also wish to thank the head of the nephrology ward at Oslo University Hospital (Ullevaal), Aud-Eldrid Stenehjem, MD, PhD. nephrologist. Solbjørg Sagedal, MD, PhD, and the head of the nephrology ward at Buskerud Regional Hospital, Kristian Selvig, MD, without whose support I would not have had access to my informants. Special thanks are due to my husband, Egil Alnaes, MD, PhD, who weeded away medical misunderstandings, proof read meticulously and whose comments have been an inspiration. Extra thanks to professor in medical ethics, Jan Helge Solbakk, MD, Dr. philos, and to my anthropologist colleague, senior researcher Kirsten Danielsen at NOVA, Oslo. Last but not least, professor emeritus in literature. Jostein Bortnes Dr. philos, Bergen University, has contributed invaluable advice and input on several drafts of this article.

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  1. Center of Medical Ethics, Medical Faculty, University of Oslo, Oslo, Norway

    Anne Hambro Alnaes

  2. Abbedisvingen 5, 0280, Oslo, Norway

    Anne Hambro Alnaes

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  1. Anne Hambro Alnaes
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Correspondence to Anne Hambro Alnaes.

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Hambro Alnaes, A. Narratives: an essential tool for evaluating living kidney donations. Med Health Care and Philos 15, 181–194 (2012). https://doi.org/10.1007/s11019-011-9337-9

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