Transplant Professionals’ Attitudes and Approaches to the Living Kidney Donor-Recipient Relationship
Bibliographic record
Abstract
Introduction Assessment of the donor-recipient relationship is recommended by international guidelines to prevent undue coercion and ensure realistic expectations. We aimed to describe attitudes and experiences of transplant professionals on the donor-recipient relationship in living kidney donation. Methods Semi-structured interviews were conducted with transplant professionals (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists). Transcripts were analysed thematically. Results Fifty-four transplant professionals from thirty-two transplant centres across nine countries participated in the study. Four themes were identified: protecting vulnerability (ensuring genuine motivation, uncovering precarious dynamics, trusting emotional bonds, shared accountability, relying on psychosocial expertise, managing overwhelming and emotionally charged decisions); safeguarding against coercion (grasping broader power dynamics, justifiable probing, resigning to inevitable opacity, understanding interpersonal dynamics); minimising potential threat to relationships (protecting the bond, giving equitable attention to donors and recipients, preempting conflict, recognising changing dynamics, ensuring realistic expectations); and ambiguities in roles and responsibilities (expanding criteria and definitions of relationship, questioning medical paternalism, uncertainties in subjective assessments). Conclusion Transplant professionals regarded the donor-recipient relationship as the driving moral imperative of the donation and thus believe that assessing the donor-recipient relationship is ethically necessary to minimise the risk of undue coercion and to protect donors and recipients. However, some feel challenged in disentangling altruism and voluntariness from the potential pressures of familial and societal duty they believe donors may not disclose, and question the level of justifiable medical paternalism.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.034 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.008 | 0.007 |
| Scholarly communication | 0.006 | 0.002 |
| Open science | 0.001 | 0.006 |
| Research integrity | 0.002 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".