Exploring Staff Attitudes Towards Unspecified Kidney Donors in the United Kingdom: Results From the BOUnD Study.

Unspecified kidney donation (UKD) has made substantial contributions to the UK living donor programme. Nevertheless, some transplant professionals are uncomfortable with these individuals undergoing surgery. This study aimed to qualitatively explore the attitudes of UK healthcare professionals towards UKD. An opportunistic sample was recruited through the Barriers and Outcomes in Unspecified Donation (BOUnD) study covering six UK transplant centres: three high volume and three low volume centres. Interview transcripts were analysed using inductive thematic analysis. The study provided comprehensive coverage of the UK transplant community, involving 59 transplant professionals. We identified five themes: staff's conception of the ethics of UKD; presence of the known recipient in the donor-recipient dyad; need for better management of patient expectations; managing visceral reactions about the "typical" unspecified kidney donor; complex attitudes toward a promising new practice. This is the first in-depth qualitative study of attitudes of transplant professionals towards UKD. The data uncovered findings with strong clinical implications for the UKD programme, including the need for a uniform approach towards younger candidates that is adhered to by all transplant centres, the need to equally extend the rigorous assessment to both specified and unspecified donors, and a new approach to managing donor expectations.

Experiences of completed and withdrawn unspecified kidney donor candidates in the United Kingdom: An inductive thematic analysis from the BOUnD study.

Objectives This study sheds light on some controversial aspects of unspecified kidney donation (UKD) as well as the ways in which potential donors are screened and prepared for the donation experience and its aftermath. The aim of this study was to qualitatively investigate the experiences of individuals involved in the United Kingdom (UK) UKD scheme, including those who complete the donation, are eventually medically withdrawn, or self-withdraw. Better insight into the different experiences of these groups will provide useful guidance to clinical teams on how to better address the differing psychological needs of completed donors as well as those who do not proceed to donation. Methods A purposive sample was recruited through the Barriers and Outcomes in Unspecified Donation (BOUnD) study covering 23 transplant centres in the United Kingdom. Semi-structured interviews were audio-recorded and transcribed verbatim and subjected to inductive thematic analysis. Results Participants consisted of 15 individuals who had donated, 11 who had been withdrawn by the transplant team and nine who had self-withdrawn. The analysis resulted in six themes and 14 subthemes. The major themes were maximizing and sharing benefits; risk-to-motivation analysis; support; self-actualization/finding meaning; the donor as patient; and relationship with the transplant team. Conclusions The data demonstrate that, although all donors enter the process with a similar level of commitment, those who did not proceed to donation expressed dissatisfaction and lingering emotional consequences linked to lack of follow-up from transplant teams. The implication for the UKD programme is that from the beginning there needs to be a strategic and consistent approach to managing expectations in order to prepare those who embark on the donation process for all possible outcomes and their associated emotional consequences.

Citizenship in practice.

The idea of citizenship dates back to classical antiquity. It was originally concerned to address legitimacy of occupancy in the public sphere. Our empirical study contributes to the project of developing a social psychology of the citizen by focusing on the dynamics of such membership, specifically rights and identities. The authors briefly describe a number of existing psychological models of the citizen. Drawing on the main theoretical principles of discursive psychology, rather than asking, 'who is the citizen?' in terms of mental states, we suggest a shift in focus to the more social question, 'how do people claim citizenship and to what ends?'. We present an analysis of private letters of complaint that formed part of a larger mixed data set used in a recent research programme centred on disputes over Britain's newer travellers' rights of settlement. Specifically our analysis demonstrates how some of the letter writers generate a basis for claims-making by making relevant a citizenship/ governance alignment of identities. We also demonstrate how the entitlements associated with the category citizen are built up and action-oriented rather than flowing from the (unproblematic) assumption of citizenship. Finally we discuss how citizenship can be used for the purposes of inclusion and exclusion.

Doing cognitive distortions: a discursive psychology analysis of sex offender treatment talk.

Theories of sex offending have for several years relied upon the notion of cognitive distortions as an important cause of sexual offending. In this study we critique this notion and suggest that the sort of phenomenon addressed by cognitive distortions is better understood by adopting a discursive psychology approach. In this approach, talk is regarded as occasioned and action oriented. Thus 'cognitive distortions' are conceptualized as something people do rather than something that people have. Sessions from a prison-based sex offender treatment programme were taped and transcribed. A discursive psychology analysis was conducted on those sessions relating to offenders' first accounts of their offences. Our analysis suggests that offenders utilize a particular narrative organization to manage their blame and responsibility for the offence. This organization is based on a first part which is oriented to quotidian precursors to the offence and an immediately following second which is oriented to a sudden shift in the definition of the situation. The implications of this analysis are discussed, in relation to the status of cognitive distortions and treatment.