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Experiences of completed and withdrawn unspecified kidney donor candidates in the United Kingdom: An inductive thematic analysis from the BOUnD study.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involved in the United Kingdom (UK) UKD scheme, including those who complete the donation, are eventually medically withdrawn, or self-withdraw.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.

Key experiences of primary social groups in Unspecified Kidney Donation.

BACKGROUND: The role of family members in directed kidney donation is well documented in the literature from both a physiological and psychosocial perspective. The experiences of families, or primary social groups (PSGs), where one member considers donating a kidney via unspecified altruistic kidney donation route (UKD) is poorly understood. This is pertinent as lack of family support has been identified as a potential contributor to donation withdrawal. OBJECTIVES: This study aimed to explore the relevant psychosocial factors underpinning completed and uncompleted donations. DESIGN: A qualitative study using semi-structured interviews. PARTICIPANTS: Qualitative interviews were conducted in the United Kingdom with 35 individuals comprising of: 11 donors who donated their kidney altruistically and 8 of their PSG members, and 11 donors who withdrew and 5 of their PSG members. APPROACH: Interviews were transcribed verbatim and analysed using Framework Analysis. RESULTS: Two major themes were identified: (1) Supportability, which contained experiences fundamental to proceeding to donate, underpinned by four subthemes Acceptability, Awareness and Information, Family Risk and Ambivalence;(2) Seeking Resolution, contained discussions of experiences following either withdrawal from or completion of the donation, and comprised two sub-themes, Unfinished Business and Resolve. CONCLUSIONS: There are key differences in the experiences between those who completed their donation and those who withdrew. It is clear from this study that UKD operates within a PSG's social framework. Clinical implications suggest interventions at the level of addressing ambivalence within the PSG and the need for promotion of better psychosocial outcomes both following completion or withdrawal from donation.

Understanding barriers and outcomes of unspecified (non-directed altruistic) kidney donation from both professional's and patient's perspectives: research protocol for a national multicentre mixed-methods prospective cohort study.

INTRODUCTION: Living donation accounts for over one-third of all kidney transplants taking place in the UK. 1 The concept of anonymously donating a kidney to a stranger (non-directed altruistic or unspecified kidney donation (UKD)) remains uncomfortable for some clinicians, principally due to concerns about the motivations and long-term physical and psychological outcomes in this donor group. AIMS: The research programme aims to provide a comprehensive assessment of the unspecified donor programme in the UK. It aims to identify reasons for variations in practice across centres, explore outcomes for donors and ascertain barriers and facilitators to UKD, as well as assess the economic implications of unspecified donation. METHODS: The research programme will adopt a mixed-methods approach to assessing UKD nationally using focus groups, interviews and questionnaires. Two study populations will be investigated. The first will include transplant professionals involved in unspecified kidney donation. The second will include a 5-year prospective cohort of individuals who present to any of the 23 UK transplant centres as a potential unspecified living kidney donor. Physical and psychological outcomes will be followed up to 1 year following donation or withdrawal from the donation process. A matched sample of specified donors (those donating to someone they know) will be recruited as a control group. Further qualitative work consisting of interviews will be performed on a purposive sample of unspecified donors from both groups (those who do and do not donate). DISSEMINATION: The findings will be reported to NHS Blood and Transplant and the British Transplant Society with a view to developing national guidelines and a protocol for the management of those presenting for unspecified donation. TRIAL REGISTRATION NUMBER: ISRCTN23895878, Pre-results.

An exploration of compassion focused therapy following acquired brain injury.

BACKGROUND: People with acquired brain injuries (ABI) frequently experience psychological difficulties such as anxiety and depression, which may be underpinned and maintained by high self-criticism and shame alongside an inability to self-soothe. Compassionate focused therapy (CFT) was developed to address shame and self-criticism and foster the ability to self-soothe. OBJECTIVES: This is a naturalistic evaluation with the aim of assessing the feasibility, safety, and potential value of CFT for ABI patients with emotional difficulties receiving neuropsychological rehabilitation. METHODS: This study employed a mixed methods design combining self-report measures and qualitative interviews. Twelve patients received a combination of CFT group and individual intervention. Self-report measures of self-criticism, self-reassurance, and symptoms of anxiety and depression were collected pre and post programme and analysed using Wilcoxon signed rank test (N=12; five female, seven males). Follow-up data were analysed in the same manner (N=9). Interviews were conducted with six patients and analysed using interpretative phenomenological analysis. RESULTS: CFT was associated with significant reductions in measures of self-criticism, anxiety, and depression and an increase in the ability to reassure the self. No adverse effects were reported. Three superordinate themes emerged from the interviews: psychological difficulties; developing trust and finding safeness; and a new approach. CONCLUSIONS: This study suggests that CFT is well accepted in ABI survivors within the context of neuropsychological rehabilitation. Furthermore, the results indicate that further research into CFT for psychological problems after ABI is needed and that there may be key aspects, which are specific to CFT intervention, which could reduce psychological difficulties after ABI. PRACTITIONER POINTS: CFT appears to be a feasible intervention for psychological problems after ABI. CFT was associated with a reduction in symptoms of anxiety and depression and associated self-criticism, as well as enhanced self-reassurance for ABI survivors. These ABI survivors reported that CFT provided them with tools to manage continued psychological difficulties.

Understanding donation experiences of unspecified (altruistic) kidney donors.

OBJECTIVES: Kidney donation from a living donor to an unknown recipient has been legal in the UK since 2006. Yet there is little research into the experiences of unspecified kidney donors (UKDs) in interaction with the health care systems. DESIGN: This article explores the experiences of 14 UKDs recruited through four regional transplant co-ordinating centres in England. At interview, they were invited to share their donation stories and discuss the antecedents, social, and psychological processes involved. Interviews were audio-taped and transcribed. METHODS: Transcripts were analysed using a grounded theory approach employing a constant comparison methodology. Themes emerging from the data were named to form categories organized around the central focus of the research, forming an analytical story of UKDs' experiences. RESULTS: Two major categories emerged: 'connected to others' and 'uneasy negotiations with others'. 'Connected to others' encompasses the motivations and psychological and social consequences of UKD. 'Uneasy negotiations with others' refer to the concerns and conflicts that arose during the donation process. CONCLUSIONS: This study highlights the importance of social relationships on the process and outcomes of UKD. These UKDs report both intra- and interpersonal benefits from donation. The donation process, however, also created interpersonal stress, and conflicting messages about the acceptability of their donation were experienced in UKDs' personal lives and in their interactions with health care services. Findings are discussed with reference to the wider literature on UKD and altruism and in relation to implications for clinical practice. STATEMENT OF CONTRIBUTION: What is already known on this subject? Unspecified living kidney donation is an under-researched area with only three research papers published worldwide that report on the motivations and experiences of donors. These studies indicate that donors endorse pro-social values and receive positive interpersonal and intrapersonal benefits from donation. What does this study add? UKDs' experiences are made explicit and provide a framework for future research. Social connections (capital) are an important precursor to and outcome from donation. Assumptions of pathological motivations were encountered by donors in their personal life and within the NHS.

The Adult Attachment Interview and self-reports of attachment style: an empirical rapprochement.

Although 10 studies have been published on the empirical overlap of the Adult Attachment Interview (AAI) and measures of self-reported attachment style, results in this literature have been inconsistently interpreted in narrative reviews. This report was designed as a rapprochement of the AAI and attachment style literatures and includes 3 studies. Study 1 (combined N = 961) is a meta-analytic review showing that by J. Cohen's (1992) criteria (mean r = .09), the association between AAI security and attachment style dimensions is trivial to small. Study 2 (N = 160) confirms meta-analytic results with state-of-the-art assessments of attachment security and also examines attachment dimensions in relation to the Big 5 personality traits. Finally, Study 3 is an investigation of 50 engaged couples that shows that developmental and social psychological measures of attachment security predict somewhat distinct--though theoretically anticipated--aspects of functioning in adult relationships.