{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:25:16Z","timestamp":1777501516960,"version":"3.51.4"},"reference-count":53,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,2,13]],"date-time":"2019-02-13T00:00:00Z","timestamp":1550016000000},"content-version":"am","delay-in-days":15,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#am"},{"start":{"date-parts":[[2019,1,29]],"date-time":"2019-01-29T00:00:00Z","timestamp":1548720000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000923","name":"Australian Research Council","doi-asserted-by":"publisher","award":["DE120101710"],"award-info":[{"award-number":["DE120101710"]}],"id":[{"id":"10.13039\/501100000923","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT1093101"],"award-info":[{"award-number":["GNT1093101"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nephrology"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>Careful assessment of the potential donor\u2010recipient relationship is recommended by guidelines to prevent undue coercion, and to ensure realistic expectations and genuine motivations. However, relationships are complex, nuanced and value\u2010laden, and can be challenging to evaluate in living kidney donation. We aimed to describe the attitudes and approaches of transplant clinicians towards assessing the relationship between potential living kidney donors and their recipients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Semi\u2010structured interviews were conducted with 54 transplant clinicians (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists) from 32 transplant centres across nine countries including Australia, United States, Canada and New Zealand. Transcripts were analyzed thematically.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four themes were identified: protecting against vulnerability and premature decisions (ensuring genuine motivation, uncovering precarious dynamics and pre\u2010empting conflict, shared accountability, relying on specialty psychosocial expertise, trusting intimate bonds, tempering emotional impulsivity); safeguarding against coercion (discerning power imbalance, justified inquiry, awareness of impression management); minimizing potential threat to relationships (preserving the bond, giving equitable attention to donors and recipients, ensuring realistic expectations); and ambiguities in making judgments (adjudicating appropriateness and authenticity of relationships, questioning professional intervening, uncertainties in subjective and emotional assessments).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Clinicians felt ethically compelled to minimize the risk of undue coercion and to protect donors and recipients when evaluating the donor\u2010recipient relationship. However, disentangling voluntariness and altruism from potential undisclosed pressures to enact societal and family duty, making decisions within this complex, multi\u2010stakeholder context, and avoiding the imposition of undue paternalism and donor autonomy, were challenging. Multidisciplinary expertise and practical strategies for managing uncertainties are required.<\/jats:p><\/jats:sec>","DOI":"10.1111\/nep.13238","type":"journal-article","created":{"date-parts":[[2018,2,13]],"date-time":"2018-02-13T16:38:28Z","timestamp":1518539908000},"page":"252-262","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinicians\u2019 attitudes and approaches to evaluating the potential living kidney donor\u2010recipient relationship: An interview study"],"prefix":"10.1111","volume":"24","author":[{"given":"Angelique F.","family":"Ralph","sequence":"first","affiliation":[{"name":"Sydney School of Public Health The Children\u2019s Hospital at Westmead  Sydney Australia"},{"name":"Centre for Kidney Research The Children\u2019s Hospital at Westmead  Sydney Australia"},{"name":"School of Psychology The University of Sydney  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Phyllis","family":"Butow","sequence":"additional","affiliation":[{"name":"School of Psychology The University of Sydney  Melbourne Australia"},{"name":"Psycho\u2010oncology Co\u2010operative Research Group The University of Sydney  Melbourne Australia"},{"name":"Centre for Medical Psychology &amp; Evidence\u2010based Decision\u2010making The University of Sydney  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan C.","family":"Craig","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health The Children\u2019s Hospital at Westmead  Sydney Australia"},{"name":"Centre for Kidney Research The Children\u2019s Hospital at Westmead  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy R.","family":"Chapman","sequence":"additional","affiliation":[{"name":"Centre for Transplant and Renal Research The University of Sydney  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John S.","family":"Gill","sequence":"additional","affiliation":[{"name":"Division of Nephrology University of British Columbia  Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Kanellis","sequence":"additional","affiliation":[{"name":"Department of Nephrology, Monash Health and Centre for Inflammatory Diseases Monash University  Melbourne Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allison","family":"Tong","sequence":"additional","affiliation":[{"name":"Sydney School of Public Health The Children\u2019s Hospital at Westmead  Sydney Australia"},{"name":"Centre for Kidney Research The Children\u2019s Hospital at Westmead  Sydney Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,1,29]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"Global Observatory on Donation and Transplantation.Organ donation and transplantation activities 2014.WHO ONT GODT editors.2016."},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000000318"},{"key":"e_1_2_11_4_1","volume-title":"39th Annual Report","author":"ANZDATA","year":"2016"},{"key":"e_1_2_11_5_1","unstructured":"Canadian Institute for Health Information.e\u2010Statistics on Organ Transplants Waiting Lists and Donors 2017.Available fromhttps:\/\/www.cihi.ca\/sites\/default\/files\/document\/donor_section_v0.1_en_2017.xlsx. 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