Main Article Content
Abstract
Introducción: In living donor kidney transplantation, the personal experience of the disease situation significantly influences the emotional adaptation and coping of the individual.
Objective: This study aims to uncover the personal significance attributed by individuals with living donor kidney transplants to their disease and its treatment and to identify any changes in this perception before and after transplantation.
Material and Method: Qualitative phenomenological study. Seven people with kidney disease who received a preventive living donor kidney transplant participated. Data were obtained through semi-structured interviews and qualitative observation.
Results: Three themes emerged from the thematic analysis of the interviews: no feeling of illness (they did not feel ill either physically or psychologically); no need for transplantation (the disease did not alter their lives, but they trusted the professionals and accepted the surgery); and transplantation to maintain the same way of life (to avoid dialysis and recover activities).
Conclusions: The meaning of the disease and renal transplantation change according to the stage (pre- or post-transplant) in which the patient is: identification of the disease is related to the presence of symptomatology, to physical symptomatology and to routines of taking daily medication and follow-up visits; and renal transplantation, means avoiding dialysis, doing the same way of life, overcoming a challenge and recovering physical condition.
Keywords
Article Details
Copyright (c) 2024 Laura Rota, Meritxell Mondéjar Pont, Elvira-Carrascal, Molina-Robles, Oriol-Vila, Bou-Folgarolas

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References
- Meleis AI, Sawyer LM, Im EO, Messias DKH, Schumacher K. Experiencing transitions: an emerging middle-range theory. ANS Adv Nurs Sci [Internet]. 2000 [consultado 7 May 2024];23(1):12-28. Disponible en: https://doi.org/10.1097/00012272-200009000-00006
- Guerrero C, Gallardo R. Conceptualización de la enfermedad renal y el trasplante. Psicología y Salud [Internet]. 2013 [consultado 23 Abr 2024];23(1):113-9. Disponible en: https://doi.org/10.25009/pys.v23i1.521
- Boaz A, Morgan M. Working to establish ‘normality’post-transplant: a qualitative study of kidney transplant patients. Chronic Illn [Internet]. 2014 [consultado 7 May 2024];10(4):247-58. Disponible en: https://doi.org/10.1177%2F1742395313504789
- De Pasquale C, Veroux M, Indelicato L, Sinagra N, Giaquinta A, Fornaro M, Veroux P, Pistorio ML. Psychopathological aspects of kidney transplantation: Efficacy of a multidisciplinary team. World J Transplant [Internet]. 2014 [consultado 7 May 2024];4(4):267. Disponible en: https://dx.doi.org/10.5500%2Fwjt.v4.i4.267
- Kamran F. Living with a kidney transplant: Perceptions and experiences. J Appl Psychol [Internet]. 2014 [consultado 23 Abr 2024];2(1):5-12. Disponible en: http://www.sciappliedpsychology.com/articles/2/1/2
- Lacomba-Trejo L, Mateu-Mollà J, Álvarez EC, Benavent AMO, Serrano AG. Enfermedad renal crónica avanzada: ansiedad, depresión y percepción de amenaza. Revista de Psicología de la Salud [Internet]. 2021 [consultado 23 Abr 2024];9(1).Disponible en: https://revistas.innovacionumh.es/index.php/psicologiasalud/article/view/959
- Griva K, Jayasena D, Davenport A, Harrison M, Newman SP. Illness and treatment cognitions and health related quality of life in end stage renal disease. Br J Health Psychol [Internet]. 2009 [consultado 7 May 2024];14(1):17-34. Disponible en: https://doi.org/10.1348/135910708X292355
- Chilcot J, Norton S, Wellsted D, Davenport A, Firth J, Farrington K. Distinct depression symptom trajectories over the first year of dialysis: associations with illness perceptions. Ann Behav Med [Internet]. 2013 [consultado 7 May 2024];45:78–88. Disponible en: https://doi.org/10.1007/s120-012-9410-5
- Parfeni M, Nistor I, Covic A. A systematic review regarding the association of illness perception and survival among end-stage renal disease patients. Nephrol Dial Transplant [Internet]. 2013 [consultado 7 May 2024];28:2407–14. Disponible en: https://doi.org/10.1093/ndt/gft194
- Rees J, Chilcot J, Donnellan W, Soulsby L. Exploring the nature of illness perceptions in people with end-stage kidney disease. J Ren Care [Internet]. 2018 [consultado 7 May 2024];44(1):19-29. Disponible en: https://doi.org/10.1111/jorc.12225
- De Groot IB, Schipper K, Van Dijk S, Van der Boog PJ, Stiggelbout AM, Baranski AG, Marang-van de Mheen PJ. Decision making around living and deceased donor kidney transplantation: a qualitative study exploring the importance of expected relationship changes. BMC Nephrol [Internet]. 2012 [consultado 7 May 2024];13(1):1-12. Disponible en: https://doi.org/10.1186/1471-2369-13-103
- Ummel D, Achille M. Transplant trajectory and relational experience within living kidney dyads. Qual Health Res [Internet]. 2016 [consultado 7 May 2024];26(2):194-203. https://doi.org/10.1177%2F1049732315570128
- Gordon EJ. “They don’t have to suffer for me”: Why dialysis patients refuse offers of living donor kidneys. Med Anthropol Q [Internet]. 2001 [consultado 7 May 2024];15(2):245-67. https://doi.org/10.1525/maq.2001.15.2.245
- McGrath P, Pun P, Holewa H. Decision-making for living kidney donors: an instinctual response to suffering and death. Mortality [Internet]. 2012 [consultado 7 May 2024];17(3): 201-20. Disponible en: https://doi.org/10.1080/13576275.2012.696356
- Farahani ZB, Esmaeili M, Salsali M, Nayeri ND. Factors affecting iranian family donors’motivation for kidney donation. Acta Med Med 2016;32:1067–73.
- Meyer KB, Bjørk IT, Wahl AK, Lennerling A, Andersen MH. Long-term experiences of Norwegian live kidney donors: qualitative in-depth interviews. BMJ open [Internet]. 2017 [consultado 7 May 2024];7(2):e014072. Disponible en: http://dx.doi.org/10.1136/ bmjopen-2016-014072
- Ummel D, Achille M, Mekkelholt J. Donors and Recipients of Living Kidney Donation: A Qualitative Metasummary of Their Experiences. J Transplant [Internet]. 2011 [consultado 7 May 2024]; Disponible en: https://doi. org/10.1155/2011/626501.
- Heinemann LL. For the sake of others: reciprocal webs of obligation and the pursuit of transplantation as a caring act. Med Anthropol Q [Internet]. 2014 [consultado 7 May 2024]; 28(1): 66-84. Disponible en: https://doi.org/10.1111/maq.12060
- Schicktanz S, Schweda M, Wöhlke S. Gender issues in living organ donation: medical, social, and ethical aspects. Dins I. Klinge, C. Wiesemann (Ed.), Sex and Gender in Biomedicine 2010: 33-57. Universitätsverlag.
- Franklin PM, Crombie AK. Live related renal transplantation: psychological, social, and cultural issues. Transplantation [Internet]. 2003 [consultado 7May 2024];76(8):1247-52. Disponible en: https://doi.org/10.1097/01.TP.0000087833.48999.3D
- Clemens KK, Thiessen-Philbrook H, Parikh CR, Yang RC, Karley MN, Boudville N, Ramesh GV, Garg AX. Psychosocial health of living kidney donors: a systematic review. Am J Transplant [Internet]. 2006 [consultado 7 May 2024];6(12): 2965–77. Disponible en: https://doi.org/10.1111/j.1600-6143.2006.01567.x
- Klop KWJ, Timman R, Busschbach JJ, Dols LFC, Dooper IM, Weimar W, Ijzermans JNM, Kok NFM. Multivariate analysis of health-related quality of life in donors after live kidney donation. Transplant Proc [Internet]. 2018 [consultado 7 May 2024]; 50(1): 42–7. Disponible en: https://doi.org/10.1016/j.transproceed.2017.10.019
- Landreneau K, Lee K, Landreneau MD. Quality of life in patients undergoing hemodialysis and renal transplantation-a meta-analytic review. Nephrol Nurs J. [Internet]. 2010 [consultado 23 Abr 2024];37(1):37–44. Disponible en: https://www.proquest.com/openview/f5c6738a2b61bb49ece71e4ab731f0e8/1?pq-origsite=gscholar&cbl=45638
- Clarke KS, Klarenbach S, Vlaicu S, Yang RC, Garg AX. The direct and indirect economic costs incurred by living kidney donors—a systematic review. Nephrol Dial Transplant [Internet]. 2006 [consultado 7 May 2024];21(7):1952–60. Disponible en: https://doi.org/10.1093/ndt/gfl069
- Kisch AM, Forsberg A, Fridh I, Almgren M, Lundmark M, Lovén C, Flodén A, Nilsson M, Karlsson V, Lennerling A. The meaning of being a living kidney, liver, or stem cell donor—a meta-ethnography. Transplantation [Internet]. 2018 [consultado 7 May 2024]; 102(5): 744-56. Disponible en: https://doi.org/10.1097/TP.0000000000002073
- Tong A, Chapman JR, Wong G, Kanellis J, McCarthy G, Craig JC. The motivations and experiences of living kidney donors: a thematic synthesis. Am J Kidney Dis [Internet]. 2012 [consultado 7 May 2024]; 60(1): 15-26. Disponible en: https://doi.org/10.1053/j.ajkd.2011.11.043
- Hanson CS, Chadban SJ, Chapman JR, Craig JC, Wong G, Ralph AF, Tong A. The expectations and attitudes of patients with chronic kidney disease toward living kidney donor transplantation: a thematic synthesis of qualitative studies. Transplantation [Internet]. 2015 [consultado 7 May 2024];99(3):540-54. Disponible en: https://doi.org/10.1097/TP.0000000000000433
- Ralph AF, Butow P, Hanson CS, Chadban SJ, Chapman JR, Craig JC, Kanellis J, Luxton G, Tong A. Donor and recipient views on their relationship in living kidney donation: thematic synthesis of qualitative studies. Am J Kidney Di [Internet]. 2017 [consultado 7 May 2024];69(5):602–16. Disponible en: https://doi.org/10.1053/j.ajkd.2016.09.017
- Hagger M, Orbell S. A meta-analytic review of the common sense model of illness representations. Psychol Health [Internet]. 2003 [consultado 7 May 2024];18,141–84. Disponible en: https://doi. org/10.1080/088704403100081321
- Lønning K, Midtvedt K, Heldal K, Andersen MH. Older kidney transplantation candidates’ expectations of improvement in life and health following kidney transplantation: semistructured interviews with enlisted dialysis patients aged 65 years and older. BMJ open
- [Internet]. 2018 [consultado 7 May 2024]; 8(6),e021275. Disponible en: http://dx.doi.org/10.1136/ bmjopen-2017-021275
- Da Silva N, Sartori DL, Zink V, Roza BDA, Schirmer J. The experience of patients who need renal transplantation while waiting for a compatible organ. Texto & Contexto- Enfermagem [Internet]. 2013 [consultado 7 May 2024];22:1160-8. Disponible en: https://doi.org/10.1590/S0104-07072013000400035
- Koons B, Smeltzer SC. The patient experience of waiting on the deceased donor kidney transplant list while receiving dialysis. Nephrol Nurs J. [Internet] 2018 [consultado 23 Abr 2024]; 45(4): 349-56. Disponible en: https://www.proquest.com/openview/a678838ce7847f92f24919ff813e4f2f/1?pq-origsite=gscholar&cbl=45638&casa_token=d0xdDyqu6SgAAAAA:JKEFNs99hi_zRYTHTBXoId0ia07--4A7iO5XB-D9fAdd1NDBQpy1CmbUCyOvlbmh3T06i2KGEcc
- Kleinman A. Writing at the margin. Discourse between anthropology and medicine 1998. University California Press.
- Davis LA, Grogan TM, Cox J, Weng FL. Inter-and intrapersonal barriers to living donor kidney transplant among black recipients and donors. J Racial Ethn Health Disparities [Internet]. 2017 [consultado 7 May 2024];4(4):671-9. Disponible en: https://doi.org/10.1007/s40615-016-0270-8
- Young A. The anthropologies of illness and sickness. Annu Rev Anthropol [Internet]. 1982 [consultado 7 May 2024];11(1):257-85. Disponible en: https://doi.org/10.1146/annurev.an.11.100182.001353
References
Meleis AI, Sawyer LM, Im EO, Messias DKH, Schumacher K. Experiencing transitions: an emerging middle-range theory. ANS Adv Nurs Sci [Internet]. 2000 [consultado 7 May 2024];23(1):12-28. Disponible en: https://doi.org/10.1097/00012272-200009000-00006
Guerrero C, Gallardo R. Conceptualización de la enfermedad renal y el trasplante. Psicología y Salud [Internet]. 2013 [consultado 23 Abr 2024];23(1):113-9. Disponible en: https://doi.org/10.25009/pys.v23i1.521
Boaz A, Morgan M. Working to establish ‘normality’post-transplant: a qualitative study of kidney transplant patients. Chronic Illn [Internet]. 2014 [consultado 7 May 2024];10(4):247-58. Disponible en: https://doi.org/10.1177%2F1742395313504789
De Pasquale C, Veroux M, Indelicato L, Sinagra N, Giaquinta A, Fornaro M, Veroux P, Pistorio ML. Psychopathological aspects of kidney transplantation: Efficacy of a multidisciplinary team. World J Transplant [Internet]. 2014 [consultado 7 May 2024];4(4):267. Disponible en: https://dx.doi.org/10.5500%2Fwjt.v4.i4.267
Kamran F. Living with a kidney transplant: Perceptions and experiences. J Appl Psychol [Internet]. 2014 [consultado 23 Abr 2024];2(1):5-12. Disponible en: http://www.sciappliedpsychology.com/articles/2/1/2
Lacomba-Trejo L, Mateu-Mollà J, Álvarez EC, Benavent AMO, Serrano AG. Enfermedad renal crónica avanzada: ansiedad, depresión y percepción de amenaza. Revista de Psicología de la Salud [Internet]. 2021 [consultado 23 Abr 2024];9(1).Disponible en: https://revistas.innovacionumh.es/index.php/psicologiasalud/article/view/959
Griva K, Jayasena D, Davenport A, Harrison M, Newman SP. Illness and treatment cognitions and health related quality of life in end stage renal disease. Br J Health Psychol [Internet]. 2009 [consultado 7 May 2024];14(1):17-34. Disponible en: https://doi.org/10.1348/135910708X292355
Chilcot J, Norton S, Wellsted D, Davenport A, Firth J, Farrington K. Distinct depression symptom trajectories over the first year of dialysis: associations with illness perceptions. Ann Behav Med [Internet]. 2013 [consultado 7 May 2024];45:78–88. Disponible en: https://doi.org/10.1007/s120-012-9410-5
Parfeni M, Nistor I, Covic A. A systematic review regarding the association of illness perception and survival among end-stage renal disease patients. Nephrol Dial Transplant [Internet]. 2013 [consultado 7 May 2024];28:2407–14. Disponible en: https://doi.org/10.1093/ndt/gft194
Rees J, Chilcot J, Donnellan W, Soulsby L. Exploring the nature of illness perceptions in people with end-stage kidney disease. J Ren Care [Internet]. 2018 [consultado 7 May 2024];44(1):19-29. Disponible en: https://doi.org/10.1111/jorc.12225
De Groot IB, Schipper K, Van Dijk S, Van der Boog PJ, Stiggelbout AM, Baranski AG, Marang-van de Mheen PJ. Decision making around living and deceased donor kidney transplantation: a qualitative study exploring the importance of expected relationship changes. BMC Nephrol [Internet]. 2012 [consultado 7 May 2024];13(1):1-12. Disponible en: https://doi.org/10.1186/1471-2369-13-103
Ummel D, Achille M. Transplant trajectory and relational experience within living kidney dyads. Qual Health Res [Internet]. 2016 [consultado 7 May 2024];26(2):194-203. https://doi.org/10.1177%2F1049732315570128
Gordon EJ. “They don’t have to suffer for me”: Why dialysis patients refuse offers of living donor kidneys. Med Anthropol Q [Internet]. 2001 [consultado 7 May 2024];15(2):245-67. https://doi.org/10.1525/maq.2001.15.2.245
McGrath P, Pun P, Holewa H. Decision-making for living kidney donors: an instinctual response to suffering and death. Mortality [Internet]. 2012 [consultado 7 May 2024];17(3): 201-20. Disponible en: https://doi.org/10.1080/13576275.2012.696356
Farahani ZB, Esmaeili M, Salsali M, Nayeri ND. Factors affecting iranian family donors’motivation for kidney donation. Acta Med Med 2016;32:1067–73.
Meyer KB, Bjørk IT, Wahl AK, Lennerling A, Andersen MH. Long-term experiences of Norwegian live kidney donors: qualitative in-depth interviews. BMJ open [Internet]. 2017 [consultado 7 May 2024];7(2):e014072. Disponible en: http://dx.doi.org/10.1136/ bmjopen-2016-014072
Ummel D, Achille M, Mekkelholt J. Donors and Recipients of Living Kidney Donation: A Qualitative Metasummary of Their Experiences. J Transplant [Internet]. 2011 [consultado 7 May 2024]; Disponible en: https://doi. org/10.1155/2011/626501.
Heinemann LL. For the sake of others: reciprocal webs of obligation and the pursuit of transplantation as a caring act. Med Anthropol Q [Internet]. 2014 [consultado 7 May 2024]; 28(1): 66-84. Disponible en: https://doi.org/10.1111/maq.12060
Schicktanz S, Schweda M, Wöhlke S. Gender issues in living organ donation: medical, social, and ethical aspects. Dins I. Klinge, C. Wiesemann (Ed.), Sex and Gender in Biomedicine 2010: 33-57. Universitätsverlag.
Franklin PM, Crombie AK. Live related renal transplantation: psychological, social, and cultural issues. Transplantation [Internet]. 2003 [consultado 7May 2024];76(8):1247-52. Disponible en: https://doi.org/10.1097/01.TP.0000087833.48999.3D
Clemens KK, Thiessen-Philbrook H, Parikh CR, Yang RC, Karley MN, Boudville N, Ramesh GV, Garg AX. Psychosocial health of living kidney donors: a systematic review. Am J Transplant [Internet]. 2006 [consultado 7 May 2024];6(12): 2965–77. Disponible en: https://doi.org/10.1111/j.1600-6143.2006.01567.x
Klop KWJ, Timman R, Busschbach JJ, Dols LFC, Dooper IM, Weimar W, Ijzermans JNM, Kok NFM. Multivariate analysis of health-related quality of life in donors after live kidney donation. Transplant Proc [Internet]. 2018 [consultado 7 May 2024]; 50(1): 42–7. Disponible en: https://doi.org/10.1016/j.transproceed.2017.10.019
Landreneau K, Lee K, Landreneau MD. Quality of life in patients undergoing hemodialysis and renal transplantation-a meta-analytic review. Nephrol Nurs J. [Internet]. 2010 [consultado 23 Abr 2024];37(1):37–44. Disponible en: https://www.proquest.com/openview/f5c6738a2b61bb49ece71e4ab731f0e8/1?pq-origsite=gscholar&cbl=45638
Clarke KS, Klarenbach S, Vlaicu S, Yang RC, Garg AX. The direct and indirect economic costs incurred by living kidney donors—a systematic review. Nephrol Dial Transplant [Internet]. 2006 [consultado 7 May 2024];21(7):1952–60. Disponible en: https://doi.org/10.1093/ndt/gfl069
Kisch AM, Forsberg A, Fridh I, Almgren M, Lundmark M, Lovén C, Flodén A, Nilsson M, Karlsson V, Lennerling A. The meaning of being a living kidney, liver, or stem cell donor—a meta-ethnography. Transplantation [Internet]. 2018 [consultado 7 May 2024]; 102(5): 744-56. Disponible en: https://doi.org/10.1097/TP.0000000000002073
Tong A, Chapman JR, Wong G, Kanellis J, McCarthy G, Craig JC. The motivations and experiences of living kidney donors: a thematic synthesis. Am J Kidney Dis [Internet]. 2012 [consultado 7 May 2024]; 60(1): 15-26. Disponible en: https://doi.org/10.1053/j.ajkd.2011.11.043
Hanson CS, Chadban SJ, Chapman JR, Craig JC, Wong G, Ralph AF, Tong A. The expectations and attitudes of patients with chronic kidney disease toward living kidney donor transplantation: a thematic synthesis of qualitative studies. Transplantation [Internet]. 2015 [consultado 7 May 2024];99(3):540-54. Disponible en: https://doi.org/10.1097/TP.0000000000000433
Ralph AF, Butow P, Hanson CS, Chadban SJ, Chapman JR, Craig JC, Kanellis J, Luxton G, Tong A. Donor and recipient views on their relationship in living kidney donation: thematic synthesis of qualitative studies. Am J Kidney Di [Internet]. 2017 [consultado 7 May 2024];69(5):602–16. Disponible en: https://doi.org/10.1053/j.ajkd.2016.09.017
Hagger M, Orbell S. A meta-analytic review of the common sense model of illness representations. Psychol Health [Internet]. 2003 [consultado 7 May 2024];18,141–84. Disponible en: https://doi. org/10.1080/088704403100081321
Lønning K, Midtvedt K, Heldal K, Andersen MH. Older kidney transplantation candidates’ expectations of improvement in life and health following kidney transplantation: semistructured interviews with enlisted dialysis patients aged 65 years and older. BMJ open
[Internet]. 2018 [consultado 7 May 2024]; 8(6),e021275. Disponible en: http://dx.doi.org/10.1136/ bmjopen-2017-021275
Da Silva N, Sartori DL, Zink V, Roza BDA, Schirmer J. The experience of patients who need renal transplantation while waiting for a compatible organ. Texto & Contexto- Enfermagem [Internet]. 2013 [consultado 7 May 2024];22:1160-8. Disponible en: https://doi.org/10.1590/S0104-07072013000400035
Koons B, Smeltzer SC. The patient experience of waiting on the deceased donor kidney transplant list while receiving dialysis. Nephrol Nurs J. [Internet] 2018 [consultado 23 Abr 2024]; 45(4): 349-56. Disponible en: https://www.proquest.com/openview/a678838ce7847f92f24919ff813e4f2f/1?pq-origsite=gscholar&cbl=45638&casa_token=d0xdDyqu6SgAAAAA:JKEFNs99hi_zRYTHTBXoId0ia07--4A7iO5XB-D9fAdd1NDBQpy1CmbUCyOvlbmh3T06i2KGEcc
Kleinman A. Writing at the margin. Discourse between anthropology and medicine 1998. University California Press.
Davis LA, Grogan TM, Cox J, Weng FL. Inter-and intrapersonal barriers to living donor kidney transplant among black recipients and donors. J Racial Ethn Health Disparities [Internet]. 2017 [consultado 7 May 2024];4(4):671-9. Disponible en: https://doi.org/10.1007/s40615-016-0270-8
Young A. The anthropologies of illness and sickness. Annu Rev Anthropol [Internet]. 1982 [consultado 7 May 2024];11(1):257-85. Disponible en: https://doi.org/10.1146/annurev.an.11.100182.001353