Donating a Kidney in Taiwan: A Study of 90 Relative Living Donors

Some specific findings from the psychiatric evaluation of 90 living relative donors and the recipients before kidney transplantation in Taiwan during the mid 1970s to the early 1980s are reported. We highlight the attitude of the parental donors, their decision-making process, and the emotional turmoil at the time of family crisis in the context of cultural background. As a required routine examination in kidney transplantation, we interviewed 90 prospective donors referred by the kidney transplantation team before and after the surgery. The interview was conducted in a semistructured and open-ended fashion. Unless medically unfit or strongly opposed by the other family members, a great majority of the parents, particularly the mothers, first volunteered to donate a kidney. Significantly, the sons had more opportunities to receive a kidney from either parent than daughters regardless of marital status. Although the decision-making for donation by the parents was instantaneous and occurred in the early stage, the rates of giving-up decision for donation was significantly lower than that of donation by siblings or other relatives. They were not or did not want to be well informed about kidney transplantation; they even gave many reasons to justify their decision to donate a kidney and to rationalize their anxiety over the results of the transplantation surgery. The process in decision-making and the donor selection often provoked the underlying intrafamily conflict, and led to giving up transplantation surgery. Denial, compensation, rationalization, and displacement were the commonly observed defense mechanisms against anxiety, guilt feelings, or hostility. Anxiety and depression were common among those donors. The importance of psychiatric evaluation before transplantation surgery and the specific need for long-term care for the donors after operation are emphasized.