Living kidney donor priorities for outcomes: A nominal group technique study.

Background: Living kidney donors must accept risks associated with nephrectomy. While this is ethically justified with informed consent, screening and access to follow up, the outcomes that are most important to donors are yet to be established. We aimed to identify living kidney donor's priorities for outcomes and describe the reasons for their choices. Method(s): Living kidney donors were purposively sampled from two Australian transplant centres. Participants identified important outcomes of kidney donation, ranked the importance of the outcomes, and discussed reasons for their priorities. For each outcome, we calculated a mean rank score from zero (least important) to 10 (most important) and analysed the transcripts thematically. Result(s): Across eight nominal groups, 67 participants aged 27-78 years identified 32 outcomes. The highest ranked outcomes were: time to recovery (mean rank score 5.39, SD =3.77), family life (5.24, SD = 4.02), donor-recipient relationship (4.25, SD = 4.07), diet and lifestyle restrictions (3.90, SD = 3.55), and kidney function (3.76, SD = 3.50). Kidney failure and mortality ranked 10th and 13th respectively. Women ranked the donor-recipient relationship, life satisfaction, and family life higher than men; whilst men ranked kidney failure, physical function (fitness), mortality and kidney function higher. The themes underpinning participants' priorities included: overriding concern for recipient wellbeing, undeterred by low risks, heightened susceptibility and unfulfilled expectations. Conclusion(s): Living kidney donors prioritised outcomes that could potentially disrupt their lifestyle and relationships, were unexpected, or caused fear and anxiety about their health. Donor assessment and follow up should address expectations regarding recovery time, relationship challenges and possible constraints on vocational and recreational activities; and donors may be more empowered with advice about diet, exercise and other healthy lifestyle