Family Functioning Before Kidney Transplantation From Living-Related Donors: Perspectives of Donors and Recipients in Japan

Introduction: In Japan, approximately 90% of kidney transplantations involve living donors who are relatives. Selection of a living donor from potential family member donors could affect the entire family. However, reports focusing on preliving-related kidney transplant (LRKT) family functioning are lacking. Family functioning comprises ways that family members communicate and cooperate with each other. The Family Assessment Device (FAD) was used to measure family functioning from the perspective of donors and recipients just prior to LRKT. Method: A total of 122 donor-recipient pairs (244 participants in total) who planned to have LRKT were recruited consecutively from July 2020 to July 2021 and included in the analysis. Results: There was no significant difference in FAD scores between donors and recipients, with approximately 20% of both groups reporting poor family functioning. Differences in family functioning according to types of relatives were shown in recipients. The rate of poor family functioning was significantly lower in the spouse group than in the parent-to-child group (recipient: 6.6%, 29.3%; donor: 8.2%, 34.1%, respectively). However, agreement regarding good or poor family functioning assessment was high in the parent-to-child pairs and low in the spouse pairs. Discussion: Most LRKT donors and recipients reported good family functioning; however, some perceived poor family functioning. Evaluations by donors did not always align with that of recipients, especially among spouse pairs. It is important to treat them as independent entities. Preoperative assessment to connect them with appropriate support can enhance recovery after LRKT.