Psychosocial and Ethical Behaviors and Attitudes of Health Care Professionals in the Clinical Setting of Living Kidney Donors: A Qualitative Study

•Health care workers had difficulty in helping donors reach voluntary decision making.•Resistance and barriers to confirming donor's wishes were experienced.•Health care workers took several steps to improve donors’ understanding of donation.•Donor care included family relations and setting the environment for examination. There are several psychosocial and ethical issues surrounding the decision making of living kidney transplant donors. This study aimed to determine what health care professionals (HPs) consider in their clinical practice and their attitudes toward donors’ decision-making processes. Face-to-face semistructured interviews were conducted with 15 HPs. A thematic analysis was performed to categorize the thematic elements of the transcripts. All procedures were approved by the relevant review board and conducted in accordance with the Declaration of Helsinki. Six main categories—maintaining family relationships, improving donor understanding, supporting voluntary decision making, setting the environment for the examination, having different attitudes toward the donor's intentions, and resisting confirmation of intent—were identified. The HPs provided diverse considerations to respect the donors’ autonomy. In clinical practice, there is a lack of practical methods to confirm living donors’ levels of understanding and spontaneity, suggesting that these methods need to be established. Factors related to family functioning may reflect the unique culture of Japan, and this may be indicative of the need to consider treatment based on cultural values.