Ruling Out Coercion in Living-Related Kidney Donation?
Can you give me some tips for ruling out coercion as a motivating factor for living-related kidney donation?

While there are no foolproof methods for ruling out the presence of coercion, the use of thorough psychosocial evaluations of both the donor and recipient are essential. The evaluations should include questions aimed at clarifying the nature of the relationship between donor and recipient, with attention paid to evidence of potential overt or covert coercion. Understanding the nature of the relationship, its length, the level of emotional intimacy, and other details can help to determine whether the offer to donate seems rational or plausible. A relationship where there is an unequal balance of power may be prone to coercion and should be explored in further detail, such as between parent-child, boss-employee, or US citizen-non-US citizen. In some cases, the donor may be on unequal footing because he/she is considered the "black sheep" of a family, and therefore the family may have minimized the risks of donor surgery. Knowledge about how the donor came to learn of the recipient's need for a transplant (eg, was a direct request for donation made?), whether the recipient has other potential donors, whether the need for transplant is urgent, and whether there will be any compensation provided to the donor (eg, lost wages, travel expenses vs greater amounts) should all be clarified. Obtaining the same detailed information from both donor and recipient can help to uncover any inconsistencies in their stories and point to whether coercion may be present. Interviewing the donor's spouse, significant other, or other primary support person can be of further benefit, as it may reveal conflicts or inconsistencies as well (eg, did the donor discuss his/her wish to donate with the family or did the donor avoid doing this to avoid serious objections?). In some cases, if there is a strong sense of hidden coercion, it is also within the transplant teams' purview to express their unease and to ask for an additional time period ("cooling off period") to allow the donor to consider his/her offer to donate.