An Investigation of the Role of Psychological Altruism in Living Kidney Donors A DISSERTATION ...

116 Pages·2015·0.74 MB·English

An Investigation of the Role of Psychological Altruism in Living Kidney Donors

A DISSERTATION
SUBMITTED TO THE FACULTY OF
UNIVERSITY OF MINNESOTA
BY

Michaela L. McLaughlin

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF
DOCTOR OF PHILOSOPHY

Patricia McCarthy Veach, Ph.D., Co-Advisor

Caroline Burke, Ph.D., Co-Advisor

May 2015
© Michaela McLaughlin
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Acknowledgements

Like most things in life, it took a village to raise this dissertation project.

First and foremost, a bow to my mom. She introduced me to organ donation
through her gift of her corneas, skin and tissue to others. And, a bow to my dad.
Following my mom’s death, my dad found hope and spread hope through his
involvement in Life Source Organ and Tissue Donation. I am lucky to have both my
parents paving the way for me, and for this dissertation, long before I ever knew it.
To my siblings. My youngest sister, Alexandra, read draft after draft after draft of
this paper. She says she wants to be a journalist; to her, I say you already are. Together
with my sister, Caroline, and my brother, Ryan, our sibling unit is a force of solidarity, of
creativity, of having-each-others’-backs-forever. This is the greatest gift; thank you for
believing in me, even when and especially when I wasn’t so sure myself.
To my partner Austin for all the ways he says, “YES” to life and to relationship
and to whatever this moment holds. To his parents and the Gift of Life House for the
precious opportunity to remember that life is a gift. That hearts, and lungs, and livers, and
stem cells, and kidneys are all gifts. For your ability to be vessels of faith and hope and
gratitude and community in the most vulnerable and scary moments.
To Pat and Carrie, thank you for leaning in, for being present and honest as we
graduate, together, with the legacy that is the CSPP PhD program. Thank you for
advising me in how to “be” in the professional world, and how to “be” more authentically
me, and more whole, and more human throughout this journey we call life.
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To Hassan, thank you for embodying altruism. Thank you for this inconceivable
opportunity to work together and to witness, through your actions, what altruism is all
about. This project would not have been possible without Danielle Berglund and Ian
MacFarlane. Thank you for being so damn good at what you do with data, and data
analysis, respectively. I bow to your knowledge and skill in translating and organizing
and collaborating; thank you.
To the kidney donors who participated in this project, thank you for inspiring.
Thank you for believing in a better world for all of us—one in which we’re all related,
and there’s enough bread and kidneys for all. Pidamaya. Mitakuye Oyasin. Hoka hey.
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Dedication

This thesis is dedicated to my mom, the first and most important organ donor in my life.
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Abstract
Altruism is the selfless concern for the wellbeing of others. Multiple researchers have
investigated altruism in the general population, but altruism has not been measured in
living kidney donors. This study assessed the altruism of 168 living kidney donors, a
representative sample from the University of Minnesota Kidney Donor Transplant
Program. Three scales measured altruism (Helping Attitudes Scale, Self-Report Altruism
Scale, and Altruism and Gift Giving Battery). Participants also responded to items
eliciting their suggestions about questions to assess altruism in living kidney donors.
Statistical analyses revealed the present sample had significantly higher altruism scores
than normative samples on the Helping Attitudes Scale and Self-Report Altruism Scale.
There were no significant differences in altruism scores for living related donors (n =
86.5, 62.9, 39.4) versus living unrelated donors (n = 88.5, 66.1, 38.5). Factor analysis of
responses to items on the altruism scales yielded four factors: Physical help to stranger;
Gifts; Volunteerism rewards; and Risk/ sacrifice in helping. Logistic regression indicated
likelihood of being a living unrelated donor increased if participants scored lower on
Volunteerism rewards, higher on Risk/sacrifice in helping, and they were older. Content
analysis of participants’ responses regarding questions to assess altruism yielded six
themes: Questions regarding the donor’s cultural ideas of giving; Questions regarding
how much risk and discomfort one is willing to endure for another; Comments regarding
personal family obligation or selfish motivation; Questions regarding the donor’s
emotional expectations post-donation; Questions regarding the financial and long-term
health cost to the donor; and Questions will not capture the true motivation as the
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decision to donate comes without hesitation. Additional findings and practice, policy and
research directions are presented.
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Table of Contents
List of Tables vii
List of Figures viii
Chapter 1: Introduction 1
Statement of the Problem 2
Significance of the Proposed Research 3
Chapter 2: Literature Review 6
How is Altruism Conceptualized? 6
What Motivates Altruism? 7
Altruism born of suffering 8
Altruism as a perspective of shared humanity 12
Altruism as attachment security 16
Altruism as pathology 20
Altruism born of abundance 24
What Factors Affect the Donation Decision-Making Process? 28
Competence and informed consent 28
Voluntariness and autonomy 31
Psychological Effects of Organ Donation 32
Benefit and harm, post-donation 32
Summary 33
Chapter 3: Methodology 35
Participants 35
Instrumentation 36
Survey 36
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Procedures 38
Data Analysis 38
Data cleaning 39
Descriptive statistics 39
Inferential statistics 39
Analysis of open-ended responses 39
Chapter 4: Results 41
Participant Demographic Characteristics 41
Research Question 1: What is the Prevalence of Altruism Among 43
Living Kidney Donors?
Research Question 2: How do Related and Unrelated Donors 45
Compare in their Degree of Altruism?
Research Question 3: Which Scale Items are the Strongest 45
Predictors of Individuals Who are High versus Low in Altruism?
Respondents’ Perceptions of Whether the Scale Assess Altruism 50
Qualitative Analysis of Comments about Relevant Survey Items 50
Qualitative Analysis of Comments Regarding the Inclusion of 51
Unasked Questions
Chapter 5: Discussion 54
Prevalence of Altruism among Living Kidney Donors 55
Comparison of Related and Unrelated Donors in their Degree of Altruism 57
Factors that Best Predict Altruism Among Living Kidney Donors 57
Results of logistic regression 60
Respondents’ Perceptions Regarding the Assessment of Altruism 62
Study Strengths and Limitations 68
Future Policy, Practice, and Research Directions 70
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References 72
Appendix A: IRB Approval 85
Appendix B: Survey Invitation via Email 86
Appendix C: Survey Invitation via Mail 87
Appendix D: Survey 89
Appendix E: Follow-up Phone Call Script 95
Appendix F: Qualitative Comments Regarding Additional Unasked Questions 96