Communication in living donor kidney transplantation across Italian nephrology and transplant settings: a qualitative descriptive interview study with nephrologists and nurses.

BACKGROUND: Communication is central to living donor kidney transplantation (LDKT). Patients must understand treatment options, donor risks, family implications, and the possibility of pre-emptive transplantation. However, how LDKT communication is perceived and managed by nephrology and transplant professionals across care settings remains insufficiently explored. METHODS: A qualitative descriptive interview study was conducted with nephrologists and nurses involved in communication with patients who may be LDKT candidates. Participants were purposively sampled from Italian low- (1-50 procedures) and high-volume (>50 procedures) transplant centers and dialysis centers across Northern, Central, and Southern Italy. Semi-structured interviews were conducted between May-October 2025 and analyzed using reflexive thematic analysis. RESULTS: Eighteen professionals were interviewed: 10 nephrologists and 8 nurses. Seven themes were identified: introducing LDKT in the care pathway; communicating benefits and donor risks; navigating recipient, donor, and family dynamics; barriers to equitable communication; professional attitudes and trust; communication competence and team coordination; and peer support and patient associations. Communication emerged as a longitudinal, relational, and organizationally mediated process. Participants emphasized early, repeated, and tailored information, with attention to donor voluntariness, recipient reluctance, family expectations, and socioeconomic constraints. High-volume transplant centers described more structured pathways; lower-volume and dialysis centers reported greater reliance on individual initiative, relational continuity, and local routines. CONCLUSIONS: LDKT communication should be recognized as a clinical and ethical competence. Improving practice requires structured training, interprofessional coordination, time, accessible materials, and stronger integration between dialysis units, transplant centers, and patient associations. Standardized yet personalized communication may support informed, voluntary, and more equitable decision-making.