Abstract
This study aimed to determine the relationship between the sociodemographic characteristics and attachment styles of liver transplant donors. This descriptive and correlational study included a sample of 156 donors. Data were collected through face-to-face interviews using a Patient Information Form and the Relationship Scales Questionnaire. In addition to normality tests, the Mann–Whitney U test, Kruskal–Wallis test, Bonferroni-corrected P-value, and Spearman correlation coefficient were used in data analysis. The significance level was set at P ≤ .05. The findings revealed that the majority of donors had a dismissive attachment style. Individuals with higher income levels, those living in rural areas, and those not related to the recipient showed a higher tendency toward secure attachment compared to other groups. Donors who had undergone previous surgery exhibited stronger secure attachment and weaker dismissive attachment than those who had not. Based on these results, future studies and organ donation campaigns are recommended to focus on attachment styles and their association with sociodemographic and sociocultural characteristics. The mean age of the participating donors was 31.65 ± 6.67 years, and 76.92% were related to the recipient. Among the donors, 93.6% exhibited a dismissive attachment style. Income level, place of residence, kinship with the recipient, and previous surgical history had a statistically significant effect on secure attachment style (P < .05), explaining 34.4% of the variance (R2 = 0.344). Previous surgical history was found to have a statistically significant effect on the dismissive attachment style (P < .05), accounting for 14.5% of the variance (R2 = 0.145).
Keywords: attachment style, donor, liver transplantation, nursing, sociodemographic factors
1. Introduction
Liver transplantation is the only viable treatment option for patients with end-stage liver failure. In Türkiye, the number of cadaveric liver transplants remains quite limited.[1] Consequently, the number of patients on the waiting list continues to rise, resulting in prolonged wait times.[2] This situation has made live donor liver transplantation a critical alternative.[1] Compared to the global average, Türkiye has a higher number of live donors, most of whom are close relatives of the recipients, which is significant for donor–recipient relationships.[3]
Attachment theory is a psychological model that primarily examines human relationships, especially close ones.[4] An individual’s attachment style is considered a lasting trait that influences expectations and experiences throughout life.[4,5] Attachment characteristics are believed to be closely linked to behavioral patterns in adult close relationships.[6] Moreover, it has been shown that individuals adopt different emotional regulation strategies based on their specific attachment styles. Securely attached individuals tend to use trust-based strategies, such as recognizing negative emotions, accepting their problems, employing problem-focused coping, and seeking social support. In contrast, dismissively attached individuals often rely on over-regulating strategies that suppress and eliminate negative emotions by distancing themselves from others. Preoccupied individuals employ strategies that increase internal activation, while those with fearful attachment avoid others and struggle to manage negative emotions.[4,7] Attachment style is considered a crucial psychological factor in the development of relationships between patients, their relatives, and healthcare professionals, indirectly influencing treatment adherence.[5]
Nurses play a key role in ensuring patients’ physical and psychological well-being and are central figures in providing information and counseling. In transplant procedures, surgical nurses must provide the best possible care to both recipients and donors.[1] Although donors are not as critically affected as recipients, they still face the risk of mortality.[2] To deliver individualized post-transplant care, surgical nurses must understand donors’ attachment styles and their relationship with sociodemographic characteristics. Attachment styles are fundamental structures shaping how individuals cope with stress, their physiological responses to stress, their tendencies to seek help and support, and their behavioral patterns in social relationships. The process of living organ donation involves significant physical and psychological risks for the donor and is characterized by high levels of stress and uncertainty.[8] Additionally, in nearly all living donor transplants, the graft comes from a family member, which influences the donor–recipient relationship.[9] Therefore, it is recommended that conceptualizations and analyses consider broader familial dynamics beyond the donor–recipient dyad.[10] A review of the literature reveals studies examining the attachment styles of liver transplant recipients,[11,12] and the effects of attachment styles on various voluntary behaviors.[13,14] However, no study has been found focusing on liver transplant donors. Given the risks associated with donation, there is a need to explore the attachment styles of living organ donors and their relationship with sociodemographic characteristics. Moreover, identifying donors’ attachment styles and their associations with sociodemographic factors is anticipated to serve a regulatory function in organ donation campaigns and educational initiatives. In this context, the present study was conducted to determine the relationship between the sociodemographic characteristics and attachment styles of liver transplant donors.
Research Question 1: What are the sociodemographic characteristics of liver transplant donors?
Research Question 2: What are the attachment styles of liver transplant donors?
Research Question 3: What is the relationship between the sociodemographic characteristics and attachment styles of liver transplant donors?
2. Materials and methods
2.1. Study design
This study was conducted using a descriptive and correlational design.
2.2. Population and sample
The study population consisted of all adult patients (n = 260) who underwent surgical intervention as liver transplant donors at a university hospital’s Liver Transplantation Institute, who were conscious, cooperative, communicative, and able to respond to the questions. The sample was determined using a known population sampling method via the computer program (https://www.openepi.com/SampleSize/SSPropor.htm). With a 95% confidence interval, 5% margin of error, and 50% assumed prevalence, the sample size was calculated as 156 donors. In this study, the R2 coefficient was 0.344, indicating an effect size of 0.58. A post hoc power analysis revealed a 1−β value of 1.00, demonstrating that the study had full statistical power.
2.3. Data collection tools
Data were collected using the Patient Information Form and the Relationship Scales Questionnaire.
2.3.1. Patient information form
This form, developed by the researchers, includes 18 questions regarding the donors’ sociodemographic characteristics such as age, gender, marital status, educational level, employment status, income level, usual place of residence, number of children, kinship with the recipient, previous surgical experience, type of previous surgery, presence of chronic illness, household composition, and presence and identity of a caregiver.
2.3.2. Relationship Scales Questionnaire
The questionnaire consists of 30 items; however, only 17 items are used to assess attachment styles. The scale aims to measure 4 dimensions of attachment: secure, preoccupied, dismissive, and fearful. Items 9 and 28 are reverse-coded. The distribution of items per dimension is as follows:
Secure attachment: Items 3, 9*, 10, 15, 28*
Fearful attachment: Items 1, 5, 12, 24
Dismissive attachment: Items 2, 6, 19, 22, 26
Preoccupied attachment: Items 6*, 8, 16, 25
Item 6 is reverse-scored for preoccupied attachment and scored directly for dismissive attachment. Each item is rated on a 7-point Likert scale (1 = Not at all like me; 7 = Very much like me) to reflect the extent to which individuals perceive the item as descriptive of themselves and their behavior in close relationships. Subscale scores are calculated by summing the relevant items, and the highest score indicates the individual’s predominant attachment style. An increase in scores for subscales other than secure attachment is interpreted as an indicator of insecure attachment.
The Turkish adaptation of the scale was conducted by Sümer and Güngör.[15] The reliability coefficients for the subscales ranged between .41 and .71, and the scale demonstrated high test–retest reliability. In this study, the Cronbach alpha coefficients were calculated as follows:
Secure attachment: α = .613
Fearful attachment: α = .755
Dismissive attachment: α = .656
Preoccupied attachment: α = .741
2.4. Data collection procedure
The study was conducted at the Liver Transplantation Institute of a university hospital. Data were collected through face-to-face interviews between December 2023 and October 2024 on days when researchers were randomly present in the clinic. To ensure participant comfort and comprehension, data collection was initiated on the 2nd postoperative day at the earliest. Patients meeting the inclusion criteria were informed about the study, and those who consented were included. The researchers read the questionnaire items aloud, and responses were recorded accordingly. Each interview lasted approximately 20 minutes per patient.
2.5. Statistical analysis
Data analysis was conducted using IBM SPSS Statistics for Windows, version 25.0 (IBM Corp., Armonk). The normality of the data was assessed using the Kolmogorov–Smirnov test. The significance level for comparative tests was set at P ≤ .05.
Since the data did not follow a normal distribution (P > .05), non-parametric statistical methods were used. Comparisons between 2 independent groups were made using the Mann–Whitney U test. For comparisons among more than 2 independent groups, the Kruskal–Wallis test was applied. When significant differences were detected, Bonferroni-corrected P-values were used to adjust for multiple comparisons, calculated as (.05/number of pairwise comparisons). P-values obtained from the Mann–Whitney U tests following the Kruskal–Wallis test were compared with the Bonferroni-corrected threshold to determine statistical significance. Since the variables did not follow a normal distribution, Spearman rank correlation coefficient was used. Cronbach alpha coefficients were calculated to assess the reliability of the scale subdimensions.
2.6. Ethical considerations
Ethical approval was obtained from the XXX University Health Sciences Scientific Research Ethics Committee (Date: October 31, 2023, Reference No: 2023/15–5091). Institutional permission was obtained from XXX University XXX Medical Center where the research was conducted (Date: October 07, 2023 Reference No: E-93629378–605.01-355226). Written informed consent was obtained from all participants. This study was conducted in accordance with the Declaration of Helsinki.
3. Results
3.1. Sociodemographic characteristics of donors
The mean age of the donors was 31.65 ± 6.67 years. Among the participants, 55.13% were male, 55.77% were married, and 58.33% had graduated from high school. Additionally, 71.79% were unemployed, and 51.92% reported that their income was lower than their expenses. Nearly half (48.08%) resided in urban areas. Of the donors, 51.92% had children, with 49.38% of those having 2 children. Regarding the relationship with the recipient, 76.92% of donors were biologically related, with 28.33% of those being the recipient’s sibling. Moreover, 80.77% had no previous surgical history, and 92.31% reported no chronic illness. In terms of living arrangements, 46.79% lived with their spouse and children, while 64.74% had a designated caregiver, 56.44% of whom were their spouses. as shown in Table 1.
Table 1.
Sociodemographic characteristics of donors (n = 156).
| Variable | Mean ± SD | Min–max | |
|---|---|---|---|
| Age | 31.65 ± 6.67 | 20–48 | |
| Variable | Group | n | % |
| Gender | Male | 86 | 55.13% |
| Female | 70 | 44.87% | |
| Marital status | Single | 69 | 44.23% |
| Married | 87 | 55.77% | |
| Education level | Primary school | 1 | 0.64% |
| Middle school | 11 | 7.05% | |
| High school | 91 | 58.33% | |
| College and above | 53 | 33.97% | |
| Employment status | Yes | 44 | 28.21% |
| No | 112 | 71.79% | |
| Income level | Income > expenses | 15 | 9.62% |
| Income = expenses | 60 | 38.46% | |
| Income < expenses | 81 | 51.92% | |
| Place of residence | City | 75 | 48.08% |
| District | 70 | 44.87% | |
| Town/village | 11 | 7.05% | |
| Parental status | Yes | 81 | 51.92% |
| No | 75 | 48.08% | |
| Number of children | One | 19 | 23.46% |
| Two | 40 | 49.38% | |
| Three | 20 | 24.69% | |
| Four | 2 | 2.47% | |
| Biological relation to recipient | Yes | 120 | 76.92% |
| No | 36 | 23.08% | |
| Type of kinship | Mother | 23 | 19.17% |
| Father | 21 | 17.50% | |
| Sibling | 34 | 28.33% | |
| Uncle | 21 | 17.50% | |
| Spouse | 14 | 11.67% | |
| Child | 7 | 5.83% | |
| History of surgery | Yes | 30 | 19.23% |
| No | 126 | 80.77% | |
| Type of surgery | Cesarean section | 30 | 100.00% |
| Presence of chronic disease | Yes | 12 | 7.69% |
| No | 144 | 92.31% | |
| Type of chronic disease | Hypothyroidism | 9 | 75.00% |
| Diabetes mellitus (DM) | 1 | 8.33% | |
| Hypertension (HT) | 2 | 16.67% | |
| Living arrangement | Living alone | 22 | 14.10% |
| With spouse | 11 | 7.05% | |
| With spouse and children | 73 | 46.79% | |
| With extended family | 50 | 32.05% | |
| Presence of caregiver | Yes | 101 | 64.74% |
| No | 55 | 35.26% | |
| Identity of caregiver | Spouse | 57 | 56.44% |
| Parent | 44 | 43.56% |
DM = diabetes mellitus, HT = hypertension, Max = maximum, Min = minimum, SD = standard deviation.
3.2. Descriptive statistics of Relationship Scales Questionnaire Subscales
It was determined that 93.6% of the donors had a dismissive attachment style. The mean total subscale scores were as follows: 15.53 ± 3.04 for secure attachment, 19.66 ± 2.69 for fearful attachment, 24.15 ± 4.01 for dismissive attachment, and 13.86 ± 2.32 for preoccupied attachment as shown in Table 2.
Table 2.
Descriptive statistics of relationship scales questionnaire subscales.
| Subscale scores | n (%) | Mean ± Sd | Min–max |
|---|---|---|---|
| Secure attachment | n:8 (%5.1) | 15.53 ± 3.04 | 9–22 |
| Fearful attachment | n:2 (%1.3) | 19.66 ± 2.69 | 13–25 |
| Dismissive attachment | n:146 (%93.6) | 24.15 ± 4.01 | 16–33 |
| Preoccupied attachment | n:0 (%0.0) | 13.86 ± 2.32 | 8–19 |
Max = maximum, Min = minimum, SD = standard deviation.
3.3. Predictors of attachment styles according to regression analysis
Four separate multivariate regression models were constructed in the study, with secure, fearful, dismissive, and preoccupied attachment style scores as the dependent variables. The independent variables included gender, age, marital status, income level, kinship with the recipient, presence of chronic illness, place of residence, cohabiting individuals, history of prior surgery, presence of a caregiver, and identity of the caregiver. The results of these models are presented in Table 3.
Table 3.
Predictors of attachment styles according to regression analysis.
| Dependent variable | Independent variables | R 2 | F | P 1 | β1 | β2 | 95% Confidence interval | |||
|---|---|---|---|---|---|---|---|---|---|---|
| t | P 2 | Lower bound | Upper bound | |||||||
| Secure attachment | (Constant) | 0.344 | 6.864 | .001* | 22.278 | 5.016 | .001* | 13.500 | 31.057 | |
| Age | 0.016 | 0.035 | 0.369 | .713 | -0.069 | 0.101 | ||||
| Gender | 0.784 | 0.129 | 1.554 | .122 | -0.213 | 1.780 | ||||
| Previous surgery | -2.695 | -0.351 | -3.997 | .001* | -4.028 | -1.362 | ||||
| Chronic disease | -1.066 | -0.094 | -1.195 | .234 | -2.829 | 0.697 | ||||
| Has caregiver | -0.267 | -0.042 | -0.181 | .857 | -3.185 | 2.651 | ||||
| Income level | -2.083 | -0.454 | -5.460 | .001* | -2.837 | -1.329 | ||||
| Related to recipient | 1.452 | 0.202 | 2.783 | .006* | 0.421 | 2.483 | ||||
| Marital status | -0.335 | -0.055 | -0.407 | .684 | -1.961 | 1.290 | ||||
| Identity of caregiver | 1.069 | 0.280 | 0.937 | .351 | -1.187 | 3.324 | ||||
| Place of residence | 0.955 | 0.195 | 2.305 | .023* | 0.136 | 1.774 | ||||
| Living with whom | 0.057 | 0.018 | 0.149 | .881 | -0.700 | 0.815 | ||||
| Fearful attachment | (Constant) | 0.041 | 1.608 | .102 | 27.036 | 5.898 | .001 | 17.975 | 36.097 | |
| Age | 0.026 | 0.065 | 0.590 | .556 | -0.061 | 0.114 | ||||
| Gender | -1.009 | -0.187 | -1.939 | .054 | -2.038 | 0.019 | ||||
| Previous surgery | -0.673 | -0.099 | -0.968 | .335 | -2.049 | 0.702 | ||||
| Chronic disease | -0.265 | -0.026 | -0.288 | .774 | -2.085 | 1.555 | ||||
| Has caregiver | -1.356 | -0.241 | -0.890 | .375 | -4.368 | 1.656 | ||||
| Income level | 0.553 | 0.136 | 1.406 | .162 | -0.225 | 1.332 | ||||
| Related to recipient | -1.573 | -0.247 | -2.921 | .054 | -2.637 | -0.508 | ||||
| Marital status | -1.765 | -0.327 | -2.080 | .059 | -3.443 | -0.087 | ||||
| Caregiver identity | -1.367 | -0.404 | -1.161 | .248 | -3.695 | 0.961 | ||||
| Place of residence | -0.217 | -0.050 | -0.508 | .612 | -1.063 | 0.628 | ||||
| Living with whom | 0.600 | 0.218 | 1.515 | .132 | -0.183 | 1.382 | ||||
| Dismissive attachment | (Constant) | 0.145 | 2.221 | .016* | 25.278 | 3.778 | .001* | 12.054 | 38.501 | |
| Age | -0.004 | -0.007 | -0.069 | .945 | -0.132 | 0.123 | ||||
| Gender | -0.593 | -0.074 | -0.781 | .436 | -2.094 | 0.908 | ||||
| Previous surgery | -2.086 | -0.206 | -2.054 | .042* | -4.094 | -0.078 | ||||
| Chronic disease | 2.383 | 0.159 | 1.773 | .078 | -0.273 | 5.039 | ||||
| Has caregiver | 1.643 | 0.196 | 0.739 | .461 | -2.753 | 6.039 | ||||
| Income level | -0.596 | -0.099 | -1.037 | .301 | -1.732 | 0.540 | ||||
| Related to recipient | -0.582 | -0.061 | -0.740 | .460 | -2.135 | 0.971 | ||||
| Marital status | -1.397 | -0.174 | -1.127 | .261 | -3.845 | 1.052 | ||||
| Caregiver identity | 0.944 | 0.187 | 0.549 | .584 | -2.454 | 4.342 | ||||
| Place of residence | -0.681 | -0.105 | -1.091 | .277 | -1.915 | 0.552 | ||||
| Living with whom | 0.464 | 0.113 | 0.804 | .423 | -0.677 | 1.606 | ||||
| Preoccupied attachment | (Constant) | 0.081 | 1.160 | .320 | 15.980 | 3.981 | .001 | 8.045 | 23.915 | |
| Age | 0.000 | -0.001 | -0.006 | .995 | -0.077 | 0.077 | ||||
| Gender | 0.018 | 0.004 | 0.039 | .969 | -0.883 | 0.918 | ||||
| Previous surgery | -0.825 | -0.141 | -1.354 | .178 | -2.030 | 0.380 | ||||
| Chronic disease | -0.396 | -0.046 | -0.491 | .624 | -1.989 | 1.198 | ||||
| Has caregiver | -0.839 | -0.173 | -0.629 | .530 | -3.477 | 1.799 | ||||
| Income level | 0.720 | 0.206 | 2.089 | .058 | 0.039 | 1.402 | ||||
| Related to recipient | 0.433 | 0.079 | 0.917 | .361 | -0.500 | 1.365 | ||||
| Marital status | 0.010 | 0.002 | 0.014 | .989 | -1.459 | 1.480 | ||||
| Caregiver identity | -0.583 | -0.200 | -0.566 | .573 | -2.622 | 1.455 | ||||
| Place of residence | -0.422 | -0.113 | -1.126 | .262 | -1.162 | 0.318 | ||||
| Living with whom | 0.056 | 0.024 | 0.162 | .872 | -0.629 | 0.741 | ||||
R2 = coefficient of determination, F = model significance test value, P1 = model significance leve, β1 = unstandardized regression coefficient, β2 = standardized regression coefficient, t = t test value for coefficient significance, P2 = significance level of coefficient.
P < .05: statistically significant difference.
The models for fearful attachment (F = 1.608, P = .102) and preoccupied attachment (F = 0.081, P = .320) were not statistically significant (P > .05) as shown in Table 3.
The model in which secure attachment style was the dependent variable was found to be statistically significant (F = 6.864, P = .001). According to the model, income level, place of residence, kinship with the recipient, and history of prior surgery had a statistically significant effect on secure attachment style (P < .05), explaining 34.4% of the variance (R2 = 0.344). Higher income levels were associated with increased secure attachment. Donors living in rural areas, those not biologically related to the recipient, and those with a history of surgery had higher secure attachment scores than other groups. as shown in Table 3.
The model with dismissive attachment style as the dependent variable was also statistically significant (F = 2.221, P = .016). In this model, history of prior surgery had a statistically significant effect on dismissive attachment style (P < .05), accounting for 14.5% of the variance (R2 = 0.145). Donors with a history of surgery had lower dismissive attachment scores than those without such a history as shown in Table 3.
4. Discussion
This study was conducted to determine the relationship between certain sociodemographic characteristics and attachment styles of living liver donors. A review of the literature revealed no previous studies investigating the attachment styles of liver transplant donors or their relationship with sociodemographic characteristics. Therefore, the findings of this study were discussed in light of results from studies conducted in different patient groups regarding attachment styles. The study revealed that the vast majority of donors (93.6%) had a dismissive attachment style (Table 2). Previous research on liver transplant recipients has similarly identified dismissive attachment as the most common style.[11,12] Likewise, a study involving individuals discharged from intensive care units also reported dismissive attachment as having the highest mean score.[16] Dismissive individuals are thought to be less likely to engage in helping behaviors due to a fear of emotional intimacy.[14] These individuals exhibit high levels of attachment avoidance, and dismissive attachment is classified as a subtype of avoidant attachment.[15,17] A study conducted in the United States, the Netherlands, and Israel found that individuals with avoidant attachment styles were less likely to engage in or volunteer for various altruistic activities.[18] Richman et al also found that avoidant attachment was consistently associated with reduced involvement and sacrifice in charitable activities concerning both humans and animals.[14] Similarly, Mikulincer et al reported that higher levels of attachment avoidance were linked to lower expressions of compassion and a reduced willingness to help a distressed woman.[13] A cross-cultural study involving Turkish and American students found that the Turkish sample exhibited significantly lower levels of dismissive attachment compared to the American sample. This finding was interpreted as a reflection of collectivist cultural values among Turkish participants, who may be less inclined to endorse descriptions that imply rejection or detachment from others, as implied in the term “dismissive.”[15] The findings of this study support existing literature showing the prevalence of dismissive attachment across various clinical groups. However, the high prevalence of dismissive attachment among donors appears to contradict findings in the literature that link avoidant (dismissive) attachment with reduced helping and volunteering behaviors. This paradox suggests that behaviors influenced by attachment styles may also be shaped by cultural norms and social roles in addition to individual predispositions.[19] In Turkish society, the social stigma, judgment, or pressure experienced by individuals who are eligible but choose not to donate may play a role in influencing donation behavior. Further research is needed on this subject.
The findings of this study revealed that individuals with higher income levels, those living in rural areas, and those who were not biologically related to the recipient had significantly higher secure attachment scores compared to other groups (Table 3). A previous study indicated that secure attachment style is especially prominent among working adults.[20] The current findings are consistent with the existing literature. However, no prior studies have been found that specifically examine the influence of place of residence and biological relationship with the recipient on secure attachment scores. Nevertheless, it has been suggested that individuals living in rural areas often share similar consciousness and moral values, which foster social cohesion within these communities. Such individuals are known to form close, first-degree relationships and maintain strong social bonds through mutual solidarity.[21] It is also well established that individuals with secure attachment engage in trust-based strategies such as seeking social support.[4] These insights may help explain why those living in rural areas displayed higher levels of secure attachment compared to other groups. Furthermore, individuals with secure attachment are generally comfortable with both approaching others and being approached, and tend to hold positive views of others.[7] In this context, the finding that individuals who were not related to the recipient had higher secure attachment scores than those who were biologically related may indicate that securely attached donors exhibit greater interpersonal trust and perceive relational risk to be lower.
The study also found that donors who had undergone previous surgery scored higher in secure attachment and lower in dismissive attachment compared to those with no surgical history (Table 3). It is widely understood that adults with secure attachment styles demonstrate greater resilience in stressful situations and utilize adaptive coping strategies.[22] Additionally, secure individuals are reported to have higher capabilities in recognizing negative emotions and developing problem-focused coping mechanisms.[4,7] These traits may enable securely attached individuals to manage the emotional impact of past surgical experiences more effectively, allowing them to remain emotionally balanced. In contrast, dismissively attached individuals are more likely to employ over-regulating strategies that suppress or eliminate negative emotions.[23] The effectiveness of emotional regulation strategies is influenced by the individual’s perceived level of stress. Although dismissively attached individuals may appear distant and independent externally, they may exhibit heightened internal physiological responses to perceived threats and stress.[8] Supporting this, a study by Erözkan (2011) among university students found a moderate and negative relationship between dismissive attachment and rational decision-making, suggesting that dismissively attached individuals may react negatively to stress caused by previous surgical experiences. Moreover, it has been noted that social support cues may play a potential role in mitigating such responses.[8] Taken together, these findings suggest that donors’ attachment styles and previous experiences may influence both their willingness to participate in the transplant process and their psychological adjustment throughout that process.[19]
5. Conclusion
This study found that the vast majority of donors exhibited a dismissive attachment style. Donors with higher income levels, those living in rural areas, and those not biologically related to the recipient had significantly higher secure attachment scores. Additionally, donors with a history of surgery had higher secure attachment scores and lower dismissive attachment scores compared to those without surgical experience.
Based on these findings, we recommend that future studies and organ donation campaigns focus more closely on attachment styles. Furthermore, in clinical practice, determining donors’ attachment styles and integrating this understanding into postoperative care may help ensure more holistic patient management. Differences in attachment styles should not be overlooked, as they may play a key role in both the postoperative donor–recipient relationship and the donor–caregiver relationship. There is also a need for studies examining the donor–surgical nurse relationship within this context. The physiological effects of attachment styles and their roles in postoperative care should be further explored. Finally, to raise awareness on this subject, nursing curricula particularly in surgical nursing education should include instruction on factors affecting attachment styles and their implications for clinical care.
Acknowledgments
The authors would like to thank all participating patients.
Author contributions
Conceptualization: Seher Tanriverdi, Neslihan Söylemez, Emine Bayrakçi, Meral Özkan.
Data curation: Seher Tanriverdi, Neslihan Söylemez, Emine Bayrakçi.
Formal analysis: Seher Tanriverdi, Neslihan Söylemez, Emine Bayrakçi.
Investigation: Seher Tanriverdi, Neslihan Söylemez.
Methodology: Seher Tanriverdi, Neslihan Söylemez.
Project administration: Neslihan Söylemez.
Software: Seher Tanriverdi, Emine Bayrakçi, Meral Özkan.
Supervision: Seher Tanriverdi, Neslihan Söylemez, Meral Özkan.
Validation: Seher Tanriverdi, Neslihan Söylemez.
Writing – original draft: Seher Tanriverdi, Neslihan Söylemez, Emine Bayrakçi, Meral Özkan.
Writing – review & editing: Seher Tanriverdi, Neslihan Söylemez, Emine Bayrakçi, Meral Özkan.
Footnotes
Written informed consent was obtained from all participants. This study was conducted in accordance with the Declaration of Helsinki.
Ethical approval was obtained from the XXX University Health Sciences Scientific Research Ethics Committee (Date: October 31, 2023, Reference No: 2023/15-5091). Institutional permission was obtained from XXX University XXX Medical Center where the research was conducted (Date: October 07, 2023 Reference No: E-93629378-605.01-355226).
The authors have no funding and conflicts of interest to disclose.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
How to cite this article: Tanriverdi S, Söylemez N, Bayrakçi E, Özkan M. Determining the relationship between the sociodemographic characteristics and attachment styles of liver transplant donors: A cross-sectional study. Medicine 2026;105:7(e47596).
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