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Assessment of the donor-recipient relationship is recommended by international guidelines to prevent undue coercion and ensure realistic expectations. We aimed to describe attitudes and experiences of transplant professionals on the donor-recipient relationship in living kidney donation.Semi-structured interviews were conducted with transplant professionals (nephrologists, surgeons, coordinators, social workers, psychiatrists and psychologists). Transcripts were analysed thematically.Fifty-four transplant professionals from thirty-two transplant centres across nine countries participated in the study. Four themes were identified: protecting vulnerability (ensuring genuine motivation, uncovering precarious dynamics, trusting emotional bonds, shared accountability, relying on psychosocial expertise, managing overwhelming and emotionally charged decisions); safeguarding against coercion (grasping broader power dynamics, justifiable probing, resigning to inevitable opacity, understanding interpersonal dynamics); minimising potential threat to relationships (protecting the bond, giving equitable attention to donors and recipients, preempting conflict, recognising changing dynamics, ensuring realistic expectations); and ambiguities in roles and responsibilities (expanding criteria and definitions of relationship, questioning medical paternalism, uncertainties in subjective assessments).Transplant professionals regarded the donor-recipient relationship as the driving moral imperative of the donation and thus believe that assessing the donor-recipient relationship is ethically necessary to minimise the risk of undue coercion and to protect donors and recipients. However, some feel challenged in disentangling altruism and voluntariness from the potential pressures of familial and societal duty they believe donors may not disclose, and question the level of justifiable medical paternalism.