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Weightman AC, Coghlan S, Clayton PA. Respecting living kidney donor autonomy: an argument for liberalising living kidney donor acceptance criteria. Monash Bioeth Rev 2023; 41:156-173. [PMID: 36484936 PMCID: PMC10654180 DOI: 10.1007/s40592-022-00166-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2022] [Indexed: 06/17/2023]
Abstract
Doctors routinely refuse donation offers from prospective living kidney donors with certain comorbidities such as diabetes or obesity out of concern for donor wellbeing. This refusal occurs despite the ongoing shortage of kidney transplants and the superior performance of living donor kidney transplants compared to those from deceased donors. In this paper, we argue that this paternalistic refusal by doctors is unjustified and that, within limits, there should be greater acceptance of such donations. We begin by describing possible weak and strong paternalistic justifications of current conservative donor acceptance guidelines and practices. We then justify our position by outlining the frequently under-recognised benefits and the routinely overestimated harms of such donation, before discussing the need to respect the autonomy of willing donors with certain comorbidities. Finally, we respond to a number of possible objections to our proposal for more liberal kidney donor acceptance criteria. We use the situation in Australia as our case study, but our argument is applicable to comparable situations around the world.
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Affiliation(s)
- Alison C Weightman
- Adelaide Medical School, University of Adelaide, Adelaide, Australia.
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, 5000, Australia.
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, 5000, Australia.
| | - Simon Coghlan
- Centre for AI and Digital Ethics, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia
| | - Philip A Clayton
- Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, SA, 5000, Australia
- Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, 5000, Australia
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2
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Fox AN, Liapakis A, Batra R, Bittermann T, Emamaullee J, Emre S, Genyk Y, Han H, Jackson W, Pomfret E, Raza M, Rodriguez-Davalos M, Rubman Gold S, Samstein B, Shenoy A, Taner T, Roberts JP. The use of nondirected donor organs in living donor liver transplantation: Perspectives and guidance. Hepatology 2022; 75:1579-1589. [PMID: 34859474 DOI: 10.1002/hep.32260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 12/13/2022]
Abstract
Interest in anonymous nondirected living organ donation is increasing in the United States and a small number of transplantation centers are accumulating an experience regarding nondirected donation in living donor liver transplantation. Herein, we review current transplant policy, discuss emerging data, draw parallels from nondirected kidney donation, and examine relevant considerations in nondirected living liver donation. We aim to provide a consensus guidance to ensure safe evaluation and selection of nondirected living liver donors and a schema for just allocation of nondirected grafts.
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Affiliation(s)
- Alyson N Fox
- Columbia University Irving Medical Center (CUIMC) Center for Liver Disease and Transplanation NY Presbyterian HospitalColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - AnnMarie Liapakis
- Yale-New Haven Health Transplanation CenterYale University School of MedicineNew HavenConnecticutUSA
| | - Ramesh Batra
- Yale-New Haven Health Transplanation CenterYale University School of MedicineNew HavenConnecticutUSA
| | - Therese Bittermann
- Penn Transplant InstitutePenn MedicinePerelman School of Medicine Unniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Juliet Emamaullee
- University of Southern California (USC) Transplant InstituteKeck School of Medicine of USCLos AngelesCaliforniaUSA
| | - Sukru Emre
- Yale-New Haven Health Transplanation CenterYale University School of MedicineNew HavenConnecticutUSA
| | - Yuri Genyk
- University of Southern California (USC) Transplant InstituteKeck School of Medicine of USCLos AngelesCaliforniaUSA
| | - Hyosun Han
- University of Southern California (USC) Transplant InstituteKeck School of Medicine of USCLos AngelesCaliforniaUSA
| | - Whitney Jackson
- Colorado Center for Transplantation Care, Research and EducationUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Elizabeth Pomfret
- Colorado Center for Transplantation Care, Research and EducationUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Muhammad Raza
- Keck School of Medicine of University of Southern CaliforniaLos AngelesCaliforniaUSA
| | | | - Susan Rubman Gold
- Yale-New Haven Health Transplanation CenterYale University School of MedicineNew HavenConnecticutUSA
| | - Benjamin Samstein
- Weill Cornell Medicine Center for Liver Disease and Transplantation NY Presbyterian HospitalWeill Cornell School of MedicineNew YorkNew YorkUSA
| | - Akhil Shenoy
- Columbia University Irving Medical Center (CUIMC) Center for Liver Disease and Transplanation NY Presbyterian HospitalColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Timucin Taner
- Mayo Clinic Transplant CenterMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - John P Roberts
- Organ Transplant ProgramUniversity of California San Francisco (UCSF) HealthUCSF School of MedicineSan FranciscoCaliforniaUSA
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3
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Dunn S, Shah A. Anonymous Nondirected Living Liver Donation: Has the Time Come to Formalize the Process? Liver Transpl 2021; 27:1373-1374. [PMID: 34309166 DOI: 10.1002/lt.26237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 07/16/2021] [Indexed: 01/13/2023]
Affiliation(s)
- Stephen Dunn
- Department of Surgery, Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Ashesh Shah
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA
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Krespi MR, Tankurt A, Acarlı K, Yankol Y, Kalayoglu M, Kanmaz T. Post-donation evaluation of life of donors of liver transplantation. COGENT PSYCHOLOGY 2016. [DOI: 10.1080/23311908.2016.1262724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Asli Tankurt
- Doga College, Counselling Service, Istanbul, Turkey
| | - Koray Acarlı
- Centre of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
| | - Yucel Yankol
- Centre of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
| | - Munci Kalayoglu
- Centre of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
| | - Turan Kanmaz
- Centre of Organ Transplantation, Memorial Sisli Hospital, Istanbul, Turkey
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Gordon EJ, Mullee J, Skaro A, Baker T. Live liver donors' information needs: A qualitative study of practical implications for informed consent. Surgery 2016; 160:671-82. [PMID: 27269968 PMCID: PMC4975671 DOI: 10.1016/j.surg.2016.04.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 03/22/2016] [Accepted: 04/16/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND As live donor liver transplantation is increasingly used to expand the donor pool, concerns remain regarding how best to obtain live liver donors' informed consent. This study assessed donors' information preferences and their perceptions of informed consent. METHODS Cognitive interviews were conducted with donors by telephone about how knowledge items in a new survey instrument were material to informed consent, between November 2011 and April 2012. Thematic analysis was used to analyze qualitative data until reaching saturation. RESULTS Twenty-nine liver donors participated (85% participation). Donors commonly reported being unable to understand or retain much information disclosed during education. Donors preferred information about major donation risks, eg, death and minor risks that would likely affect their daily lives, eg, wound infection. Donors expressed less interest in information about their rights, confidentiality, or the medical procedure itself. Donors' preferences varied regarding statistical information. Many perceived the disclosure of risk information to be excessive, and rationalized risks they believed to be uncommon or not serious. Donors were disappointed by the brevity of the postdonation hospital stay. CONCLUSION Our findings suggest that the complexity and volume of disclosed information during evaluation were difficult for donors to adequately comprehend. Donors' lack of appreciation for the seriousness of complications may undermine their ability to provide informed consent. Future research should develop effective methods of information delivery to enhance informed consent.
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Affiliation(s)
- Elisa J Gordon
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL; Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
| | - Jack Mullee
- Department of Anthropology, University of Chicago, Chicago, IL
| | - Anton Skaro
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL; Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Talia Baker
- Division of Transplantation, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Exploring Knowledge About Dialysis, Transplantation, and Living Donation Among Patients and Their Living Kidney Donors. Int J Behav Med 2016; 22:580-9. [PMID: 25634574 PMCID: PMC4577545 DOI: 10.1007/s12529-015-9461-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background In order to make a well-considered decision and give informed consent about renal replacement therapy, potential living kidney donors and recipients should have sufficient understanding of the options and risks. Purpose We aimed to explore knowledge about Dialysis & Transplantation (DT) and Living Donation (LD) among prospective living kidney donors and recipients. Methods Eighty-five donors and 81 recipients completed the Rotterdam Renal Replacement Knowledge-Test (R3K-T) 1 day before surgery. The questionnaire was available in various languages. Results Recipients knew significantly more about DT than donors (p < 0.001); donors knew more about LD than recipients (p < 0.001). A minority of donors (15 %) and recipients (17 %) had a score that was comparable to the knowledge level of the naïve general population. Recipients and donors knew less about DT and LD if their native language was not Dutch. In addition, recipients knew less about DT if they were undergoing pre-emptive transplantation. Conclusions We conclude that recipients and donors retain different information. The decision to undergo living donation appears to be not always based on full knowledge of the risks. We recommend that professionals assess knowledge of prospective donors and recipients during the education process using the R3K-T, and extra attention is required for non-native speakers.
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Psychiatric and surgical outcome in Egyptian donors after living-donor liver transplantation. MIDDLE EAST CURRENT PSYCHIATRY 2016. [DOI: 10.1097/01.xme.0000475734.16388.f1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Gordon EJ, Rodde J, Skaro A, Baker T. Informed consent for live liver donors: A qualitative, prospective study. J Hepatol 2015; 63:838-47. [PMID: 26003265 DOI: 10.1016/j.jhep.2015.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/02/2015] [Accepted: 05/07/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Adult-to-adult live donor liver transplantation (LDLT) poses serious health risks and no direct health benefits to donors. Ensuring live donors' autonomy through informed consent is critical. We assessed live liver donors' (LD) comprehension, information needs, risk perceptions, and demographics. METHODS Semi-structured interviews were prospectively conducted with LDs after completing donor evaluation and informed consent at our transplant center. Likert scales measured informed consent domains. Open-ended responses underwent thematic analysis. RESULTS Thirty LDs participated (100% participation rate). Although 90% of LDs reported being informed about donation 'a great deal', only 66% reported understanding information about donation 'a great deal.' Many (40%) reported difficulty understanding medical terminology. Information LDs most desired to feel comfortable with their decision included: incidence and type of donor complications (67%), description of donation procedure (57%), and the process of donor preparation (43%). Most (83%) LDs rated risks to themselves as 'not at all' to 'somewhat' risky, and minimized these risks. CONCLUSIONS Although LDs perceived that they were adequately informed, their actual comprehension about donation was inadequate. Findings suggest the value of informed consent for preparation for the procedure and potential periprocedural risks rather than for decision-making. More comprehensible information disclosure may optimize informed consent.
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Affiliation(s)
- Elisa J Gordon
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States; Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
| | - Jillian Rodde
- Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Anton Skaro
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Talia Baker
- Comprehensive Transplant Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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Goldschmidt I, Migal K, Rückert N, van Dick R, Pfister ED, Becker T, Richter N, Lehner F, Baumann U. Personal decision-making processes for living related liver transplantation in children. Liver Transpl 2015; 21:195-203. [PMID: 25504770 DOI: 10.1002/lt.24064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 10/09/2014] [Accepted: 10/16/2014] [Indexed: 01/12/2023]
Abstract
Living related liver transplantation (LRLT) is a valuable transplant option for children with end-stage liver disease who face long waiting times on regular waiting lists. The subjection of a healthy adult to a potentially life-threatening operation can raise issues of freedom of choice, fear, and family conflict for the potential donors. We examined attitudes, fears, and influencing factors in the decision-making process for living liver donation for children in order to identify factors to improve support for living liver donors in the future. In a retrospective, questionnaire-based survey of 93 adults evaluated for living liver donation between 1997 and 2010, 47 of whom actually proceeded to donation, we asked about attitudes, motivation, fears, influencing factors, and well-being during the LRLT evaluation process and during the donation period. Answers were recorded on Likert scales and compared with Pearson's rho correlation and the Mann-Whitney U test as appropriate. Although there was a strong sense of a lack of alternatives among the donors, the majority of the donors felt free in their decision to donate. Donors who were asked to donate for a relative who was not their own child appeared at higher risk of lacking support and of feeling coerced. Family and social support and good and empathic information about the donation process were identified as key factors for donor well-being. In conclusion, potential living liver donors need to have adequate, sufficient, and empathic information, and they need to be provided a supportive framework, including family support, in order to promote their well-being. Care needs to be taken in identifying and counseling potential donors at risk of feeling coerced into donation.
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Affiliation(s)
- Imeke Goldschmidt
- Pediatric Gastroenterology and Hepatology, Children's Hospital, and, Hannover Medical School, Hannover, Germany
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10
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Morooka Y, Umeshita K. Perceptions of transplant surgery among living liver donors in Japan. Prog Transplant 2014; 24:381-6. [PMID: 25488563 DOI: 10.7182/pit2014400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT To minimize impaired psychosocial outcomes among living liver donors, it may be useful to obtain their views about being a donor with respect to their specific backgrounds. OBJECTIVE To describe the perceptions of living liver donors with respect to transplant surgery and to determine whether any differences in perceptions were related to the recipient's age or prognosis. DESIGN, SETTING, AND PATIENTS In total, 240 living liver donors (mean age, 44.4 years) openly and freely described their views on transplant. RESULTS Content analysis of the descriptions revealed 4 categories: grateful for the benefits of living donor liver transplant (n = 143, 59.6%), facing the limitations of living liver transplant (n = 125, 52.1%), donor stress (n = 105, 43.8%), and crucial preoperative period (n = 75, 31.2%). The frequency of descriptions of gratitude for the benefits of transplant differed significantly between adult-to-adult and adult-to-child transplants: donors to children (ie, recipients <18 years old) were more grateful than were donors to adults (ie, recipients ≥18 years old). In addition, descriptions of gratitude differed significantly depending on the recipient's prognosis: donors with recipients who survived were more grateful and experienced fewer difficulties than did donors with recipients who died. CONCLUSIONS In general, living liver donors were satisfied with transplant surgery but experienced living donor liver transplant as a burden, which was affected by the transplant outcome and the age of the recipient.
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Affiliation(s)
- Yuki Morooka
- Osaka University Graduate School of Medicine, Osaka, Japan
| | - Koji Umeshita
- Osaka University Graduate School of Medicine, Osaka, Japan
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Thiessen C, Kim YA, Yoo PS, Rodriguez-Davalos M, Mulligan D, Kulkarni S. Written informed consent for living liver donor evaluation: compliance with Centers for Medicare and Medicaid Services and Organ Procurement and Transplantation Network Guidelines and alibi offers. Liver Transpl 2014; 20:416-24. [PMID: 24415564 DOI: 10.1002/lt.23822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/01/2014] [Indexed: 02/07/2023]
Abstract
We examined written informed consent forms for living liver donor evaluations to determine whether they incorporated elements required by the Centers for Medicare and Medicaid Services (CMS) and suggested by the Organ Procurement and Transplantation Network (OPTN). We contacted each of the 41 US centers that performed at least 1 living donor liver transplant in 2011; 37 centers reported active living donor evaluation programs. Twenty-six centers shared their consent form for living donor evaluation (response rate = 70%). Each document was double-coded for consent element content. We found that 57% of the centers included the 9 mandated CMS elements. Although the OPTN guidelines are non-binding, 78% of the centers used consent forms that addressed at least two-thirds of the elements recommended by OPTN. Only 17% of the centers provided written offers of an alibi to donors who withdrew from the evaluation. On the basis of our findings, we offer suggestions that may be relevant to ongoing revisions to the OPTN living liver donor consent policy and may help centers to improve the clarity of their written consent forms.
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Affiliation(s)
- Carrie Thiessen
- Section of Transplantation and Immunology, Department of Surgery, Yale School of Medicine, New Haven, CT
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Grover S, Sarkar S. Liver transplant-psychiatric and psychosocial aspects. J Clin Exp Hepatol 2012; 2:382-92. [PMID: 25755459 PMCID: PMC3940381 DOI: 10.1016/j.jceh.2012.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/17/2012] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation is a life saving surgical procedure that is associated with improved longevity and enhanced quality of life. The number of successful liver transplants is growing worldwide. The procedure requires a dedicated and trained team of experts. A psychiatrist plays an important role in such a team. Psychiatric and psychosocial assessment is considered imperative to evaluate the candidate's suitability as a transplant recipient. Many psychiatric disorders may lead to the need for liver transplant, and if kept unchecked can adversely affect outcomes. Psychiatric problems arising in the post-transplant period may also require intervention of the psychiatrist. The donor too needs to be evaluated adequately to assess for psychological fitness for the procedure. This article provides broad overview of the various psychiatric and psychosocial issues pertaining to liver transplantation.
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Affiliation(s)
- Sandeep Grover
- Address for correspondence: Dr. Sandeep Grover, Assistant Professor, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India. Tel.: +91 172 2756807 (O); fax: +91 172 2744401, +91 172 2745078.
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Gordon EJ. Informed consent for living donation: a review of key empirical studies, ethical challenges and future research. Am J Transplant 2012; 12:2273-80. [PMID: 22594620 DOI: 10.1111/j.1600-6143.2012.04102.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Given the organ scarcity, live organ donation is increasingly considered a viable alternative for kidney and liver transplantation. Yet living donation challenges the ethical principle of nonmaleficence by subjecting healthy individuals to medical, psychosocial and unknown risks. Therefore, transplant providers, policy-makers and donors are committed to ensuring that prospective donors provide adequate informed consent to undergo the procedure. Informed consent for living donation is ethically required as a means of demonstrating respect for donor's autonomy and protecting their safety. However, all elements of informed consent are fraught with difficulties due to the unique nature of the donation process and outcome. This paper reviews empirical research on informed consent for live kidney donors (LKD) and live liver donors (LLD) for both adult and pediatric recipients. As this review shows, studies that empirically assessed the quality of informed consent elements reveal considerable variability and deficiencies across the informed consent process, suggesting the need for improvement. This review highlights challenges to each element of consent for both LKDs and LLDs, and situates trends within broader policy contexts, ethical debates and avenues for future innovative research.
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Affiliation(s)
- E J Gordon
- Institute for Healthcare Studies, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Informed consent and decision-making about adult-to-adult living donor liver transplantation: a systematic review of empirical research. Transplantation 2012; 92:1285-96. [PMID: 22143436 DOI: 10.1097/tp.0b013e31823817d5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Adult-to-adult living donor liver transplantation (LDLT) is a complex procedure that poses serious health risks to and provides no direct health benefit for the donor. Because of this uneven risk-benefit ratio, ensuring donor autonomy through informed consent is critical. To assess the current knowledge pertaining to informed consent for LDLT, we conducted a systematic review of the empirical literature on donors' decision-making process, comprehension about risks and outcomes, and information needs for LDLT. Of the 1423 identified articles, 24 met final review criteria, representing the perspective of approximately 2789 potential and actual donors. As donors' decisions to donate often occur before evaluation, they often make uninformed decisions. The review found that 88% to 95% of donors reported understanding information clinicians disclosed about risks and benefits. However, donors reported unmet information needs, knowledge gaps regarding risks, and unanticipated complications. Few donors reported feeling pressure to donate. Most studies were limited by cultural differences, small sample sizes, inconsistent measures, and poor methodological approaches. This systematic review suggests that informed consent for LDLT is sub-optimal as donors do not adequately appreciate disclosed information during the informed consent process, despite United Network for Organ Sharing/CMS regulations requiring formal psychological evaluation of donor candidates. Interventions are needed to improve donor-clinician communication during the LDLT informed consent process such as through the use of comprehension assessment tools and e-health educational tools that leverage adult learning theory to effectively convey LDLT outcome data.
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Long-term follow-up after right hepatectomy for adult living donation and attitudes toward the procedure. Ann Surg 2012; 254:694-700; discussion 700-1. [PMID: 22005145 DOI: 10.1097/sla.0b013e31823594ae] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine the long-term health status of donors after right hepatectomy for adult live donor liver transplantation (ALDLT). BACKGROUND The long-term outcomes for ALDLT donors are unknown. METHODS ALDLT donors undergoing right hepatectomy from April 1998 to June 2007 were invited to complete a questionnaire regarding health status, satisfaction (1-10/worst-best scale), self-esteem, willingness to donate again, and suggestions for improvement. In addition, donor files and cholecystectomy specimens were reviewed. Fisher's exact test, Kaplan-Meier and logistic regression analyses were performed. RESULTS Eighty-three donors were contacted (median age: 36 years; median follow-up: 69 months). 39 (47%) were free of symptoms. The remaining 44 (53%) reported: intolerance to fatty meals and diarrhea (31%), gastroesophageal reflux associated with left liver hypertrophy (9%), incisional discomfort requiring pain medications (6%), severe depression requiring hospitalization (4%), rib pain affecting lifestyle (2%), and exacerbation of psoriasis (1%). Median satisfaction score was 8. Self-esteem diminished in 5%. Thirty-nine (47%) recommended improvements particularly more detailed informed donor consent and a centralized living donor liver registry. Seventy-eight (94%) were willing to donate again. There were no differences between donors with and without complaints with respect to: donor age, gender, early complications and follow-up time, young-to-old donation, recipient diagnosis of malignancy and death of the recipient. Noninflamed donor cholecystectomy specimens correlated with intolerance to fatty meals and diarrhea (P = 0.001). CONCLUSIONS ALDLT donors are at risk for long-term complaints that are neither reflected nor related to early complications. This information should be included in both the donor evaluation and the ALDLT decision-making process.
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Psychological Factors Influencing Donors' Decision-Making Pattern in Living-Donor Liver Transplantation. Transplantation 2011; 92:936-42. [DOI: 10.1097/tp.0b013e31822e0bb5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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