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Krespi MR, Tankurt A, Acarli K, Kanmaz T, Yankol Y, Kalayoglu M. Beliefs of Living Donors About Recipients' End-Stage Liver Failure and Surgery for Organ Donation. Transplant Proc 2017; 49:1369-1375. [PMID: 28736009 DOI: 10.1016/j.transproceed.2017.02.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/26/2017] [Accepted: 02/07/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The concept of beliefs could provide a basis for how donors may perceive recipients' end-stage liver failure (ESLF) and surgery for organ donation. However, there is no such quantitative study. Therefore, the objective of this study was to explore beliefs of living donors about recipients' ESLF and surgery for organ donation. METHODS The sample comprised 16 living donors who donated a part of their liver to a patient who had ESLF. The data were analyzed by following established procedures for inductive qualitative analysis. RESULTS Analysis showed that donors' beliefs can be viewed in a number of groups. Beliefs about recipients' ESLF included diverse explanations for ESLF (blaming oneself and physicians) and physical symptoms (developmental slowing down). Beliefs about being a donor included reasons for being a donor (performing a good deed, being healed), barriers to being a donor (other people being ignorant and selfish), ways to manage these barriers (following one's gut feeling), and factors facilitating being a donor (the feeling that one does not have many people to leave behind). Beliefs about surgery for organ donation included physical effects (pain, feeling stiff). Beliefs about organ donation included views that general organ donation should be encouraged and that people's awareness should be raised. CONCLUSIONS Existing psychological perspectives could help to interpret some beliefs. Nevertheless, other beliefs, not previously reported, could be considered as targets for individual consultations/psycho-educational programs for fostering emotional well-being.
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Affiliation(s)
- M R Krespi
- Department of Psychology, Kadir Has University, Istanbul, Turkey.
| | - A Tankurt
- Department of Child and Adolescent Mental Health, Bezmialem Foundation Trust University, Istanbul, Turkey
| | - K Acarli
- Memorial Sisli Hospital, Centre of Organ Transplantation, Istanbul, Turkey
| | - T Kanmaz
- Memorial Sisli Hospital, Centre of Organ Transplantation, Istanbul, Turkey
| | - Y Yankol
- Memorial Sisli Hospital, Centre of Organ Transplantation, Istanbul, Turkey
| | - M Kalayoglu
- Memorial Sisli Hospital, Centre of Organ Transplantation, Istanbul, Turkey
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Abstract
As a result of the cadaveric organ shortage, the number of centers performing living donor liver transplantation has increased. Living donor liver transplantation provides immediate organ availability and avoids the risk of life-threatening complications that occur with long waiting times for cadaveric organs; however, it puts a healthy person at risk for little personal gain. A standardized approach to donor evaluation ensures safety to potential donors. Careful medical (physical examination as well as laboratory and radiological evaluation) and psychological evaluation is imperative to reduce donor complications and ensure good outcomes in recipients. A social worker and psychiatrist assess for mental competency, provide emotional support, and can serve as independent donor advocates. Informed understanding and consent are crucial aspects of the evaluation and include ensuring that the donor understands all potential complications and is free of coercion. Safety of the donor must be the highest priority.
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Affiliation(s)
- Dianne LaPointe Rudow
- Center for Liver Disease and Transplantation, New York Presbyterian Hospital Center, Columbia University, New York, NY, USA
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Papachristou C, Walter M, Schmid G, Frommer J, Klapp BF. Living donor liver transplantation and its effect on the donor-recipient relationship--a qualitative interview study with donors. Clin Transplant 2009; 23:382-91. [PMID: 19537301 DOI: 10.1111/j.1399-0012.2008.00948.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
An important aspect in the preoperative evaluation and a legal precondition for an living donor liver transplantation (LDLT) is a family or emotionally close relationship between donor and recipient. We investigated the development of the donor-recipient relationship after LDLT. We conducted semi-structured clinical interviews with 18 donors as part of a regular postoperative follow-up and analyzed them using the method of Grounded Theory. The donation does not lead to any major changes in the donor-recipient relationship, probably due to careful pre-selection. It does however enhance the existing positive or conflicting character of the relationship. Donors sometimes downplay negative aspects in the relationship and emphasize the improvement as a way of dealing with a major life event. A donation cannot fulfill expectations linked to it and it is unfavorable to be used to improve the relationship. Potential misuse or instrumentalization of the donation by the donor are possible. Postoperative feelings of gratitude are an issue after surgery. A good relationship enhances a better management of the postoperative course. The preoperative donor-recipient relationship should be as free of conflict as possible. A thorough preoperative evaluation of the donor-recipient relationship is particularly important to assess the donors' suitability and clarify conflicts and unrealistic expectations.
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Affiliation(s)
- C Papachristou
- Medical Clinic for Psychosomatics, Charité University Medicine Berlin, Berlin, Germany.
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Abstract
The purpose of this phenomenological study was to examine the meaning of being a live liver donor. Six people between ages 27 and 53 years participated. A qualitative, in-depth, semistructured interview format was used to explore donors' thoughts and feelings about being an organ donor. Five themes were identified: (1) no turning back—how do I live without you? (2) roller coaster marathon, (3) donor network, (4) the scar, and (5) reflections—time to think. At the center of the experience was the donor's commitment to the recipient. Once donors began the process, they were determined to see it through. The process was complex, and donors received various levels of support from family, friends, health care professionals, and others. After donation, as donors recovered and were able to resume their usual daily responsibilities, they reflected on the impact of the experience and how it changed their view of life.
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Affiliation(s)
- Charlotte C. Cabello
- New York Presbyterian Hospital (CCC) and Columbia University School of Nursing (JS), New York, NY
| | - Janice Smolowitz
- New York Presbyterian Hospital (CCC) and Columbia University School of Nursing (JS), New York, NY
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Walter M, Papachristou C, Pascher A, Danzer G, Neuhaus P, Klapp BF, Frommer J. Impaired psychosocial outcome of donors after living donor liver transplantation: a qualitative case study. Clin Transplant 2006; 20:410-5. [PMID: 16842514 DOI: 10.1111/j.1399-0012.2006.00464.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Adult-to-adult living donor liver transplantation (LDLT) of the right hepatic lobe has been developing into an established therapy for treating pre-terminal liver diseases. There is little experience available on the psychosocial outcome of living donors. The aim of this first qualitative case study was to investigate the patterns for impaired psychosocial outcome in donors after LDLT. Donor hepatectomies were performed in 30 donors at the Charité Berlin. Six months after surgery, the six of the 30 donors with negative moods and physical complaints in psychometric monitoring were examined. The post-operative interviews were transcribed and analysed using current qualitative research methods. These six donors (20%) reported various unspecific complaints and psychological conflicts. Sadness was expressed about organ rejection and death of the recipient. Anxieties about the recipient and their own health were verbalized. Disappointment and anger refer to the experience that they were not as fully appreciated by the medical system and their social environment as expected. The negative emotions of donors with impaired psychosocial outcome could be related to a decrease in self-esteem in the post-operative course. Adequate medical and psychological treatment opportunities for these donors should be provided.
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Affiliation(s)
- Marc Walter
- Department of Internal Medicine/Psychosomatics, Charité- University Medicine Berlin, Berlin, and Department of Psychosomatic Medicine and Psychotherapy, Otto-von-Guericke University Hospital, Madgeburg, Germany.
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7
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Walter M, Pascher A, Jonas S, Danzer G, Frommer J, Neuhaus P, Klapp BF. [Living donor liver transplantation from the perspective of the donor: results of a psychosomatic investigation]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2006; 51:331-45. [PMID: 16402332 DOI: 10.13109/zptm.2005.51.4.331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Living donor liver transplantation (LDLT) has been gaining importance in the treatment of endstage liver disease in adults. Thus far, only few empirical studies have been published on the psychosocial situation of donors who are faced with the risk of medical complications after resection of the right hepatic lobe. The aims were to describe the clinical problems before and after transplantation and to contribute to the discussion of ethical issues based on empirical findings. METHODS In the present overview, the pre-/post-transplant and follow-up periods are characterized from a psychosocial point of view using actual psychosocial and medical findings in living donors of the right hepatic lobe. RESULTS Before LDLT, 11 % of potential donors were not recommended for the transplantation due to marked ambivalence about the operation. After donation 26 % of donors showed high values for anxious depression and physical complaints despite low rates of surgical complications. CONCLUSIONS For clinical psychosomatic evaluations of potential donors it is important to provide donors an opportunity to report any misgivings and anxieties as openly as possible. The psychosocial impairment and physical complaints of some donors after transplantation are yet not clearly understood. More psychosocial studies in this field will be necessary to investigate ethical questions and to develop criteria for an evidence-based medical care of living donors.
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Affiliation(s)
- Marc Walter
- Medizinische Klinik mit Schwerpunkt Psychosomatik der Charité, Berlin, Germany.
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Walter M, Papachristou C, Pascher A, Danzer G, Neuhaus P, Klapp BF, Frommer J. Impaired psychosocial outcome of donors after living donor liver transplantation: a qualitative case study. Clin Transplant 2006. [DOI: 10.1111/j.1399-0012.2005.00464.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Roshan Shrestha
- Division of Gastroenterology and Hepatology, Center for Liver Diseases and Transplantation, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7080, USA.
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Beavers KL, Cassara JE, Shrestha R. Practice patterns for long-term follow-up of adult-to-adult right lobectomy donors at US transplantation centers. Liver Transpl 2003; 9:645-8. [PMID: 12783412 DOI: 10.1053/jlts.2003.50123] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Protocols used by transplant centers to care for donors after right hepatectomy for living donor liver transplantation are not well described in the medical literature. Our goal is to describe practice patterns for the long-term follow-up of adult-to-adult right lobectomy donors at US transplantation centers. All adult liver transplantation centers listed with the United Network for Organ Sharing were surveyed between October and November 2002. A transplant coordinator, hepatologist, or surgeon from each center completed a 10-item telephone questionnaire. Of 97 adult liver transplantation centers, 90 centers (92.8%) completed the survey. Ninety-six percent of participants were transplant coordinators; 2%, hepatologists; and 2%, surgeons. One thousand forty-four right lobectomies have been performed by 51 (56.7%) transplant programs (range, 1 to 101 per center). Thirty-eight percent of active programs have performed fewer than 10 donation right lobectomies. Fifty-one percent of programs have a transplant coordinator who works specifically with donors. Thirty-five programs (68.3%) have a formal follow-up protocol, and an additional 13 centers (14.4%) reported their usual follow-up patterns. Protocols ranged from no formal follow-up to visits every few weeks in the early postoperative period followed by evaluation every 6 months. Evaluation beyond 12 months is typically on an as-needed basis. Personal psychosocial support services after donation were unusual and included regular phone calls from the coordinator (5 centers), quality-of-life instruments (3 centers), scheduled follow-up with the psychologist (1 center), or a satisfaction survey (1 center). Several centers provided newsletters, combined donor-recipient support groups, recognitions parties, and certificates. There is significant variability in the long-term care of donors. Formal psychosocial support after donation is rare.
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Affiliation(s)
- Kimberly L Beavers
- Division of Digestive Diseases and Nutrition, University of North Carolina School of Medicine, Chapel Hill 27599, USA
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Abstract
As a result of the cadaveric organ shortage, the number of centers performing living donor liver transplantation has increased. Living donor liver transplantation provides immediate organ availability and avoids the risk of life-threatening complications that occur with long waiting times for cadaveric organs; however, it puts a healthy person at risk for little personal gain. A standardized approach to donor evaluation ensures safety to potential donors. Careful medical (physical examination as well as laboratory and radiological evaluation) and psychological evaluation is imperative to reduce donor complications and ensure good outcomes in recipients. A social worker and psychiatrist assess for mental competency, provide emotional support, and can serve as independent donor advocates. Informed understanding and consent are crucial aspects of the evaluation and include ensuring that the donor understands all potential complications and is free of coercion. Safety of the donor must be the highest priority.
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Affiliation(s)
- Dianne LaPointe Rudow
- Center for Liver Disease and Transplantation, New York Presbyterian Hospital Center, Columbia University, New York, NY, USA
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Walter M, Bronner E, Pascher A, Steinmüller T, Neuhaus P, Klapp BF, Danzer G. Psychosocial outcome of living donors after living donor liver transplantation: a pilot study. Clin Transplant 2002; 16:339-44. [PMID: 12225430 DOI: 10.1034/j.1399-0012.2002.02002.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In view of the scarcity of organ resources available for transplantation, living donor liver transplantation (LDLT) is gaining growing importance in the treatment of chronically terminal liver diseases. In the period between December 1999 and October 2000, 47 potential living liver donors were evaluated and 24 right hepatic lobes and two left lateral segments were transplanted at the Virchow-Klinikum of the Charité Hospital in Berlin. The present study looks into biomedical and psychosocial parameters of 23 donors before and 6 months after LDLT. Our aims were to investigate the development of psychosocial parameters after donation and the relationship between psychosocial findings and post-operative complications. Most donors showed an improved quality of life (QoL) after LDLT when compared with pre-operative results. Twenty-six percent of donors show high values for 'tiredness', 'fatigue' and 'limb pain' following donation. The post-operative complications had no influence on the psychosocial outcome. In this pilot study the resection of the right hepatic lobe amounts to a safe operation for donors and holds promise of a good psychosocial outcome for most donors, irrespective of donation-related complications. The pronounced complaints appears to indicate psychological tension and distress in some donors following donation.
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Affiliation(s)
- Marc Walter
- Clinic for Internal Medicine, Psychosomatics/Psychotherapy, Charité, Campus Mitte, Humboldt-University, Berlin, Germany.
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