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Menjivar A, Torres X, Manyalich M, Fehrman-Ekholm I, Papachristou C, de Sousa-Amorim E, Paredes D, Hiesse C, Yucetin L, Oppenheimer F, Kondi E, Peri JM, Kvarnström N, Ballesté C, Dias L, Frade IC, Lopes A, Diekmann F, Revuelta I. Psychosocial risk factors for impaired health-related quality of life in living kidney donors: results from the ELIPSY prospective study. Sci Rep 2020; 10:21343. [PMID: 33288792 PMCID: PMC7721886 DOI: 10.1038/s41598-020-78032-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Living kidney donors' follow-up is usually focused on the assessment of the surgical and medical outcomes. Whilst the psychosocial follow-up is advocated in literature. It is still not entirely clear which exact psychosocial factors are related to a poor psychosocial outcome of donors. The aim of our study is to prospectively assess the donors' psychosocial risks factors to impaired health-related quality of life at 1-year post-donation and link their psychosocial profile before donation with their respective outcomes. The influence of the recipient's medical outcomes on their donor's psychosocial outcome was also examined. Sixty donors completed a battery of standardized psychometric instruments (quality of life, mental health, coping strategies, personality, socio-economic status), and ad hoc items regarding the donation process (e.g., motivations for donation, decision-making, risk assessment, and donor-recipient relationship). Donors' 1-year psychosocial follow-up was favorable and comparable with the general population. So far, cluster-analysis identified a subgroup of donors (28%) with a post-donation reduction of their health-related quality of life. This subgroup expressed comparatively to the rest, the need for more pre-donation information regarding surgery risks, and elevated fear of losing the recipient and commitment to stop their suffering.
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Affiliation(s)
- Ana Menjivar
- Medical School, University of Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Torres
- Psychiatry and Clinical Psychology Service, Institut Clinic de Neurociencies, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marti Manyalich
- Medical School, University of Barcelona, Barcelona, Spain.,Transplant Assessorial Unit, Medical Direction, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ingela Fehrman-Ekholm
- Karolinska Institutet, Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Papachristou
- Department for Internal Medicine and Psychosomatics, Charité, University Medicine, Berlin, Germany.,School of Psychology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Erika de Sousa-Amorim
- Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - David Paredes
- Medical School, University of Barcelona, Barcelona, Spain.,Donation and Transplant Coordination Section, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Christian Hiesse
- Service de Néphrologie et de Transplantation Rénale, Hôpital Foch, Suresnes Cedex, France
| | - Levent Yucetin
- Organ Transplant Coordination, Antalya Medical Park Hospital, Antalya, Turkey
| | - Federico Oppenheimer
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Entela Kondi
- Medical School, University of Barcelona, Barcelona, Spain.,Transplant Assessorial Unit, Medical Direction, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Josep Maria Peri
- Psychiatry and Clinical Psychology Service, Institut Clinic de Neurociencies, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Niclas Kvarnström
- Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chloë Ballesté
- Medical School, University of Barcelona, Barcelona, Spain
| | - Leonidio Dias
- Nephrology and Transplant Departments, Hospital Geral de Santo António, Porto, Portugal
| | - Inês C Frade
- Liaison-Psychiatry and Health Psychology Unit, Hospital Geral de Santo António, Porto, Portugal
| | - Alice Lopes
- Liaison-Psychiatry and Health Psychology Unit, Hospital Geral de Santo António, Porto, Portugal
| | - Fritz Diekmann
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ignacio Revuelta
- Medical School, University of Barcelona, Barcelona, Spain. .,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain.
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Liu KL, Wang HH, Hsieh CY, Huang XY, Lin CT, Lin KJ, Chiang YJ, Chien CH. Kidney Donation Withdrawal and Related Factors Among the Potential Donors of Living Kidney Transplant. Transplant Proc 2020; 52:73-77. [PMID: 31901327 DOI: 10.1016/j.transproceed.2019.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to discuss the reasons for kidney donation withdrawal and related factors among the potential donors of living kidney transplant. METHODS This study was conducted in outpatient departments with purposive sampling. Potential donors received relevant examinations and completed questionnaires when they would donate their kidneys for living related kidney transplant. Researchers tracked the final decision of potential donors. The structured questionnaire included basic data, psychosocial adjustment to illness scale, and decisional conflict scale. RESULTS A total of 53 potential donors participated in this study, 46 of whom completed the kidney donation surgery (86.6%). The factors related to the final decision of kidney donation or kidney donation withdrawal included self-ranking health condition, value clarity, feeling supported in decision making, and overall decisional conflict. CONCLUSION Organ transplant teams should conduct a complete physical and psychological assessment of potential donors, provide information and support, and assist potential donors to clarify their true values and willingness to undergo kidney donation. Thus, each potential donor can decide to donate in true accordance with their willingness.
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Affiliation(s)
- Kuan-Lin Liu
- Department of Urology, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
| | - Hsu-Han Wang
- Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; Organ Transplantation Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chin-Yi Hsieh
- Department of Nursing, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
| | - Xuan-Yi Huang
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chih-Te Lin
- Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
| | - Kuo-Jen Lin
- Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; Organ Transplantation Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yang-Jen Chiang
- Department of Urology, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; Organ Transplantation Institute, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan; School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Hui Chien
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.
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Abstract
PURPOSE OF REVIEW The safety of living donor nephrectomy is essential to the continued success, growth, and sustainability of the clinical practice of living donor kidney transplantation. This review summarizes recent advances in our understanding of the perioperative and long-term risks faced by living kidney donors. RECENT FINDINGS Although adverse perioperative complications are extremely rare, donors particularly men, Black, or obese, frequently experience minor complications that result in delayed return to normal duties at home and work. Similarly, although long-term complications such as end-stage renal disease (ESRD) are rare, recent studies suggest a relative increase in risk of ESRD that is attributable to donation. Several risk calculators have been developed to help donors and their care providers quantify the baseline and postdonation risk of ESRD based on demographic and health characteristics. Thresholds of risk may help define what is an acceptable level of risk to the donor and the transplant center. SUMMARY Individualized risk calculators now allow care providers and potential donors to objectively and transparently participate in shared decision-making about the safety of living kidney donation.
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Affiliation(s)
- Luckmini Liyanage
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Abimerki Muzaale
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Macey Henderson
- Department of Surgery, Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Acute and Chronic Care, Johns Hopkins School of Nursing, Baltimore, MD, USA
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The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review. Transplant Direct 2018; 4:e394. [PMID: 30498771 PMCID: PMC6233672 DOI: 10.1097/txd.0000000000000833] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/04/2018] [Indexed: 12/19/2022] Open
Abstract
Supplemental digital content is available in the text. Introduction The process of evaluating candidates for living kidney donation can be inefficient. A structured review of existing information on this topic can provide a necessary foundation for quality improvement. Methods We conducted a scoping review to map the published literature to different themes related to an efficient donor candidate evaluation. We reviewed the websites of living donor programs to describe information provided to candidates about the nature and length of the evaluation process. Results We reviewed of 273 published articles and 296 websites. Surveys of living donor programs show variability in donor evaluation protocols. Computed tomography (a routinely done test for all successful candidates) may be used to assess split renal volume instead of nuclear renography when the 2 kidneys differ in size. Depending on the candidate’s estimated glomerular filtration rate, a nuclear medicine scan for measured glomerular filtration rate may not be needed. When reported, the time to complete the evaluation varied from 3 months to over a year. The potential for undesirable outcomes was reported in 23 studies, including missed opportunities for living donation and/or preemptive transplants. According to living donor websites, programs generally evaluate 1 candidate at a time when multiple come forward for assessment, and few programs describe completing most of the evaluation in a single in-person visit. Conclusions Data on the efficiency of the living donor evaluation are limited. Future efforts can better define, collect, and report indicators of an efficient living donor evaluation to promote quality improvement and better patient outcomes.
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Bieniasz M, Kieszek R, Jakubowska-Winecka A, Zatorski M, Kwapisz M, Jędrzejko K, Nita M, Durlik M, Pączek L, Kwiatkowski A. Psychological Aspects of Living Kidney Donation in Poland: Experience of One Center. Transplant Proc 2018; 50:1637-1639. [PMID: 30056874 DOI: 10.1016/j.transproceed.2018.04.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 04/08/2018] [Accepted: 04/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Living kidney transplantation is the optimal treatment of end-stage renal disease. The benefits for recipients are obvious. The psychological consequences for living kidney donors in Poland are not known. OBJECTIVE The objective of the study was to evaluate the psychological aspects of living kidney donation in Poland. PATIENTS AND METHODS A total of 66 living donor open nephrectomies were performed in our institution between 1995 and 2005. The psychological aspects were assessed in 40 donors after nephrectomy. The study applied the Satisfaction With Life Scale (SWLS), the Situation Assessment Questionnaire, the Health Behaviors Survey, and our own questionnaire. The mean observation period was 65.6 months. RESULTS There was a trend toward better life satisfaction in living kidney donors compared to Polish adults. Donor life satisfaction was significantly lower when the recipient was dead than when the recipient was alive. Most donors perceived the kidney donation as a challenge in cognitive judgment. The mean score of the Health Behaviors Survey was not significantly different than in the general population in Poland. The mean pain score after donation was 3.2 in a 5-item scale (1 = severe pain, 5 = mild pain). The mean time of return to work was 3.5 months. No donors regretted their decisions about kidney donation. CONCLUSION Living kidney donation in Poland has a positive impact on donors' quality of life. Among living kidney donors, the sense of danger concerning the risk of donation depends on the degree of the relationship with the recipient.
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Affiliation(s)
- M Bieniasz
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Kieszek
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - A Jakubowska-Winecka
- Department of Health Psychology, The Children's Memorial Health Institute, Warsaw, Poland
| | - M Zatorski
- University of Social Sciences and Humanities, Poznań, Poland
| | - M Kwapisz
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - K Jędrzejko
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Nita
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Durlik
- Department of Transplantation Medicine and Nephrology and Nephrology, Medical University of Warsaw, Poland
| | - L Pączek
- Department of Immunology, Transplant Medicine and Internal Disease, Transplantation Institute, Medical University of Warsaw, Poland
| | - A Kwiatkowski
- Department of General and Transplantation Surgery, Medical University of Warsaw, Warsaw, Poland
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Nolan MT, Walton-Moss B, Taylor L, Dane K. Living Kidney Donor Decision Making: State of the Science and Directions for Future Research. Prog Transplant 2016; 14:201-9. [PMID: 15495779 DOI: 10.1177/152692480401400305] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The Federal government and transplantation organizations have called for further study of living donation at a time when 3 new living donor protocols are being introduced throughout the United States that promise to significantly increase the donor pool and change the face of living donation. Donation to a once incompatible and sometimes unknown recipient may now occur through the use of plasmapheresis therapy or paired and nondirected living donor protocols. Objective To describe the state of the science on living kidney donor decision making, and to provide recommendations for future research to guide donor education and care. Data Sources Automated literature search using PubMed and CINAHL scientific literature databases. Study Data Extraction Research papers on living donor decision making from 1997 to 2003. Studies available only as abstracts were excluded. Data Synthesis Studies of living kidney donor decision making and outcomes have been limited in scope, with small sample sizes and inconsistent reports of racial and ethnic characteristics of the sample. The retrospective nature of the majority of living donor studies is a significant limitation. Conclusions Future prospective studies that are diverse by sex, race, and ethnicity will contribute to our knowledge of factors that influence the decision to be a living kidney donor.
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Affiliation(s)
- Marie T Nolan
- Johns Hopkins University School of Nursing, Baltimore, Md, USA
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Waterman AD, Stanley SL, Covelli T, Hazel E, Hong BA, Brennan DC. Living Donation Decision Making: Recipients' Concerns and Educational Needs. Prog Transplant 2016; 16:17-23. [PMID: 16676669 DOI: 10.1177/152692480601600105] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Despite the advantages of living donor transplantation, evidence suggests that some potential recipients with living donors have psychological concerns that prevent them from pursuing living donation. Addressing these concerns through education may increase the rates of living donation. Objective To understand the psychological barriers and educational needs of potential kidney recipients regarding living donation. Subjects and Design Qualitative focus group study of kidney transplant recipients, donors, and family members to explore their assessment of the advantages of dialysis and deceased donor transplantation over living donation, their concerns about living donation, and what types of living donation education would be most helpful. Results Kidney recipients reported that they might not pursue living donation because they felt guilty and indebted to the donor, did not want to harm or inconvenience the donor, did not want to accept a kidney that a family member might need later, and did not want to disappoint the donor if the kidney failed. Recipients were generally unaware that donors could personally benefit from donating and would rather wait for donor volunteers than ask anyone directly. Both donors and recipients thought that training on how to make the donation request and education about living donors' motivations for donation and transplant experience could help more renal patients pursue living donation.
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Affiliation(s)
- Amy D Waterman
- Washington University School of Medicine, St. Louis, Mo, USA
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8
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Lunsford SL, Shilling LM, Chavin KD, Martin MS, Miles LG, Norman ML, Baliga PK. Racial Differences in the Living Kidney Donation Experience and Implications for Education. Prog Transplant 2016; 17:234-40. [DOI: 10.1177/152692480701700312] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Context Much has been written about the barriers to deceased organ donation in the African American community. However, relatively little research has been conducted on barriers to living donation among African Americans. A shortage of suitable deceased donor kidneys among African Americans has encouraged donation from living donors. Objective As a follow-up to several focus groups with health professionals about barriers to living donation and suggestions for educational interventions, we sought to determine kidney donors' thoughts and feelings about their donation. Design Telephone interviews with past donors. Participants Nine African Americans and 9 whites were selected from a database of laparoscopic donor nephrectomies from 1993 to 2003. Outcome Measures Transcribed phone interviews were reviewed by 3 researchers to determine recurring themes and categorize responses. Results Responses were categorized into 8 areas of concern: health, financial, life with 1 kidney, procreation, psychosocial matters, surgery related, success of the transplant, and concerns about the future. Whites (n =9) tended to volunteer more for laparoscopic kidney donation than did African Americans (n = 2). African American concerns focused on future health and living with only 1 kidney, whereas whites had concerns about the surgery and the medical system. Conclusions Findings indicated that education is the best way to reach living donors and dispell fears. Promoting general health of African Americans may increase their willingness to be a living donor. Altruistic motives are the main motivation for donation, and intervention programs should target groups on a personal level to help individuals see that they can make a difference in improving or saving lives.
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Affiliation(s)
- Shayna L. Lunsford
- Medical University of South Carolina, Charleston, SC (SLL, LMS, KDC, MSM, LGM, PKB), Virginia Commonwealth University, Richmond, VA (MLN)
| | - Lilless M. Shilling
- Medical University of South Carolina, Charleston, SC (SLL, LMS, KDC, MSM, LGM, PKB), Virginia Commonwealth University, Richmond, VA (MLN)
| | - Kenneth D. Chavin
- Medical University of South Carolina, Charleston, SC (SLL, LMS, KDC, MSM, LGM, PKB), Virginia Commonwealth University, Richmond, VA (MLN)
| | - Margaret S. Martin
- Medical University of South Carolina, Charleston, SC (SLL, LMS, KDC, MSM, LGM, PKB), Virginia Commonwealth University, Richmond, VA (MLN)
| | - Lucia G. Miles
- Medical University of South Carolina, Charleston, SC (SLL, LMS, KDC, MSM, LGM, PKB), Virginia Commonwealth University, Richmond, VA (MLN)
| | - Michele L. Norman
- Medical University of South Carolina, Charleston, SC (SLL, LMS, KDC, MSM, LGM, PKB), Virginia Commonwealth University, Richmond, VA (MLN)
| | - Prabhakar K. Baliga
- Medical University of South Carolina, Charleston, SC (SLL, LMS, KDC, MSM, LGM, PKB), Virginia Commonwealth University, Richmond, VA (MLN)
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The need for a standardized informed consent procedure in live donor nephrectomy: a systematic review. Transplantation 2015; 98:1134-43. [PMID: 25436923 DOI: 10.1097/tp.0000000000000518] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Informed consent in live donor nephrectomy is a topic of great interest. Safety and transparency are key items increasingly getting more attention from media and healthcare inspection. Because live donors are not patients, but healthy individuals undergoing elective interventions, they justly insist on optimal conditions and guaranteed safety. Although transplant professionals agree that consent should be voluntary, free of coercion, and fully informed, there is no consensus on which information should be provided, and how the donors' comprehension should be ascertained. METHODS Comprehensive searches were conducted in Embase, Medline OvidSP, Web-of-Science, PubMed, CENTRAL (The Cochrane Library 2014, issue 1) and Google Scholar, evaluating the informed consent procedure for live kidney donation. The methodology was in accordance with the Cochrane Handbook for Interventional Systematic Reviews and written based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS The initial search yielded 1,009 hits from which 21 articles fell within the scope of this study. Procedures vary greatly between centers, and transplant professionals vary in the information they disclose. Although research has demonstrated that donors often make their decision based on moral reasoning rather than balancing risks and benefits, providing them with accurate, uniform information remains crucial because donors report feeling misinformed about or unprepared for donation. Although a standardized procedure may not provide the ultimate solution, it is vital to minimize differences in live donor education between transplant centers. CONCLUSION There is a definite need for a guideline on how to provide information and obtain informed consent from live kidney donors to assist the transplant community in optimally preparing potential donors.
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Smith SW, Nazione S, LaPlante C, Clark-Hitt R, Park HS, Sung R, Leichtman A. Living kidney donor decision making and communication. JOURNAL OF HEALTH COMMUNICATION 2011; 16:870-888. [PMID: 21660829 DOI: 10.1080/10810730.2011.563668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There is high demand for kidney donors in the United States, and it is widely accepted that living donation is optimal for individuals who need a kidney. Much research has focused on the potential recipient, but little has been studied about the communication and decision making of living kidney donors. Interviews assessed the communication and decision-making processes of 43 kidney donor volunteers. Almost all of the participants were not asked, but instead volunteered, to donate. The majority of donors reported having conversations with the recipient and speaking about their decisions with other individuals in their social networks besides the recipient. Some participants said that they stopped talking to others because of negative feedback. Future research should further examine the communication of donors with non-recipient others and potential methods of training recipients and donors to communicate effectively about the donation process.
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Affiliation(s)
- Sandi W Smith
- Department of Communication, Michigan State University, East Lansing, Michigan 48824, USA.
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11
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Gordon EJ, Bergeron A, McNatt G, Friedewald J, Abecassis MM, Wolf MS. Are informed consent forms for organ transplantation and donation too difficult to read? Clin Transplant 2011; 26:275-83. [PMID: 21585548 DOI: 10.1111/j.1399-0012.2011.01480.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Informed consent for organ transplantation and donation is an ethical obligation, legally required, and considered as part of the Patient's Rights Condition of Medicare Participation for hospitals. National policy-makers recommend that informed consent forms and patient education materials be written at a low reading level (5th-8th grade level) to facilitate patient comprehension. We assessed reading levels of informed consent forms (CFs) for adult organ transplant recipients and living organ donors across US transplant centers. CFs were analyzed using three measures of reading level: Lexile Measure, Flesch-Kincaid Grade Level, and the Gunning Fog Index. Of active transplant centers contacted (N=209), 75 (36%) sent a total of 332 CFs. CFs were written, on average, at the college level, which is a considerably higher reading level than the standards set by policy-makers. CF reading levels were negatively correlated with transplant center volume (r=-0.119; p<0.03). CFs for intestine transplantation and for evaluation/listing were the easiest to read, while consent forms for liver transplantation/donation and pre-transplant agreements were the most difficult to read. Reducing CFs' reading level may help to increase patient comprehension for adequate informed consent.
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Affiliation(s)
- Elisa J Gordon
- Department of Surgery, Comprehensive Transplant Center, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611-3152, USA.
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12
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Oliveira B, Mascarenhas C, Cardoso G, Sá J, Casal M. Assessment of the Degree of Satisfaction Among Living Kidney Donors. Transplant Proc 2011; 43:43-7. [DOI: 10.1016/j.transproceed.2010.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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González Monte E, Delgado I, Polanco N, Hernández E, Dipalma T, Hernández A, Castillo M, Morales E, Praga M, Morales J, Andrés A. Results of a Living Donor Kidney Promotion Program. Transplant Proc 2010; 42:2837-8. [DOI: 10.1016/j.transproceed.2010.09.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Manyalich M, Ricart A, Martínez I, Balleste C, Paredes D, Vilardell J, Avsec D, Dias L, Fehrman-Eckholm I, Hiesse C, Kyriakides G, Line PD, Maxwell A, Nanni Costa A, Paez G, Turcu R, Walaszewski J. EULID project: European living donation and public health. Transplant Proc 2010; 41:2021-4. [PMID: 19715823 DOI: 10.1016/j.transproceed.2009.05.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The choice of transplantation from a living donor offers advantages over a deceased donor. However, it also carries disadvantages related to donor risks in terms of health and safety. Furthermore, there are several controversial ethical aspects to be taken into account. Several national and international institutions and the scientific community have stated standards that have great influence on professional codes and legislations. Living organ donation and transplantation are to some extent regulated by parliamentary acts in most European countries. It is necessary to take a step forward to develop a legal framework to regulate all of these processes to guarantee the quality and to prevent illegal and nonethical practices. It is also necessary to develop and implement living donor protection practices not only in terms of physical health, but also to minimize potential impacts on the psychological, social, and economic spheres. Finally, an additional effort should be made to create a database model with recommendations for registration practices as part of the standardized follow-up care for the living donor. The European Living Donation (EULID) project's (http://www.eulivingdonor.eu/) main objective was to contribute to a European consensus to set standards and recommendations about legal, ethical, and living donor protection practices to guarantee the health and safety of living donors.
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Affiliation(s)
- M Manyalich
- Hospital Clínic of Barcelona, Barcelona, Spain.
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15
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Robinson DHZ, Borba CPC, Thompson NJ, Perryman JP, Arriola KRJ. Correlates of support for living donation among African American adults. Prog Transplant 2009. [PMID: 19813487 DOI: 10.7182/prtr.19.3.p095706722443230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Living donation is studied with much less intensity among African Americans than among the general population. Examination of barriers to living donation can lead to effective strategies to educate dialysis patients and their families about this alternative. OBJECTIVE To explore the correlates of likelihood of becoming a living donor among community-recruited African American adults. DESIGN/PARTICIPANTS Cross-sectional data were gathered via self-administered questionnaire from 425 African American adults, age 18 years and older, who were recruited from 9 churches in Atlanta. MAIN OUTCOME MEASURES Self-reported likelihood of becoming a living donor to a close family member, an extended family member or friend, or a stranger. RESULTS More than three-quarters of participants were willing to act as living donors to a close family member or spouse and two-thirds to friends or extended family. For likelihood of donating to a friend or extended family member, only willingness to engage in deceased donation was significantly associated; to a stranger, both willingness to engage in deceased donation and attitudes toward donation were significantly associated. Knowledge of and personal experiences with donation and/or transplantation were not significantly associated with likelihood of any type of living donation. CONCLUSIONS Findings indicate widespread support for living donation to a close family member or spouse. These findings have important implications for dialysis patients who must decide whether to approach friends and/or family about the possibility of serving as a living donor and emphasize the need for interventions to help facilitate this process.
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Affiliation(s)
- Dana H Z Robinson
- Rollins School of Public Health of Emory University, Atlanta, GA 30322, USA.
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16
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Barnieh L, McLaughlin K, Manns B, Klarenbach S, Yilmaz S, Hemmelgarn B. Development of a survey to identify barriers to living donation in kidney transplant candidates. Prog Transplant 2009. [DOI: 10.7182/prtr.19.4.e227513768045169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Barnieh L, McLaughlin K, Manns B, Klarenbach S, Yilmaz S, Hemmelgarn B. Development of a Survey to Identify Barriers to Living Donation in Kidney Transplant Candidates. Prog Transplant 2009; 19:304-11. [DOI: 10.1177/152692480901900404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Kidney transplantation from living donors, compared with deceased donors, has improved health care outcomes for patients with end-stage renal disease; however, less than 40% of transplants come from living donors. Numerous barriers may impede the identification of, and transplantation from, living donors. Objective To develop and validate a survey to identify barriers that transplant candidates may encounter when seeking a living donor for kidney transplantation. Methods The survey was developed in 3 phases: item identification by using persons with a stake in the process to identify key components; survey refinement, including assessment of content and face validity; and assessment of test-retest reliability by using the kappa coefficient and percent agreement for each of the scaled response items. Results The final survey contained 10 items with a Likert scale response and 5 open-ended questions. Expert nephrologists in the field confirmed face validity and content validity of the survey. The overall kappa coefficient for the scale was 0.76, reflecting excellent agreement, with an overall percent agreement of 88.7%. Conclusion We developed a survey to identify barriers that kidney transplant candidates may experience when seeking a living donor, which demonstrated content and face validity as well as reproducibility. This survey can by used by end-stage renal disease programs to identify barriers in candidates seeking a transplant. The results of the survey can be used to develop interventions to overcome such barriers with an ultimate goal of increasing rates of living kidney donation.
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Wiedebusch S, Reiermann S, Steinke C, Muthny FA, Pavenstaedt HJ, Schoene-Seifert B, Senninger N, Suwelack B, Buyx AM. Quality of life, coping, and mental health status after living kidney donation. Transplant Proc 2009; 41:1483-8. [PMID: 19545662 DOI: 10.1016/j.transproceed.2009.02.102] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 02/23/2009] [Indexed: 10/20/2022]
Abstract
The main aim of the study was to explore well-being after donation. This retrospective, cross-sectional study of 161 living kidney donors (104 women; response rate 81.4%) who were aged between 32 and 80 years (x = 56.3; standard deviation = 10.9) included responses to standardized questionnaires concerning quality of life (QOL), coping, and mental health status. Most donors recovered fully from donation within 6 months (90.8%). Donor willingness to donate again (96.1%) was high. Their relationship to the recipient did not change (67.9%) or even improved (27.5%) in most cases. Donor QOL (as assessed by the Short-Form [SF]-36) did not differ from healthy norms. In 25% of donors, screening with the Hospital Anxiety and Depression Scale revealed anxious and/or depressive symptoms above the clinical cutoff score. Donor predominant coping style with their recipient's renal disease was "active problem-focused coping." The component scores of the SF-36 correlated positively with sociodemographic and self-reported medical parameters, coping, and mental health status. Although living kidney donation again proved to be a treatment without negative impact on donor QOL, the results underlined the importance of screening for donor mental health status and coping both in the evaluation process and after the procedure.
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Affiliation(s)
- S Wiedebusch
- Department of Medical Psychology, University Hospital Muenster, Germany
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19
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Robinson DHZ, Borba CPC, Thompson NJ, Perryman JP, Arriola KRJ. Correlates of Support for Living Donation among African American Adults. Prog Transplant 2009; 19:244-51. [DOI: 10.1177/152692480901900310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Living donation is studied with much less intensity among African Americans than among the general population. Examination of barriers to living donation can lead to effective strategies to educate dialysis patients and their families about this alternative. Objective To explore the correlates of likelihood of becoming a living donor among community-recruited African American adults. Design/Participants Cross-sectional data were gathered via self-administered questionnaire from 425 African American adults, age 18 years and older, who were recruited from 9 churches in Atlanta. Main Outcome Measures Self-reported likelihood of becoming a living donor to a close family member, an extended family member or friend, or a stranger. Results More than three-quarters of participants were willing to act as living donors to a close family member or spouse and two-thirds to friends or extended family. For likelihood of donating to a friend or extended family member, only willingness to engage in deceased donation was significantly associated; to a stranger, both willingness to engage in deceased donation and attitudes toward donation were significantly associated. Knowledge of and personal experiences with donation and/or transplantation were not significantly associated with likelihood of any type of living donation. Conclusions Findings indicate widespread support for living donation to a close family member or spouse. These findings have important implications for dialysis patients who must decide whether to approach friends and/or family about the possibility of serving as a living donor and emphasize the need for interventions to help facilitate this process.
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Alvaro EM, Siegel JT, Turcotte D, Lisha N, Crano WD, Dominick A. Living Kidney Donation among Hispanics: A Qualitative Examination of Barriers and Opportunities. Prog Transplant 2008; 18:243-50. [DOI: 10.1177/152692480801800406] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Despite their increasing need for kidneys and low nonliving donation rates, minimal research has been conducted to ascertain the perceptions of Hispanic Americans about living organ donation and the process of asking for such a donation. Objective To examine perceptions of Hispanics regarding barriers to and benefits of living donation as well as the process of asking someone to be a living donor. Design A qualitative study consisting of 10 focus groups conducted in 2 series. Participants Adult Spanish-language-dominant Hispanic members of the general population of Tucson, Arizona. Results The main barriers to living organ donation were a lack of knowledge or information and fear of the donation process. Knowing that one has helped save or improve another's life was the central benefit. Most participants reported being willing to ask a relative to be a living donor if they were ever in need. Two main responses typified these individuals: no concern about asking because of a strong desire to fight for one's health and for one's family, or asking despite difficulties and concerns about the process. A significant minority of participants indicated they would not ask for a donation, because of either a desire to avoid harming others or the expectation that a relative would initiate an offer.
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Affiliation(s)
- Eusebio M. Alvaro
- Claremont Graduate University, Claremont, California (EMA, JTS, DT, NL, WDC), Arizona Kidney Foundation, Phoenix, Arizona (AD)
| | - Jason T. Siegel
- Claremont Graduate University, Claremont, California (EMA, JTS, DT, NL, WDC), Arizona Kidney Foundation, Phoenix, Arizona (AD)
| | - Dana Turcotte
- Claremont Graduate University, Claremont, California (EMA, JTS, DT, NL, WDC), Arizona Kidney Foundation, Phoenix, Arizona (AD)
| | - Nadra Lisha
- Claremont Graduate University, Claremont, California (EMA, JTS, DT, NL, WDC), Arizona Kidney Foundation, Phoenix, Arizona (AD)
| | - William D. Crano
- Claremont Graduate University, Claremont, California (EMA, JTS, DT, NL, WDC), Arizona Kidney Foundation, Phoenix, Arizona (AD)
| | - Alexander Dominick
- Claremont Graduate University, Claremont, California (EMA, JTS, DT, NL, WDC), Arizona Kidney Foundation, Phoenix, Arizona (AD)
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21
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Alvaro E, Siegel J, Turcotte D, Lisha N, Crano W, Dominick A. Living kidney donation among Hispanics: a qualitative examination of barriers and opportunities. Prog Transplant 2008. [DOI: 10.7182/prtr.18.4.d81554656r475t01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Parekh AM, Gordon EJ, Garg AX, Waterman AD, Kulkarni S, Parikh CR. Living kidney donor informed consent practices vary between US and non-US centers. Nephrol Dial Transplant 2008; 23:3316-24. [PMID: 18599559 DOI: 10.1093/ndt/gfn295] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Living kidney donation rates are increasing in the United States and internationally. Major consensus statements on the care of living kidney donors recommend communicating all potential health and psychosocial risks to donors. We evaluated the degree of international variation in the process of informed consent of potential donors during their evaluation. METHODS Transplant professionals attending the 2006 World Transplant Congress responded to a survey assessing their process of informed consent, evaluation and communication of living donor risk. US-based respondents were compared to non-US respondents. RESULTS There were 221 respondents from 177 transplant centers and 40 countries (48% US respondents). Across US and non-US transplant centers, potential donors were most likely to receive written material about living donor risk by mail prior to evaluation, receive risk information in person during evaluation, have a psychosocial evaluation, which usually lasted longer than 30 min and sign an official donation consent form presented to them by a surgeon or nephrologist. Although over 75% of respondents stated that donors received information about medical risks such as hypertension, chronic kidney disease and potential need for dialysis, there was less consistency regarding whether or not respondents conveyed an increased risk of these medical complications to donors. Additionally, the financial and psychosocial costs associated with being a living donor were inconsistently communicated to donors during the informed consent process. Compared to non-US respondents, US respondents were more likely to use written material and visual aids to convey risks to donors, have mandatory psychosocial evaluations and provide access to donor support groups. US transplant centers were also more likely to discuss the possibility of the donors needing dialysis or a transplant if their remaining kidney fails in the future, possible travel expenses and loss of work income due to donation recovery. Conversely, the US respondents were less likely to offer long-term follow-up and to utilize nephrologists to obtain written donor consent for donation. CONCLUSIONS As dependence on living organ donation increases best practices for informed consent, donor evaluation and uniform risk conveyance need to be established. This may be accomplished by using a model informed consent template to ensure that informed consent from donors is consistently obtained.
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Affiliation(s)
- Ami M Parekh
- Department of Medicine, Yale University, New Haven, CT, USA
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23
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Valapour M. The live organ donor's consent: is it informed and voluntary? Transplant Rev (Orlando) 2008; 22:196-9. [DOI: 10.1016/j.trre.2008.02.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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24
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Waterman A, Barrett A, Stanley S. Optimal transplant education for recipients to increase pursuit of living donation. Prog Transplant 2008. [DOI: 10.7182/prtr.18.1.d4r0564645ut6074] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Waterman AD, Barrett AC, Stanley SL. Optimal Transplant Education for Recipients to Increase Pursuit of Living Donation. Prog Transplant 2008; 18:55-62. [DOI: 10.1177/152692480801800111] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Inadequate transplant education may stop kidney patients from beginning or completing evaluation or limit recipients from considering living donation. Objective To learn about recipients' decision making about living donation and preferred transplant education resources. Design Retrospective, cross-sectional survey. Patients—304 kidney recipients. Main Outcome Measures Living donation comfort, concerns, education preferences. Results Recipients spent 10 median hours learning about transplant, primarily by speaking to medical staff (2–3 hours) and reading transplant brochures (0–1 hour). Twelve percent had not received any education before coming to the transplant center. At least 75% wanted education discussing the evaluation, surgery, and medical tests required of recipients and donors, as well as common transplant-related fears. Recipients who received living donor transplants were more interested in information about donors' evaluation ( P< .001), surgery ( P< .001), medical tests ( P< .001), and donation concerns ( P= .004) than were other recipients. Recipients who had living donors evaluated were more comfortable accepting family members or friends who volunteered rather than asking potential donors because of concerns about pressuring donors (85%), harming their health (83%), or causing them pain or inconvenience (76%). Besides providing accurate medical information, education that addresses recipients' fears about transplantation, explains living donors' donation experiences, and teaches patients how to pursue living donation may increase recipients' pursuit of living donation.
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Affiliation(s)
- Amy D. Waterman
- Washington University School of Medicine, St Louis, Missouri
| | - Ann C. Barrett
- Washington University School of Medicine, St Louis, Missouri
| | - Sara L. Stanley
- Washington University School of Medicine, St Louis, Missouri
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26
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Andersen MH, Bruserud F, Mathisen L, Wahl AK, Hanestad BR, Fosse E. Follow-up interviews of 12 living kidney donors one yr after open donor nephrectomy. Clin Transplant 2008; 21:702-9. [PMID: 17988262 DOI: 10.1111/j.1399-0012.2007.00726.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Very few studies have prospectively followed living kidney donors the first year after donor surgery. In 2003, we in-depth interviewed living kidney donors one wk after donation to explore their immediate experiences of going through nephrectomy. The aim of the current investigation was to explore experiences regarding physical and psychosocial health during the first year after donor surgery. Twelve donors going through open donor nephrectomy were interviewed by telephone at one yr after donation. The analysis was carried out with an empirical phenomenological method. All participants expressed an overall positive experience about being a donor a year after transplantation. However, several participants experienced physical disincentives longer than expected post-donation. Emotional distress, such as mild depression and a feeling of loss, was also part of the donor experiences. Donors experiencing unsuccessful recipient outcome reported severe physical and mental reactions. This study provides insights on the physical and mental cost to living kidney donation. Awareness of how donors may experience their situations can help transplantation professionals in their efforts to understand and provide support.
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Affiliation(s)
- Marit Helen Andersen
- Department of Surgery and The Interventional Centre, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway.
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Brown JB, Karley ML, Boudville N, Bullas R, Garg AX, Muirhead N. Living kidney donors' experiences with the health care system. SOCIAL WORK IN HEALTH CARE 2008; 46:53-68. [PMID: 18551829 DOI: 10.1300/j010v46n03_03] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The purpose of this study was to explore living kidney donors' perceived experiences with the health care system from the period prior to being tested as a potential donor, through to post donation discharge and follow-up. Qualitative methodology, using a phenomenological approach, explored the experiences, feelings, and ideas of 12 purposefully selected living kidney donors' interface with the health care system. Eight men and four women were interviewed four to 29 years post donation. Interviews were audio taped and transcribed verbatim. An iterative and interpretive analysis was conducted. Themes emerging from the data included factors influencing living kidney donors' decision to be tested as potential donors, the importance of emotional support, and humanistic care. This in turn impacted on their experience of: (1) the role of information in the decision-making process; (2) their tolerance of issues related to hospitalization and; (3) their perception of the quality of care. The findings of this study provide suggestions for the role of social work and improvement in the health care system to better address the needs of living kidney donors.
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Affiliation(s)
- Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Suite 245, 100 Collip Circle, London, ON, Canada N6G 4X8
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Sajjad I, Baines LS, Salifu M, Jindal RM. The dynamics of recipient-donor relationships in living kidney transplantation. Am J Kidney Dis 2007; 50:834-54. [PMID: 17954298 DOI: 10.1053/j.ajkd.2007.07.029] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2007] [Accepted: 07/31/2007] [Indexed: 01/10/2023]
Abstract
Psychosocial issues in kidney transplant donors and recipients are a cause for concern. We reviewed studies that investigated psychosocial issues in donors and recipients of living kidney transplants. A variety of instruments were used for this purpose. However, there was a lack of consensus regarding the structure and method of psychosocial assessment in living kidney donors. We found that only a few centers currently carry out a systematic psychosocial follow-up of recipients and their donors. The majority of psychosocial studies were of living kidney donors, indicating a preference of researchers to study psychosocial issues in live kidney donors. We believe living kidney transplant recipients are also an important group, and more studies should be done to better understand the psychosocial issues in this group. The majority of studies were retrospective in nature. We also discuss relationships, interactions, and communication patterns that characterize living kidney donation. We place emphasis on understanding the relational history of donors and recipients to provide supportive intervention and enable the potential donor make an informed decision about surgery. We recommend comprehensive psychosocial screening before and after transplantation and donation. This may decrease psychological problems and increase satisfaction with the transplantation process. Furthermore, the transplant community will need to address the type of instruments, duration of follow-up, and funding sources to carry out our recommendations.
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Affiliation(s)
- Imran Sajjad
- Department of Medicine, University of Wisconsin, Madison, USA
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29
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Lunsford S, Shilling L, Chavin K, Martin M, Miles L, Norman M, Baliga P. Racial differences in the living kidney donation experience and implications for education. Prog Transplant 2007. [DOI: 10.7182/prtr.17.3.np2316450n345u67] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Moody EM, Clemens KK, Storsley L, Waterman A, Parikh CR, Garg AX. Improving on-line information for potential living kidney donors. Kidney Int 2007; 71:1062-70. [PMID: 17361119 DOI: 10.1038/sj.ki.5002168] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Individuals who consider becoming living kidney donors often search the internet for reliable information before contacting the transplant center. The quality of such information requires due consideration. Using the search engines Google and Yahoo and the WebMD information portal, two reviewers independently abstracted data on the classification, readability, and general quality of websites. The coverage and accuracy of each site's discussion of the risks, benefits, and process of living donation was also assessed against a checklist of recommended information. Eighty-six unique websites on living kidney donation were found. Most were created by transplant programs and transplant organizations. Although the content of most sites was accurate, almost all (98%) were written above the recommended patient reading level (i.e., fifth grade). On average, each site covered 38% of the recommended information on living donation (range 8-76%). Educational topics of potential long-term medical risks, psychological risks, and expected benefits to the donor were often missing. The most visited websites were often not ranked among the best sites to provide information. By better understanding the nature of on-line information, transplant professionals can direct their patients to the best available websites. Local educational efforts, including the effective use of internet resources, will ensure living donation and complete understanding of the risks by potential donors and recipients.
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Affiliation(s)
- E M Moody
- Division of Nephrology, University of Western Ontario, London, Canada
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31
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Walton-Moss B, Boulware LE, Cooper M, Taylor L, Dane K, Nolan MT. Prospective pilot study of living kidney donor decision-making and outcomes. Clin Transplant 2007; 21:86-93. [PMID: 17302596 DOI: 10.1111/j.1399-0012.2006.00588.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In its recent report on organ donation, the Institute of Medicine has recommended rigorous studies of how living organ donors make the decision to donate. In this pilot study, 65 donor applicants were interviewed while being evaluated in the outpatient donor clinic and 20 were surveyed again three months after donation. Fifteen and six of these subjects were surveyed again in six and 12 months respectively. Several strategies for retaining donors in a prospective longitudinal study are discussed. Half of the donors indicated that the decision to donate was a shared family decision. Married donors were slightly more likely than non-married donors to involve another family member in this decision. Several donors made practical recommendations for improved education of donors during what many perceived to be a very lengthy evaluation process. Some subjects recommended more discussion about post-operative pain and the expected pace of recovery after discharge. Others spoke of the challenge of completing basic homemaking tasks when the donor and recipient were in the same nuclear family. We are continuing to explore these and other aspects of donor decision-making and outcomes and have expanded our sample to include non-donors in the post-evaluation period.
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Gres P, Avances C, Iborra F, Mourad G, Guiter J. Prélèvement rénal chez le donneur vivant : morbidité et suivi à long terme. Prog Urol 2007; 17:194-8. [PMID: 17489317 DOI: 10.1016/s1166-7087(07)92262-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the morbidity of living donor kidney harvesting and the long-term medical consequences and impact on quality of life (QoL). MATERIAL AND METHODS Retrospective analysis of medical and surgical data for 114 living kidney donors in a single teaching hospital between 1977 and 2005. Complications were evaluated in relation to the surgical approach and body mass index (BMI) using a Chi-square test or Fisher's exact test. Changes in renal function (serum creatinine, creatinine clearance), proteinuria and blood pressure (BP) were studied by Student's t test or a Mann-Whitney U or Wilcoxon nonparametric test. Long-term QoL was evaluated by the MOS SF-36 questionnaire and a local questionnaire and was then compared to that of the French general population. RESULTS The median follow-up was 63 months. The morbidity of kidney harvesting was significantly correlated with the surgical approach (p = 0.018) and a BMI > or = 25 kg/m2 (p = 0.014). No mortality was observed in this series. A moderate elevation of serum creatinine was observed during follow-up (mean serum creatinine increased from 82.2 micromol/l [+/- 16.3] to 104.5 micromol/l [+/- 19.9]), and mean creatinine clearance decreased from 113.4 ml/min [+/- 27.6] to 76 ml/min [+/- 29.9]. Little impact was observed on proteinuria and BP and QoL was not altered by kidney harvesting. CONCLUSION The perioperative complication rate is correlated with BMI and a flank incision. Kidney harvesting lowers glomerular filtration, but clearance remained stable during follow-up. Macroalbuminuria or hypertension may be observed, but their frequency is not higher than in the general population. The QoL of living donors is not altered. Clear information for the general public would allow promotion of living donor transplantation.
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Affiliation(s)
- Pascal Gres
- Service d'Urologie, Hôpital Lapeyronie, CHU de Montpellier, France.
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Clemens KK, Thiessen-Philbrook H, Parikh CR, Yang RC, Karley ML, Boudville N, Ramesh Prasad GV, Garg AX. Psychosocial health of living kidney donors: a systematic review. Am J Transplant 2006; 6:2965-77. [PMID: 17294524 DOI: 10.1111/j.1600-6143.2006.01567.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Knowledge of the psychosocial benefits and harms faced by living kidney donors is necessary for informed consent and follow-up. We reviewed any English language study where psychosocial function was assessed using questionnaires in 10 or more donors after nephrectomy. We searched MEDLINE, EMBASE, Web of Science, Psych INFO, Sociological Abstracts and CINAHL databases and reviewed reference lists from 1969 through July 2006. Independently, two reviewers abstracted data on study, donor and control group characteristics, psychosocial measurements and their outcomes. Fifty-one studies examined 5139 donors who were assessed an average of 4 years after nephrectomy. The majority experienced no depression (77-95%) or anxiety (86-94%), with questionnaire scores similar to controls. The majority reported no change or an improved relationship with their recipient (86-100%), spouse (82-98%), family members (83-100%) and nonrecipient children (95-100%). Some experienced an increase in self-esteem. A majority (83-93%) expressed no change in their attractiveness. Although many scored high on quality of life measures, some prospective studies described a decrease after donation. A small proportion of donors had adverse psychosocial outcomes. Most kidney donors experience no change or an improvement in their psychosocial health after donation. Harms may be minimized through careful selection and follow-up.
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Affiliation(s)
- K K Clemens
- Division of Nephrology, University of Western Ontario, London, Canada
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Sterner K, Zelikovsky N, Green C, Kaplan BS. Psychosocial evaluation of candidates for living related kidney donation. Pediatr Nephrol 2006; 21:1357-63. [PMID: 16807761 DOI: 10.1007/s00467-006-0177-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2006] [Revised: 03/16/2006] [Accepted: 03/20/2006] [Indexed: 11/25/2022]
Abstract
Living kidney donation has raised practical and ethical questions since renal transplantation became possible 50 years ago. Nevertheless, living donors are a common source for badly needed organs in the pediatric population. The safety and well being of the living donor are important concerns. Among the risks of living donation are those of a psychological and social nature. To protect these donor interests, psychosocial evaluations of donors are done at some transplant centers, but there is a lack of consistency regarding standardization of the evaluation, the content of the evaluation, and the role of the interviewer. Goals of the overall living donor evaluation for kidney transplantation at The Children's Hospital of Philadelphia, and the components of the psychosocial evaluation protocol in particular, are presented. The protocol's strengths are discussed, including the standardization of evaluations for all potential donors; the broad spectrum of psychosocial domains assessed; the psychometric measures administered; the systematic handling of negative results and some donors' desire to opt out; and the protection of confidentiality. Future directions with regard to long-term psychosocial outcomes and research protocols are discussed.
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Clarke KS, Klarenbach S, Vlaicu S, Yang RC, Garg AX. The direct and indirect economic costs incurred by living kidney donors-a systematic review. Nephrol Dial Transplant 2006; 21:1952-60. [PMID: 16554329 DOI: 10.1093/ndt/gfl069] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the many benefits of living donor kidney transplantation, economic consequences can result for donors. We reviewed studies which quantified the direct and indirect costs incurred by living kidney donors, in order to understand the strengths and limitations of existing literature. METHODS We identified relevant studies in MEDLINE, EMBASE and ECONOLIT bibliographic databases, in the Science Citation Index and study reference lists. Any study which reported at least one cost relevant to donors was included. The accuracy of abstracted data was verified by two reviewers and reported in year 2004 US dollars. RESULTS Thirty-five studies from 12 countries described costs incurred by individuals who donated between the years 1964 and 2003. No study comprehensively quantified all relevant expenses-the sum of select costs considered in one US study averaged Dollars 837 per donor and ranged from Dollars 0 to 28,906. Travel and/or accommodation costs were incurred by 9-99% of donors, and were higher in countries with a larger land mass. Post-discharge analgesics were required by 4-24% of donors, but prescription costs were not reported. Between 14 and 30% of donors incurred costs for lost income, with an average loss of Dollars 3386 in one study from the UK and Dollars 682 in another study from the Netherlands. Costs for dependent care were incurred by 9-44% of donors, while costs for domestic help were incurred by 8% of donors. CONCLUSIONS Donors incur many types of costs attributable to kidney donation and the total costs are certainly higher than previously reported. To guide informed consent and fair reimbursement policies, further data on all relevant costs, preferably from a detailed prospective multi-centre cohort study, are required.
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Waterman A, Stanley S, Covelli T, Hazel E, Hong B, Brennan D. Living donation decision making: recipients' concerns and educational needs. Prog Transplant 2006. [DOI: 10.7182/prtr.16.1.h8t81214751905lu] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
What is the value of a human face? It is a vexing question with no simple answer. The question, however, is no longer fanciful given the trajectory of biomedical science that simultaneously captures our imagination and challenges our essence. Essential to each of us and to the whole of humanity, the face is primal in its individuated image and identity. It is intrinsically connected with us in a way that defied question—until now, given the highly anticipated next step in transplant science and technology, facial transplantation. This Article examines the value of the face in this context, along with a range of related issues.The human face has rich significance. It is intrinsic and instrumental to the ontology of a person. A portal for emotions and expressions, the face reveals an inner-self essential to identity and is inscribed with an inherent dignity of human life.
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Affiliation(s)
- Rhonda Gay Hartman
- Center for Bioethics and Health Law, University of Pittsburgh School of Medicine, USA.
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Nolan MT, Walton-Moss B, Taylor L, Dane K. Living kidney donor decision making: state of the science and directions for future research. Prog Transplant 2004. [PMID: 15495779 DOI: 10.7182/prtr.14.3.440p7266x4524344] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Federal government and transplantation organizations have called for further study of living donation at a time when 3 new living donor protocols are being introduced throughout the United States that promise to significantly increase the donor pool and change the face of living donation. Donation to a once incompatible and sometimes unknown recipient may now occur through the use of plasmapheresis therapy or paired and nondirected living donor protocols. OBJECTIVE To describe the state of the science on living kidney donor decision making, and to provide recommendations for future research to guide donor education and care. DATA SOURCES Automated literature search using PubMed and CINAHL scientific literature databases. STUDY DATA EXTRACTION: Research papers on living donor decision making from 1997 to 2003. Studies available only as abstracts were excluded. DATA SYNTHESIS Studies of living kidney donor decision making and outcomes have been limited in scope, with small sample sizes and inconsistent reports of racial and ethnic characteristics of the sample. The retrospective nature of the majority of living donor studies is a significant limitation. CONCLUSIONS Future prospective studies that are diverse by sex, race, and ethnicity will contribute to our knowledge of factors that influence the decision to be a living kidney donor.
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Affiliation(s)
- Marie T Nolan
- Johns Hopkins University School of Nursing, Baltimore, Md, USA
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