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Massey EK, Rule AD, Matas AJ. Living Kidney Donation: A Narrative Review of Mid- and Long-term Psychosocial Outcomes. Transplantation 2024:00007890-990000000-00794. [PMID: 38886889 DOI: 10.1097/tp.0000000000005094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Living kidney donors make a significant contribution to alleviating the organ shortage. The aim of this article is to provide an overview of mid- and long-term (≥12 mo) living donor psychosocial outcomes and highlight areas that have been understudied and should be immediately addressed in both research and clinical practice. We conducted a narrative review by searching 3 databases. A total of 206 articles were included. Living donors can be divided into those who donate to an emotionally or genetically related person, the so-called directed donors, or to an emotionally or genetically unrelated recipient, the so-called nondirected donors. The most commonly investigated (bio)psychosocial outcome after living donation was health-related quality of life. Other generic (bio)psychological outcomes include specific aspects of mental health such as depression, and fatigue and pain. Social outcomes include financial and employment burdens and problems with insurance. Donation-specific psychosocial outcomes include regret, satisfaction, feelings of abandonment and unmet needs, and benefits of living kidney donation. The experience of living donation is complex and multifaceted, reflected in the co-occurrence of both benefits and burden after donation. Noticeably, no interventions have been developed to improve mid- or long-term psychosocial outcomes among living donors. We highlight areas for methodological improvement and identified 3 areas requiring immediate attention from the transplant community in both research and clinical care: (1) recognizing and providing care for the minority of donors who have poorer long-term psychosocial outcomes after donation, (2) minimizing donation-related financial burden, and (3) studying interventions to minimize long-term psychosocial problems.
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Affiliation(s)
- Emma K Massey
- Erasmus Medical Center Transplant Institute, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam, Zuid Holland, the Netherlands
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Arthur J Matas
- Department of Surgery, Transplantation Division, University of Minnesota, Minneapolis, MN
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2
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Winterling J, Pahnke S, Lagnebjörk J, Hägglund H, Larfors G, Lenhoff S, Kisch AM. Worries and Psychological Well-Being in Potential Hematopoietic Stem Cell Donors Before Donation-A Swedish National Study. Transplant Proc 2023; 55:242-248. [PMID: 36528407 DOI: 10.1016/j.transproceed.2022.10.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 10/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The physical risks involved in donating hematopoietic stem cells have been thoroughly studied, but little is known about the psychological risks potential donors might face before donation. The aim of this study was to describe potential the pre-donation worries and psychological well-being of hematopoietic stem cell donors and investigate possible associations between donor characteristics and psychological well-being. METHODS In a cross-sectional, national cohort study, we describe pre-donation worries and psychological well-being and investigate possible associations between donor characteristics and psychological well-being. A questionnaire was sent to prospective adult hematopoietic stem cells donors. RESULTS The study included 210 participants, 47% of whom were related and 53% unrelated to the recipient. Of the participants, 39% reported great worry about the recipient and 12% great worry about themselves as potential donors. Symptoms of anxiety were expressed by 21%, whereas symptoms of depression were uncommon and perceived general mental health was slightly lower than in the Swedish population. Great worry about oneself, lower age, and female sex were related to increased anxiety and lower mental health. CONCLUSION This study highlighted that some potential donors report high levels of pre-donation worry and that greater worry about oneself, lower age, and female sex are associated with lower psychological well-being. Although further studies are needed to investigate this psychological risk over time, it is clear that some potential donors are particularly vulnerable.
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Affiliation(s)
- Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Medical unit HHLH, Comprehensive Cancer Centre, Karolinska University Hospital, Stockholm, Sweden.
| | - Simon Pahnke
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Johanna Lagnebjörk
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Hans Hägglund
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Gunnar Larfors
- Unit of Haematology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Stig Lenhoff
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Annika M Kisch
- Department of Haematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden; Institute of Health Sciences, Lund University, Sweden
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Wadden JJ, Hermiston J, Blydt-Hansen TD, Dhaliwal R, Gielen S, Virani A. Exploring the Ethical Considerations of Direct Contact in Pediatric Organ Transplantation: A Qualitative Study. AJOB Empir Bioeth 2022; 14:143-154. [PMID: 36574227 DOI: 10.1080/23294515.2022.2160513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Nonanonymized direct contact between organ recipients and donor families is a topic of international interest in the adult context. However, there is limited discussion about whether direct contact should be extended to pediatric settings due to clinician and researcher concerns of the potential harms to pediatric patients. METHODS We interviewed pediatric organ recipients, their families, and donorfamilies in British Columbia, Canada, to determine their views on direct contact. Interviews were conducted in two stages, with those who were further removed from the transplant process informing the approach to interviews with those who more recently went throughthe transplant process. RESULTS Twenty-nine individuals participated in twenty in-depth interviews. The study included participants from three major organ systems: kidney, heart, and liver. Only five participants expressed that direct contact might cause harm or discomfort, while twenty-three indicated they saw significant potential for benefits. Nearly half focused on the harms to others rather than themselves, and nearly two-thirds focused on the benefits for others rather than themselves. CONCLUSION There appears to be a community desire for direct contact in pediatric organ transplant programs among those living in British Columbia, Canada. These results suggest a need to revisit the medical community's assumptions around protection and paternalism in our practice as clinicians and researchers.
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Affiliation(s)
- Jordan Joseph Wadden
- Ethics Department, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Philosophy, University of British Columbia, Vancouver, BC, Canada
| | - Jordan Hermiston
- Family Services, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics (Nephrology), University of British Columbia, Vancouver, BC, Canada
- Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Ranjeet Dhaliwal
- Patient and Family Partner, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Shelby Gielen
- Patient and Family Partner, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Alice Virani
- Ethics Services, Provincial Health Services Authority, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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Shrestha P, Van Pilsum Rasmussen SE, Fazal M, Chu NM, Garonzik-Wang JM, Gordon EJ, McAdams-DeMarco M, Humbyrd CJ. Patient Perspectives on the Use of Frailty, Cognitive Function, and Age in Kidney Transplant Evaluation. AJOB Empir Bioeth 2022; 13:263-274. [PMID: 35802563 DOI: 10.1080/23294515.2022.2090460] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The allocation of scarce deceased donor kidneys is a complex process. Transplant providers are increasingly relying on constructs such as frailty and cognitive function to guide kidney transplant (KT) candidate selection. Patient views of the ethical issues surrounding the use of such constructs are unclear. We sought to assess KT candidates' attitudes and beliefs about the use of frailty and cognitive function to guide waitlist selection. METHODS KT candidates were randomly recruited from an ongoing single-center cohort study of frailty and cognitive function. Semi-structured interviews were conducted, and thematic analysis was performed. Inductively derived themes were mapped onto bioethics principles. RESULTS Twenty interviews were conducted (65% contact rate, 100% participation rate) (60% male; 70% White). With respect to the use of frailty and cognitive function in waitlisting decisions, four themes emerged in which participants: (1) valued maximizing a scarce resource (utility); (2) prioritized equal access to all patients (equity); (3) appreciated a proportional approach to the use of equity and utility (precautionary utility); and (4) sought to weigh utility- and equity-based concerns regarding social support. While some participants believed frailty and cognitive function were useful constructs to maximize utility, others believed their use would jeopardize equity. Patients were uncomfortable with using single factors such as frailty or cognitive impairment to deny someone access to transplantation; participants instead encouraged using the constructs to identify opportunities for intervention to improve frailty and cognitive function prior to KT. CONCLUSIONS KT candidates' values mirrored the current allocation strategy, seeking to balance equity and utility in a just manner, albeit with conflicting viewpoints on the appropriate use of frailty and cognitive impairment in waitlisting decisions.
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Affiliation(s)
- Prakriti Shrestha
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Maria Fazal
- Johns Hopkins, University School of Medicine, Baltimore, MD, USA
| | - Nadia M Chu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Elisa J Gordon
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Casey Jo Humbyrd
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
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5
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Influence of Self-Determination and Social Support on Post-Traumatic Growth among Living Kidney Donors: A Cross-Sectional Study. Medicina (B Aires) 2022; 58:medicina58091155. [PMID: 36143833 PMCID: PMC9502488 DOI: 10.3390/medicina58091155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/28/2022] Open
Abstract
Background and Objectives: Although many studies have reported that kidney donation is not physically harmful to living kidney donors, there are few studies on the psychological changes that they experience, especially post-traumatic growth. This study aimed to investigate the influence of self-determination and social support on post-traumatic growth among living kidney donors. Materials and Methods: This study used a descriptive, cross-sectional design. Data were collected from 114 living kidney donors who visited the outpatient solid organ transplant center at Seoul National University Hospital. The data were analyzed using the t-test, one-way analysis of variance, and stepwise multiple regression. Results: The results showed that the mean for post-traumatic growth of living kidney donors was 4.24 (0.81), a level higher than the midpoint. The factors affecting total post-traumatic growth were the relatedness of self-determination, the social support of their significant other, and donor type. In particular, the relatedness of self-determination was a significant factor affecting changed perceptions of self, relating to others, and spiritual change, subscales of post-traumatic growth. Additionally, the social support of donors’ significant others was a significant factor affecting relating to others and new possibilities, subscales of post-traumatic growth. Conclusions: Healthcare providers should endeavor to help living kidney donors experience post-traumatic growth, which can be facilitated by improving their self-determination and social support.
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Wong D, Adjei-Bosompem T, Maxwell L, Melendez-Suarez J, Smith B, Boutin-Foster C. Factors influencing decision making for kidney transplantation among Black and Latino patients on dialysis: A qualitative study applying the social ecological model. Chronic Illn 2022; 18:286-294. [PMID: 32972238 DOI: 10.1177/1742395320959411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This qualitative study explored factors that may influence decisions regarding kidney transplantation among African-American and Latino adults on dialysis. METHODS Qualitative interviews were audio-recorded and transcribed. Open-coding techniques were used to identify concepts, categories, and themes. The Social Ecological Model (SEM) was used to organize themes and identify potential solutions across multiple levels (individual, interpersonal, community, and policy/health system). RESULTS Thirty-six patients were interviewed. Their mean age was 53 SD 12 years; 50% were female; and their duration on dialysis was 4.9 SD 6 years. Five themes emerged and were organized according to the levels of the SEM: 1) Fear about the outcomes of transplantation and 2) faith in God (individual level); 3) Family dynamics and reluctance to involve family in the decision making process (interpersonal level); 4) The experiences of friends and social networks (community level); and 5) Concerns about the social and economic impact of transplantation (policy and health system). DISCUSSION The application of a Social Ecological model in this study helped to illuminate the complex and multilevel factors that may influence the decisions for kidney transplantation. Future studies are needed to further explore how family members, social networks, faith communities, and policies/health systems influence the decision making process.
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Affiliation(s)
- Diandra Wong
- SUNY Downstate Health Sciences University, State University of New York, Brooklyn, USA
| | - Tina Adjei-Bosompem
- SUNY Downstate Health Sciences University, State University of New York, Brooklyn, USA
| | - Lakia Maxwell
- SUNY Downstate Health Sciences University, State University of New York, Brooklyn, USA
| | | | | | - Carla Boutin-Foster
- SUNY Downstate Health Sciences University, State University of New York, Brooklyn, USA
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Mamode N, Van Assche K, Burnapp L, Courtney A, van Dellen D, Houthoff M, Maple H, Moorlock G, Dor FJMF, Lennerling A. Donor Autonomy and Self-Sacrifice in Living Organ Donation: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View. Transpl Int 2022; 35:10131. [PMID: 35387400 PMCID: PMC8979023 DOI: 10.3389/ti.2022.10131] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
Clinical teams understandably wish to minimise risks to living kidney donors undergoing surgery, but are often faced with uncertainty about the extent of risk, or donors who wish to proceed despite those risks. Here we explore how these difficult decisions may be approached and consider the conflicts between autonomy and paternalism, the place of self-sacrifice and consideration of risks and benefits. Donor autonomy should be considered as in the context of the depth and strength of feeling, understanding risk and competing influences. Discussion of risks could be improved by using absolute risk, supra-regional MDMs and including the risks to the clinical team as well as the donor. The psychological effects on the donor of poor outcomes for the untransplanted recipient should also be taken into account. There is a lack of detailed data on the risks to the donor who has significant co-morbidities.
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Affiliation(s)
- Nizam Mamode
- Department of Transplantation, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
- *Correspondence: Nizam Mamode,
| | - Kristof Van Assche
- Research Group Personal Rights and Property Rights, University of Antwerp, Antwerp, Belgium
| | - Lisa Burnapp
- Department of Transplantation, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Aisling Courtney
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, United Kingdom
| | - David van Dellen
- Department of Renal and Pancreas Transplantation, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Mireille Houthoff
- Erasmus MC Transplant Institute, Department of Internal Medicine, University Medical Centre, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Hannah Maple
- Department of Transplantation, Guys and St Thomas NHS Foundation Trust, London, United Kingdom
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Woldemichael A, Berhanu E, Fritsch C, Satarino C, Demisse A. Psychological Well-Being of Living Kidney Donors and Recipients. EXP CLIN TRANSPLANT 2021; 19:779-787. [PMID: 34269647 DOI: 10.6002/ect.2020.0423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Previous research has indicated that kidney transplantation is associated with longer and better quality of life and can also have psychological impacts to both recipients and living donors. This study aimed to examine the psychological well-being of kidney transplant recipients and living donors in the first Ethiopian kidney transplant program using a psychological well-being framework developed by Ryff. MATERIALS AND METHODS All 82 kidney recipients and living donors who underwent medical screening for transplantation or living donation at the St. Paul's Hospital Millennium Medical Transplant Center between the establishment of the Center (September 2015)and the data collection end date (December 2018) were selected using medical records. Seventyfive recipients and 64 donors participated in the study. This study used a cross-sectional study design. Demographic questionnaires and Ryff's 84-item psychological well-being assessment were used. Collected data were analyzed through frequency, percentages, means, t tests, and analyses of variance. RESULTS Approximately 83% of study recipients scored in the upper 3 quartiles for composite psychological well-being scores, and 50% of study donors scored in the middle 2 quartiles for composite psychological well-being scores, with roughly 20% in the highest quartile. We found no significant mean difference between recipient and donor subscales, excluding the Personal Growth Subscale, which showed a significant mean difference between recipients (mean [SD] of 69.01[8.39]) and donors (mean [SD] of 65.89 [8.84]). This study revealed no significant psychological mean differences between kidney recipients and donors regarding the demographic characteristics of sex, age, marital status, and education. CONCLUSIONS Our single-center study cohort of kidney transplant recipients and living donors revealed overall psychological well-being scores similar to established transplant centers in other countries. Psychological well-being subscore data can provide meaningful information about the experiences of recipients and donors.
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Affiliation(s)
- Abel Woldemichael
- From the St. Paul's Hospital Millennium Medical College, Department of Psychiatry, Addis Ababa, Ethiopia
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Ordin YS, Karayurt Ö, Aksu Kul G, Kılıç M, Taylor LA. Exploration Into Donor-Recipient Relationship After Living-Donor Liver Transplantation Using Gift-Exchange Theory. Florence Nightingale Hemsire Derg 2021; 29:150-157. [PMID: 34263233 PMCID: PMC8245026 DOI: 10.5152/fnjn.2021.20065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/08/2021] [Indexed: 11/22/2022] Open
Abstract
AIM This qualitative study aimed to explore the donor-recipient relationships following living-donor liver transplantation. METHOD A 1-time cross-sectional qualitative interview was conducted with liver transplant recipients (n = 17) and living liver donors (n = 11) post-transplant. The interviews were transcribed verbatim and analyzed manually by using thematic content analysis. RESULTS The mean age of the recipients and the donors was 54.41 ± 8.0 (range 39-71) and 36.6 ± 7.69 (range 28-57) years, respectively. Following the interviews, 2 overarching themes emerged: (1) Became care providers, and (2) differentiation in relationships after transplantation. A total of 3 sub-themes were explained under "differentiation in relationships after transplantation;" feeling guilty, becoming closer and more intense owing to a feeling of indebtedness, and putting some distance owing to a feeling of indebtedness. CONCLUSION The study focused on the reciprocation stage according to gift-exchange theory. During reciprocation, although recipients expressed positive feelings such as gratitude, closer relationships, and special bonds; they also reported negative feelings like guilt and indebtedness resulting in a purposeful distancing from their donors. Most donors understood what the recipients felt, but they wanted their relationship to return to normal. Married female donors had worse experiences, such as divorce or a weakened marital relationship after donation.
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Affiliation(s)
- Yaprak Sarıgöl Ordin
- Department of Surgical Nursing, Dokuz Eylül University, Faculty of Nursing, İzmir, Turkey
| | - Özgül Karayurt
- Department of Nursing, İzmir University of Economics, Faculty of Health Science, İzmir, Turkey
| | - Gülay Aksu Kul
- Department of Nursing, İzmir University of Economics, Faculty of Health Science, İzmir, Turkey
| | - Murat Kılıç
- Department of Nursing, İzmir University of Economics, Faculty of Health Science, İzmir, Turkey
| | - Laura A Taylor
- Adult Gerontology Clinical Nurse Specialist Program, Uniformed Services University of Health Sciences Daniel K. Inouye Graduate School of Nursing, Bethesda, USA
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The Tangible Benefits of Living Donation: Results of a Qualitative Study of Living Kidney Donors. Transplant Direct 2020; 6:e626. [PMID: 33204824 PMCID: PMC7665258 DOI: 10.1097/txd.0000000000001068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/03/2020] [Accepted: 08/18/2020] [Indexed: 11/25/2022] Open
Abstract
The framework currently used for living kidney donor selection is based on estimation of acceptable donor risk, under the premise that benefits are only experienced by the recipient. However, some interdependent donors might experience tangible benefits from donation that cannot be considered in the current framework (ie, benefits experienced directly by the donor that improve their daily life, well-being, or livelihood).
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Rota-Musoll L, Subirana-Casacuberta M, Oriol-Vila E, Homs-Del Valle M, Molina-Robles E, Brigidi S. The experience of donating and receiving a kidney: A systematic review of qualitative studies. J Ren Care 2020; 46:169-184. [PMID: 31868304 DOI: 10.1111/jorc.12309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND The experiences described by people who have undergone kidney transplant are complex. Understanding how donors and recipients experience kidney transplantation can help us to design strategies that provide a more person-centred health care. OBJECTIVES To review articles that report the experiences of donors and recipients in the living-donor kidney transplantation process. METHOD A systematic review of qualitative studies was carried out. PubMed, Scopus, Web of Science, CINAHL and PsycINFO databases were used to search for articles published in English, French and Spanish between 2005 and 2018. RESULTS Twenty-nine articles were included in this review. For recipients, receiving a kidney is a positive experience (positive feelings and significant experience) that also involves certain difficulties and stressors (making a difficult decision, fears and worries). The experience of the donors is positive as they are motivated to improve the life of the recipient. They are committed to donating and use coping strategies as well as experiencing personal growth. On the contrary, being a donor involves certain difficulties and stressors (personal investment, mental, physical and economic impact and overcoming opposition) and a perception of deficiency in the health system (lack of information and attentiveness). CONCLUSION Donating and receiving a kidney is a positive experience that involves certain difficulties and a variety of stressors for both the donors and recipients. Moreover, the donors note deficiencies in the health system.
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Affiliation(s)
- Laura Rota-Musoll
- Consorci Hospitalari de Vic, Nephrology, Vic, Barcelona, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Mireia Subirana-Casacuberta
- Department of Nursing Management, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Ester Oriol-Vila
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
| | | | - Esmeralda Molina-Robles
- Department of Nephrology, Consorci Hospitalari de Vic, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
| | - Serena Brigidi
- Faculty of Health Science and Welfare, Universitat de Vic-Universitat Central de Catalunya, Vic, Catalunya, Spain
- Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Science and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain
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12
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Li L, Yang L, Dong C, Yang Q, Huang W, Liao T, Sun X. Psychosocial Assessment of Donors in Pediatric Living Donor Liver Transplantation: A Systematic Review. Transplant Proc 2020; 53:3-15. [PMID: 32631582 DOI: 10.1016/j.transproceed.2020.02.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 01/22/2020] [Accepted: 02/09/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Pediatric living donor liver transplantation (LDLT) is the only way to save children with end-stage liver disease. The donor for liver transplantation (LT) may have a complicated psychosocial condition. PURPOSE This review aims to identify the domains of the donor psychosocial questions that should be addressed and summarize the aspects and tools future psychosocial assessments should include. METHODS We searched the PubMed, Medline, Cochrane Library, Embase, Web of Science, and Google Scholar databases for the terms pediatric, liver transplantation, donor, and psychosocial. We used the Joanna Briggs Institute Critical Appraisal Tool to appraise reporting quality. Two researchers independently selected the papers and performed data extraction and quality appraisal. RESULTS The articles included in this review contain 26 quantitative studies and 2 qualitative studies. The study quality was moderate to high. Donors have ambivalence, anxiety, the need for family and social support, the need for adequate information, distress, and low self-esteem during the preoperative period. In the postoperative period they have poor psychological condition, panic disorder, conversion disorder and substance use/abuse disorder, abnormal family functioning, better psychosocial outcome, or among others. The assessment methods consisted of the questionnaire survey and semi-structured interview. Among the 28 studies, 17 different psychosocial domains were mentioned. The most frequently referred to was family and social support. CONCLUSION The contents of the psychosocial assessment must include anxiety or depression, family and social support, ambivalence, information, and positive psychosocial characteristics. Assessment methods should use the questionnaire survey and semi-structured interview. According to this review, future research can develop a specific psychosocial assessment tool for pediatric LT donors.
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Affiliation(s)
- Lin Li
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Li Yang
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China.
| | - Chunqiang Dong
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Qiaoling Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Weijia Huang
- Department of Health Management, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Tingting Liao
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
| | - Xihui Sun
- Department of Nursing, The First Affiliated Hospital of Guangxi Medical University, Guangxi Zhuang Autonomous Region, China
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14
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Al Breizat AH, Abunaser MT, Al Breizat Z. Living Donors: Altruism and Feeling Forgotten. EXP CLIN TRANSPLANT 2020; 18:22-28. [PMID: 32008488 DOI: 10.6002/ect.tond-tdtd2019.l25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Living donors endure several challenges throughout the organ donation process. Physically related effects are further compounded by social and emotional challenges. To date, no previous studies have addressed the motives and impact of organ donations from living donors in Jordan. MATERIALS AND METHODS We conducted a qualitative exploratory study to understand the experiences of a random sample of genetically and legally related living donors in Jordan. Participants were identified through the Directorate of the Jordanian Center for Organ Transplantation database. Our sample included Jordanians and non-Jordanians who donated a kidney or liver. Most data were collected by phone interviews with living donors; some donors were personally interviewed. Donors were asked about their experiences during the periods before and after the process of donation, including their feelings, emotions, and motives. Interviews were analyzed using the thematic analysis approach. RESULTS In total, 360 participants (337 kidney and 23 liver donors; 290 Jordanians and 70 non-Jordanians) completed the interview. The time from donation to interview ranged from 14 days to 7 years. The period before donation was characterized by fear and confusion. After donation, most donors described a positive emotional state that was marked by selfsatisfaction, pride, and increased support of organ donation. However, many stated that they felt forgotten. Most donors were motivated by social solidarity, and others invoked the role of their religious beliefs as the main motive. Other motives included improving the recipient's life and fear that patients would be abandoned. CONCLUSIONS The emotional distress of living donors during the predonation period emphasizes the need for social and psychological support in addition to medical evaluations. Donors who had positive experiences with donation can play a role in advocating for donation. Finally, in Jordan, social solidarity and religious beliefs are the most important factors that motivate donation.
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Affiliation(s)
- Abdel-Hadi Al Breizat
- From the Jordanian Ministry of Health, Jordanian Centre of Organ Transplantation, General and HPB Surgery
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Guignard VV, Fortin MC. Emerging Ethical Challenges in Living Kidney Donation. CURRENT TRANSPLANTATION REPORTS 2019. [DOI: 10.1007/s40472-019-00241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Heru A. Should narrative coherence be considered in the assessment of motivation in the non-directed kidney donation? Gen Hosp Psychiatry 2018; 55:1-3. [PMID: 30153558 DOI: 10.1016/j.genhosppsych.2018.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 08/07/2018] [Accepted: 08/08/2018] [Indexed: 11/17/2022]
Abstract
Donating a kidney to a stranger is known as a Good Samaritan, altruistic, or non-directed donation. Living donation is the only instance in medicine where the "do-no-harm" dictum is intentionally violated. Healthcare professionals 'doing the harm' are ethically responsible to ensure the lowest risk for both the physical and psychological health of the potential donor. To this end, experts in the transplant community published Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States [1]. These Guidelines focus on the identification of risk and protective factors, and basic principles underlying informed consent and outlined a recommended process for donor evaluation. The components of the evaluation include a comprehensive history and current status, capacity to consent, psychological status, relationship to recipient, motivation, donor knowledge and understanding, social support, and financial suitability. The case of a donor, Ms. Angelo, is presented because her responses during evaluation raised questions about how best to understand her motivation. My proposal is that altruism and motivation are best understood by considering the narrative coherence in the donor's story.
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Affiliation(s)
- Alison Heru
- Department of Psychiatry, University of Colorado Hospital, University of Colorado School of Medicine, 13001 East 17th Place Room 2317, Aurora, Colorado 80045, United States..
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