Symptoms of pain and depression in related marrow donors: changes after transplant

Depression, anxiety, and associated psychological outcomes in living organ transplant donors: A systematic review

With increasing demands for living organ donations, understanding the prevalence of depression and anxiety, which are the commonest psychiatric disorders in donors following organ transplantation, will serve to improve psychiatric care to safeguard donors' mental wellbeing. This descriptive systematic review examines all observational studies in English investigating prevalence of depression and anxiety in adult transplant donors using bibliographic databases. Sixty-two papers were included (kidney, n = 25; liver, n = 25; bone marrow, n = 7; uterus, n = 2; lung, n = 1; kidney and lung concurrently, n = 2). Post-transplantation depression and anxiety prevalence rates (Depression: 0-46.9%, Anxiety: 0-66.7%) did not differ significantly from pre-transplantation and were largely comparable to the general population. Other psychiatric disorders observed included bipolar disorder, conversion disorder, adjustment disorder and sleep disorder. Other psychological outcomes observed included lower quality of life, lower satisfaction of life and regret after donation. Pre-donation risk factors such as poor physical/psychological health status, and post-donation risk factors such as complicated post-surgical recovery and poor physical/psychological health in recipients were identified, predisposing donors to poor psychological outcomes. Individuals with risk factors should be monitored and provided with social support, psychoeducation, psychotherapy and long-term follow up. Future studies should adopt consistent methodological approaches to improve comparability between various studies. More research investigating poor psychological outcomes in other organ donors besides kidney and liver donors, donors who have past psychiatric history, unrelated and parent donors is warranted.

« Faire le deuil » en temps d’innovations thérapeutiques

Nous traitons la problématique du deuil dans le cadre de l’allogreffe de cellules souches hématopoïétiques à partir d’un donneur haplo-identique. L’analyse d’un cas clinique permet d’interroger l’application systématique des catégories du normal et du pathologique au deuil, la surmédicalisation des sujets endeuillés ainsi que l’injonction sociale à « faire son deuil », selon les modalités décrites par la nosographie psychiatrique. Les modalités d’accompagnement des donneurs endeuillés seront questionnées en réaffirmant la pertinence d’une clinique nourrie par une réflexion psychanalytique.

Experiences and unmet needs of family members requested to donate haematopoietic stem cells to an ill relative: findings from a prospective multi-centre study

BACKGROUND

Despite well-documented physical effects of haematopoietic stem cell (HSC) donation, far less attention has been focused on the psychosocial impact for family donors. This study aimed to better understand the psychosocial aspects of HSC donation by family members, focusing, in particular on their needs for information and supportive care.

METHODS

Thirty-one adult HSC family donors from two clinical hospitals were interviewed before, during and 1 month after HSC donation. Interviews explored ambivalence, motivation, perceived pressure, preparedness, the donor-recipient relationship, information and support received and suggestions for improvement.

RESULTS

Three main themes about the donation experience were identified: 'call to arms' (focused on the recipient, stressful urgency, making meaning of being a donor, decisional ambivalence), 'proceeding with donation' (living in limbo, unsettling uncertainty, pervasive pain, feeling supported) and 'after the dust settles' (feeling discarded, downplaying role, residual symptoms, dealing with adverse recipient outcomes). Underlying system and communication issues included time for consideration prior to donor work-up, management of confidentiality, information inadequacy and access to support. Donors wanted information about the emotional challenges specific to being a family donor, such as ways in which previous donors coped with recipient death. For donors whose recipient had died, the priority for improved care was follow-up support.

CONCLUSION

Our findings emphasise a gap in information and supportive care for family donors and the need for a protocol specifically designed to inform and support family donors before, during and after HSC donation.

Physical and Psychological Discomfort Experienced by Hematopoietic Stem-Cell Donors

This study investigates the types and degrees of physical and psychological discomfort experienced by hematopoietic stem cell donors before, during, and after the donation process in order to provide helpful information for developing education programs that can help donors to cope with their discomforts. One hundred and thirty-one individuals who donated hematopoietic stem cells from 2017 to 2019 were asked to self-report the types and degrees of physical and psychological discomfort they felt in the process, and the results were analyzed using SPSS. All participants donated peripheral blood stem cells; the most commonly reported physical discomfort was myalgia (72.5%), followed by bone pain (62.6%), fatigue (60.3%), and headache (55.0%). Of the donors, 88.5% responded that they experienced psychological discomforts, including fear (44.3%), anxiety (44.3%), stress (39.7%), depression (31.3%), loneliness (31.3%), regret (29.8%), and ambivalence (23.7%). In particular, female donors experienced more discomfort than males in rash (Z = -2.123, p = 0.034), fear (Z = -2.851, p = 0.004), and anxiety (Z = -1.861, p = 0.044). Therefore, it is necessary for healthcare providers and experts to make efforts to educate and help donors to prepare and mitigate their discomfort throughout the donation process, and to strategically manage donors' well-being by monitoring and evaluating their discomfort levels and providing interventions if necessary.

Hematopoietic cell transplant nurse coordinators' perceptions of related donor care: a European survey from the EBMT Nurses Group

Allogeneic haematopoietic cell transplantation (HCT) is a curative procedure for patients with haematological malignancies and immune deficiencies. A human leukocyte antigen (HLA) identical sibling is only available for 25-35% of patients in need. The improvement in haplo-identical transplantation has led to a marked increase in cell donation from relatives. Despite international recommendations, discrepancies in related-donors (RD) care exist between centres, particularly regarding medical suitability criteria, consenting procedures and donor follow-up. This European survey aimed to explore hematopoietic cell transplantation coordinators nurses' (HCT-CNs) perceptions of RD care, in particular the association with the presence or not of an independent unit (IU). Ninety-three HCT-CNs from seventy-six EBMT centres responded, representing 19 countries (response rate: 27%). Our results did not show a significant association between IU and HCT-CNs perceptions of related-donors care. The practices for RD care vary among centres regarding presence or not of an IU (48%), person caring for RD (haematologist in 54%, HCT physician in 17%, HCT-CNs in 20%), person to whom the results of HLA typing are communicated, use of a booklet for RD, follow-up or not and periodicity of follow-up. Qualitative data highlight the related-donation ethical issues and the need for improvement in RD care. HCT-CNs' main concerns were: the necessary confidentiality to insure the voluntary status of RD, the perceived conflict of interest felt by professionals when managing both patients and RD, plus the psychosocial aspects of related-donation. Even if there is a variety of a practice among centres, the presence of an IU is not significantly associated with an improvement in RD care.

Adult related haematopoietic stem cell donor care: Views of Transplant Nurses

PURPOSE

The objective of this mixed-methods study was to explore the experiences and perspectives of Transplant Nurses (TNs) in caring for related donors (RDs).

METHOD

In this mixed-methods study, both quantitative and qualitative data were collected from semi-structured interviews with seven TNs from two clinical hospitals. Closed and multiple-choice questions regarding the organisation of RD care were administered in addition to an in-depth exploration of TN experiences and perspectives of RD care. Interviews were audio-recorded, transcribed, and qualitative data was subjected to thematic analyses.

RESULTS

The analysis identified 5 themes relating to RD care: managing complex family dynamics and ambivalence; concerns about RD psychological adjustment; identifying and correcting RD misperceptions; limited guidelines and structured processes; limited training for the role and access to supervision. Five themes were identified describing the barriers to delivering RD care: RDs unwilling to express their concerns; language; time constraints; medical priority of clinicians; biomedical focus of TNs. All TNs agreed they would like additional training in the psychosocial management of RDs. TNs identified key areas for improvement, including psychosocial support and educational material.

CONCLUSIONS

Our results highlight the significant role of TNs in RD care, and underline issues specific to the current RD care environment. Lack of training for the role and limited guidelines addressing RD care management are key issues which may detrimentally affect RD care. The pivotal role of TNs must be acknowledged and supported by improving TN training and implementing clear guidelines for the management of RDs. The trial has been registered on the publicly accessible register: www.clinicaltrials.gov site with the identifier ACTRN12617000407392.

Adult-related haematopoietic stem cell donor experiences and the provision of information and psychosocial support: A systematic literature review

For blood cancer patients, haematopoietic stem cells (HSC) donated by a relative can be lifesaving. However, related donors can face significant physical and psychosocial challenges. As the demand for adult-related HSC donors is increasing, it is important to review our understanding of adult-related HSC donors' need for and availability of information and psychosocial support with a view to identifying gaps in the literature. A systematic review of relevant studies (2000-2017) was conducted using five databases with supplementary hand searching. Sixteen studies involving 1,024 related HSC donors met the following criteria: English or Dutch language, peer-reviewed, sampled first-time-related HSC donors, ≥18 years, haematological malignancies, assessed psychosocial aspects, retrospective or prospective and with or without comparison group. Data were abstracted, and study quality was assessed using the PRISMA criteria. Studies contained limited information on the provision of information and psychosocial support. Most studies addressed pre-donation information, and none reported providing information or support to donors post-donation. Additionally, few studies formally assessed unmet needs. Recommendations include improved transparency of reporting for the availability, sources and timing of information and psychosocial support, and the identification of unmet needs to enable the development of educational and psychosocial interventions for this invaluable donor population.

The influence of the donor-recipient relationship on related donor reactions to stem cell donation

Previous research has begun to delineate the complicated reactions experienced by bone marrow and stem cell donors. The purpose of this study was to examine the influence of the donor-recipient relationship on the related donor's emotional reactions. Twenty-eight adult stem cell donors completed questionnaires before donation, 30 days post stem cell infusion, and 1 year after infusion. Questionnaires addressed the donor-recipient relationship, depression, mood, guilt and responsibility, self-esteem, ambivalence about donation and reactions to the donation itself. Results indicated that most donors reported little ambivalence about donation, and their reactions to the donation itself were generally positive. Closer and more positive donor-recipient relationships were associated with less anticipated guilt and responsibility if the transplant did not work. The relationships between the donor and the recipient did not change over time. Mood disturbance and depression were low overall, not related to the donor-recipient relationship, and did not significantly change over time. These results indicate that related stem cell donors are generally without significant emotional distress, and are comfortable with the donation process. Further, a more positive relationship with the recipient may help donors to avoid feeling guilty and responsible if the transplant does not work.

Bone Marrow Donation from the Perspective of Sibling Donors

This study aimed to characterize the sociodemographic profile of sibling bone marrow donors and to describe how they perceive the donation. This was a descriptive, exploratory and longitudinal study. Participants were 20 related bone marrow donors, between 18 and 42 years of age (mean=30.5 years, sd=7.47). Interviews were held before and immediately after the donation. Sociodemographic data were subject to descriptive statistical analysis and qualitative data to categorical content analysis. In the interviews held before the donation, stressor events were the sibling’s disease and treatment and the responsibility of being the donors. During the interviews after the donation, the following were mentioned: anxiety on the day before and on the day of the donation, pain the following day, and acknowledgement of the health team’s support as a facilitator of the donation process. In view of the findings, it is important for the team to outline intervention strategies to meet to the donors’ specific needs.

Practice patterns for evaluation, consent, and care of related donors and recipients at hematopoietic cell transplantation centers in the United States

Conflict of interest may arise when 1 physician serves 2 persons whose medical care is interdependent. In hematopoietic cell transplantation (HCT) from unrelated donors and in the setting of solid organ transplantation from living donors, the standard of care is for donors and recipients to be managed by separate physicians to provide unbiased care. However, the practice patterns of evaluation and care of related donors and recipients are not well described. A survey of HCT centers in the United States was conducted by the Donor Health and Safety Working Committee of the Center for International Blood and Marrow Transplant Research to determine the type of provider involved in medical clearance, informed consent, and medical management of hematopoietic cell collection and the relationship of that provider to the HC transplant recipient. The response rate was 40%. In greater than 70% of centers, transplantation physicians were involved or potentially involved in overlapping care of the HC transplant donor and the recipient. These patterns were similar between transplantation teams caring for adult or pediatric donors and recipients. Among responding centers, medical management of recipients and their related donors by the same provider is common, a practice that has the potential for conflict of interest.

Repercussões psicológicas do transplante de medula óssea no doador relacionado

O desenvolvimento do transplante de medula óssea (TMO), nas últimas décadas, permitiu o tratamento de doenças que antes eram invariavelmente fatais. Dentre os tipos de transplante realizados, o alogênico exige a participação ativa de um membro familiar, em geral, o irmão, que arca com o encargo da doação. O objetivo do presente estudo é analisar as repercussões psicológicas dessa doação nos doadores relacionados. A amostra foi composta por dez doadores, vinculados à Unidade de TMO do HCFMRP-USP, avaliados antes e após a doação. Os instrumentos utilizados foram: roteiro de entrevista, escalas e técnicas projetivas. Os resultados demonstraram que o nível de ansiedade dos sujeitos se encontrava dentro do esperado, porém foram constatados sintomas de estresse. Afirmaram terem ficado ansiosos e relataram dor no momento pós-doação, mas acreditam que esta foi mais fácil do que imaginaram. Finalmente, em relação aos dados das técnicas projetivas, constatou-se uma alta suscetibilidade emocional, indícios de sugestionabilidade e dependência.