Pain Experienced by Laparoscopic Donor Nephrectomy Patients in an Academic Medical Setting

Context

Since 1996, 414 laparoscopic live donor nephrectomy procedures have been completed at our institution. Although this procedure has gained acceptance within the past 5 years, little is known about its nursing implications.

Objective

The purpose of this performance improvement project was to identify pain management practices, satisfaction levels, and clinical outcomes among patients undergoing laparoscopic live donor nephrectomy.

Patients

Data were collected for a convenience sample of 70 patients for 18 months.

Intervention

Several pain management methods were used, including patient-controlled analgesia and intramuscular and oral medications.

Results

Pain ratings ranged from 3.2 to 3.8 for the first 36 hours postoperatively. The mean pain level did not differ significantly between pain regimes. At discharge, patients perceived a mean overall pain level of 5.0 but anticipated a pain level of 6.1. A significant negative correlation between satisfaction and pain rating also was noted.

Conclusions

Opportunities exist to standardize current regimens of pain medications and address pain level and treatment 24 hours postoperatively.

Living Donors' Perception of Their Quality of Health after Donation

To alleviate the long wait on the cadaveric transplant list, recipients are pursuing the option of living donation. Potential donors may have significant concerns about the decision to donate, including the quality of health after donation. This study identifies living donors' perception regarding their quality of health after donating a kidney, and identifies the perception of the adequacy of the medical follow-up after donation. In this retrospective study, the 36-Item Short Form Health Survey was mailed to all kidney donors at the transplant center from January 1995 to December 1998 (n = 118). The study population scored significantly better than the US sample population in all 8 categories of the questionnaire. When comparing scores using the relationship of the donor to the recipient, mean scores of donors who were “distant relatives” were found to be lower in 7 of the 8 categories. Most donors who had follow-up after donation felt it to be excellent to good; yet 50% stated they had no healthcare follow-up after donation. Themes were identified regarding the type of follow-up donors felt they needed after donation. Donors perceived their quality of health after donation as better than the general US population. Donor follow-up needs to be emphasized and followed more systematically.

Potential Living Kidney Donors' Health Education Use and Comfort with Donation

Context

Much living kidney donation research focuses on actual donors rather than all donors who are evaluated by the transplant center.

Objective

To determine (1) what concerns and benefits potential donors saw possible from donation, (2) how they educated themselves before contacting the transplant center, and (3) who were the most comfortable donors.

Design

A telephone survey of 91 potential donors before transplant evaluation.

Setting

Barnes-Jewish Hospital Transplant Center in St Louis, Mo.

Main Outcome Measures

Willingness and comfort donating, key concerns and perceived benefits to donation, hours of transplant-related education.

Results

On a 7-point scale, potential donors were very willing (mean=6.65, SD=0.95) and comfortable (mean=6.31, SD=1.12) donating. They were most concerned that their recipients would die if they could not donate, the evaluation and surgery would be anxiety provoking or painful, and they did not understand what donation would require. Donors previously spent an average of 6 hours reading health resources and 32 hours discussing donation. Using logistic regression, those donors with 0 to 4 concerns (odds ratio=7.1, 95% confidence interval [CI], 2.2–23.16), more than 5 benefits (odds ratio=3.7, 95% CI, 1.2–11.0), and who were family members (odds ratio=4.7, 95% CI, 1.4–15.8) were more likely to be extremely comfortable donating compared to others.

Conclusions

Before evaluation, most potential donors are willing to donate because they think that it is important to improve the health of a loved one. Their knowledge of donation varies and they need clear information about medical testing and support coping with any negative donation outcomes.

Optimal Transplant Education for Recipients to Increase Pursuit of Living Donation

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.