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Berg T, Aehling NF, Bruns T, Welker MW, Weismüller T, Trebicka J, Tacke F, Strnad P, Sterneck M, Settmacher U, Seehofer D, Schott E, Schnitzbauer AA, Schmidt HH, Schlitt HJ, Pratschke J, Pascher A, Neumann U, Manekeller S, Lammert F, Klein I, Kirchner G, Guba M, Glanemann M, Engelmann C, Canbay AE, Braun F, Berg CP, Bechstein WO, Becker T, Trautwein C. S2k-Leitlinie Lebertransplantation der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) und der Deutschen Gesellschaft für Allgemein- und Viszeralchirurgie (DGAV). ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1397-1573. [PMID: 39250961 DOI: 10.1055/a-2255-7246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Affiliation(s)
- Thomas Berg
- Bereich Hepatologie, Medizinischen Klinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Niklas F Aehling
- Bereich Hepatologie, Medizinischen Klinik II, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Tony Bruns
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Martin-Walter Welker
- Medizinische Klinik I Gastroent., Hepat., Pneum., Endokrin. Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Tobias Weismüller
- Klinik für Innere Medizin - Gastroenterologie und Hepatologie, Vivantes Humboldt-Klinikum, Berlin, Deutschland
| | - Jonel Trebicka
- Medizinische Klinik B für Gastroenterologie und Hepatologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Frank Tacke
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Berlin, Deutschland
| | - Pavel Strnad
- Medizinische Klinik III, Universitätsklinikum Aachen, Aachen, Deutschland
| | - Martina Sterneck
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Hamburg, Hamburg, Deutschland
| | - Utz Settmacher
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Universitätsklinikum Jena, Jena, Deutschland
| | - Daniel Seehofer
- Klinik für Viszeral-, Transplantations-, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Eckart Schott
- Klinik für Innere Medizin II - Gastroenterologie, Hepatologie und Diabetolgie, Helios Klinikum Emil von Behring, Berlin, Deutschland
| | | | - Hartmut H Schmidt
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Essen, Essen, Deutschland
| | - Hans J Schlitt
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Johann Pratschke
- Chirurgische Klinik, Charité Campus Virchow-Klinikum - Universitätsmedizin Berlin, Berlin, Deutschland
| | - Andreas Pascher
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Deutschland
| | - Ulf Neumann
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Essen, Deutschland
| | - Steffen Manekeller
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Frank Lammert
- Medizinische Hochschule Hannover (MHH), Hannover, Deutschland
| | - Ingo Klein
- Chirurgische Klinik I, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - Gabriele Kirchner
- Klinik und Poliklinik für Chirurgie, Universitätsklinikum Regensburg und Innere Medizin I, Caritaskrankenhaus St. Josef Regensburg, Regensburg, Deutschland
| | - Markus Guba
- Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, Universitätsklinikum München, München, Deutschland
| | - Matthias Glanemann
- Klinik für Allgemeine, Viszeral-, Gefäß- und Kinderchirurgie, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - Cornelius Engelmann
- Charité - Universitätsmedizin Berlin, Medizinische Klinik m. S. Hepatologie und Gastroenterologie, Campus Virchow-Klinikum (CVK) und Campus Charité Mitte (CCM), Berlin, Deutschland
| | - Ali E Canbay
- Medizinische Klinik, Universitätsklinikum Knappschaftskrankenhaus Bochum, Bochum, Deutschland
| | - Felix Braun
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schlewswig-Holstein, Kiel, Deutschland
| | - Christoph P Berg
- Innere Medizin I Gastroenterologie, Hepatologie, Infektiologie, Universitätsklinikum Tübingen, Tübingen, Deutschland
| | - Wolf O Bechstein
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - Thomas Becker
- Klinik für Allgemeine Chirurgie, Viszeral-, Thorax-, Transplantations- und Kinderchirurgie, Universitätsklinikum Schlewswig-Holstein, Kiel, Deutschland
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Ashkenazi T, Cohen J, Gelman D, Katvan E. The psychological examination and evaluation of unrelated kidney donors in Israel: a suggested model. PSYCHOL HEALTH MED 2023; 28:629-639. [PMID: 36124360 DOI: 10.1080/13548506.2022.2119265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Altruistic organ donors represent a special population when compared to related living donors, requiring appropriate protection and attention regarding informed consent and psychological aspects related to the donation. Following the introduction of the Israeli Transplant Law of 2008, a retrospective study of altruistic donor files revealed that important psycho-diagnostic aspects were not emphasized in the existing guidelines. Thus, a new tool was formulated which incorporated those elements, including assessment of emotional maturity, ego strength, degree of interest in others, reality testing, degree of pressure to donate, anxiety, dysphoric and depressive factors and the ability to function under stress. The study examined 598 cases reviewed by the Central Evaluation Board over the period May 2008 - June 2016. Overall, 23.4% candidates were disqualified of whom 41% were declined on grounds related to mental health. Most of the donors were rejected based on 3-5 elements. Of these, a deficient assessment of reality in ambiguous situations, lack of emotional maturity, and lacking or partial ability to function effectively under stress, were most commonly cited as reasons for rejection. This model allowed the detection of important conditions previously not incorporated into existing guidelines and may serve as a model for other transplantation programs worldwide.
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Affiliation(s)
- Tamar Ashkenazi
- Israel National Transplantation Center, Israel Ministry of Health, Tel Aviv, Israel
| | - Jonathan Cohen
- Israel National Transplantation Center, Israel Ministry of Health, Tel Aviv, Israel
| | - Daniel Gelman
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Eyal Katvan
- Bar-Ilan University and Peres Academic Center, Rehovot, Israel
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3
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Psychosocial and Ethical Behaviors and Attitudes of Health Care Professionals in the Clinical Setting of Living Kidney Donors: A Qualitative Study. Transplant Proc 2022; 54:1750-1758. [PMID: 35985877 DOI: 10.1016/j.transproceed.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are several psychosocial and ethical issues surrounding the decision making of living kidney transplant donors. This study aimed to determine what health care professionals (HPs) consider in their clinical practice and their attitudes toward donors' decision-making processes. METHODS Face-to-face semistructured interviews were conducted with 15 HPs. A thematic analysis was performed to categorize the thematic elements of the transcripts. All procedures were approved by the relevant review board and conducted in accordance with the Declaration of Helsinki. RESULTS Six main categories-maintaining family relationships, improving donor understanding, supporting voluntary decision making, setting the environment for the examination, having different attitudes toward the donor's intentions, and resisting confirmation of intent-were identified. The HPs provided diverse considerations to respect the donors' autonomy. CONCLUSION In clinical practice, there is a lack of practical methods to confirm living donors' levels of understanding and spontaneity, suggesting that these methods need to be established. Factors related to family functioning may reflect the unique culture of Japan, and this may be indicative of the need to consider treatment based on cultural values.
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The Transplant Trolley Problem. Camb Q Healthc Ethics 2022; 31:281-284. [PMID: 35899539 DOI: 10.1017/s0963180121000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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5
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Ghobrial P, Akkina S, Anderson EE. Risks to Relationships in Kidney Transplant Research with Living Donors and Recipients. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2021; 21:110-112. [PMID: 33825649 DOI: 10.1080/15265161.2021.1891330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - Sanjeev Akkina
- Loyola University of Chicago, Stritch School of Medicine
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6
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Organ donation in the US and Europe: The supply vs demand imbalance. Transplant Rev (Orlando) 2020; 35:100585. [PMID: 33071161 DOI: 10.1016/j.trre.2020.100585] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
Organ donation and transplantation remain the best and most cost-effective clinical solution for end-stage organ failure. Several agencies across the US and Europe provide legislative, regulatory, and humanitarian services to generate smoother applications in all transplantation processes and donor-recipient relationships. US and European statistics present nine types of grafts, with kidneys being the most transplanted organ worldwide. However, organ shortage, religion, underrepresented minority groups, difficulties in obtaining consent, lack of understanding, and general ethical concerns present challenging barriers to organ donation, reflecting the complexity of graft procurement and allocation. Breaking down these barriers to reduce the organ-supply imbalance requires an appropriate multifaceted approach. Some of the key areas include increasing the potential donor pool and consent rates, apt organ allocation, and improving organ health. Additionally, suitable policies and standardized guidelines for both donors and recipients, alongside educational initiatives, are needed to ensure patient safety and global awareness. Looking forward, novel and effective research plans and initiatives are needed if we are to avoid a colossal supply-demand gap.
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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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Leal-Costa C, Ramos-Morcillo AJ, Martínez Zaragoza F, Bernabeu Juan P, Rodríguez-Marín J, Ruzafa-Martínez M, van-der Hofstadt Román CJ. Personality and psychopathology in potential live kidney donors: A cluster analysis of personality features. PLoS One 2019; 14:e0221222. [PMID: 31412089 PMCID: PMC6693753 DOI: 10.1371/journal.pone.0221222] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background The previous psychosocial evaluation of the potential living kidney donors (PLKD) requires a detailed understanding of the psychosocial benefits and the possible damages of the act of donation. Objective The aim was to create clusters by using the clinical patterns of personality and to evaluate their influence on psychopathological variables. Methods Observational, analytical and cross-sectional study that included the PLKD from February 2009 to March 2017. The patients were referred to the Hospital Psychology Unit by the Transplant Coordination Unit. The total sample was composed of 100 participants. The socio-demographic characteristics, the relationship with the recipient and the Millon Clinical Multiaxial Inventory were included. Results The final sample was composed by 100 PLKD. The mean age of the participants was 45.70, and most were women (70%). The analysis showed a final result of 3 personality clusters that best represented the data, in agreement with the DSM-5 classification. The PLKD from cluster 3 obtained greater scores in all the clinical syndromes. Conclusions The personality evaluation of the PLKD could help with the planning of monitoring protocols of the participants who were classified to cluster 3, in order to improve their post-transplant psychosocial adjustment. This result makes us consider the usefulness of the psychosocial evaluation to preserve the psychological health of the PLKD.
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Affiliation(s)
- César Leal-Costa
- Nursing Department, Faculty of Nursing, University of Murcia, Murcia, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL—Fundación FISABIO), Alicante, Spain
| | | | | | | | - Jesús Rodríguez-Marín
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL—Fundación FISABIO), Alicante, Spain
- Health Psychology Department, Miguel Hernandez University (UMH), Elche, Spain
- Hospital Psychology Unit, University Hospital of Alicante, Alicante, Spain
| | | | - Carlos Javier van-der Hofstadt Román
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL—Fundación FISABIO), Alicante, Spain
- Health Psychology Department, Miguel Hernandez University (UMH), Elche, Spain
- Hospital Psychology Unit, University Hospital of Alicante, Alicante, Spain
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Kook YWA, Shenoy A, Hunt J, Desrosiers F, Gordon-Elliott JS, Jowsey-Gregoire S, Trompeta JA, Vandrovec M, Weinberg S, Fan W, LaPointe Rudow D. Multicenter investigation of the reliability and validity of the live donor assessment tool as an enhancement to the psychosocial evaluation of living donors. Am J Transplant 2019; 19:1119-1128. [PMID: 30414243 DOI: 10.1111/ajt.15170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/15/2018] [Accepted: 10/21/2018] [Indexed: 01/25/2023]
Abstract
The live donor assessment tool (LDAT) is the first psychosocial assessment tool developed to standardize live donor psychosocial evaluations. A multicenter study was conducted to explore reliability and validity of the LDAT and determine its ability to enhance the psychosocial evaluation beyond its center of origin. Four transplant programs participated, each with their own team of evaluators and unique demographics. Liver and kidney living donors (LDs) undergoing both standard psychosocial evaluation and LDAT from June 2015 to September 2016 were studied. LDAT interrater reliability, associations between LDAT scores and psychosocial evaluation outcome, and psychosocial outcomes postdonation were tested. 386 LD evaluations were compared and had a mean LDAT score of 67.34 ± 7.57. In 140 LDs with two LDATs by different observers, the interrater scores correlated (r = 0.63). LDAT scores at each center and overall stratified to the conventional grouping of psychosocial risk level. LDAT scores of 131 subjects who proceeded with donation were expectedly lower in LDs requiring postdonation counseling (t = -2.78, P = .01). The LDAT had good reliability between raters and predicted outcome of the psychosocial evaluation across centers. It can be used to standardize language among clinicians to communicate psychosocial risk of LD candidates and assist teams when anticipating postdonation psychosocial needs.
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Affiliation(s)
- Yoon Won Amy Kook
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Akhil Shenoy
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Farrah Desrosiers
- New York-Presbyterian/Weill Cornell Medical College, New York, New York
| | | | - Sheila Jowsey-Gregoire
- William J. Von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, Minnesota
| | - Joyce A Trompeta
- University of California (UCSF), San Francisco, San Francisco, California
| | - Margo Vandrovec
- William J. Von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, Minnesota
| | - Sandra Weinberg
- University of California (UCSF), San Francisco, San Francisco, California
| | - Weijia Fan
- Columbia University Mailman School of Public Health, New York, New York
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Hambro Alnæs A. Supplementing living kidney transplantees' medical records with donor- and recipient-narratives. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2018; 21:489-505. [PMID: 29332204 DOI: 10.1007/s11019-017-9822-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Norway provides total social welfare coverage for organ transplantations, including free immunosuppressive medication and prepaid life-long follow up for both recipients and donors. Despite these benefits the proportion of living kidney donors (LKD) has in recent years declined from around 40% (2011) of all kidney transplantations to 24% (2016). This study suggests harnessing patient- and donor-narratives as a tool for addressing the current fall in donation rates. The hospital records of 18 recipient/donor dyads were compared with patient and donor accounts elicited in semi-structured interviews. Narratives afford a pertinent supplement to the primarily biomedical and technical information stored in medical records. Even in condensed form, the messages embedded in narratives contribute to a 'thicker' understanding of the complexity of living kidney donation (LKD)-decisions. Narratives represent a source of education for referring-nephrologists wishing to deepen their evaluation skills and avoid making decisions based on insufficient insight into patients' and potential donors' values and life-situation. Recipients' and donors' unedited accounts of their motivations, worries, doubts and expectations afford a revealing and edifying supplement to the primarily biomedical and technical information stored in medical records. In narratives, the predicaments and dilemmas surrounding LKD become visible and debatable and can serve as support for future donors, recipients and the nephrologists responsible for evaluation-conclusions. Generating narratives raises a number of practical, epistemic and normative challenges.
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Affiliation(s)
- Anne Hambro Alnæs
- Centre for Medical Ethics, Faculty of Medicine, Institute of Health and Society, University of Oslo, Oslo, Norway.
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Dholakia S, Sinha S, Vrakas G, Sullivan M, Vaidya A, Cranston D, Friend PJ. Urological Nephrectomies for Benign Disease: A Possible Missed Resource in Organ Donation. EXP CLIN TRANSPLANT 2018; 16:515-521. [PMID: 30084762 DOI: 10.6002/ect.2018.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES The deficit of organs for renal transplant is a global issue. The United Kingdom Hospital Episode Statistics indicates there that were 8168 nephrectomies undertaken in 2014. Furthermore, according to the British Association of Urological Surgeons 2014 nephrectomy report, 71.8% of patients undergoing a nephrectomy had creatinine levels of less than 120 IU/L and roughly 20% had the procedure for benign and functional causes. MATERIALS AND METHODS We report a prospective case series from March 2014 to March 2016 involving 6 patients showing 3 successful transplants performed following 3 native nephrectomies. RESULTS All recipients had normal creatinine levels with good function at 12 months, and all nephrectomy patients, in addition to maintaining normal renal function, had definitive resolution of symptoms. The main limitation of this series was the small sample size. CONCLUSIONS There is no doubt that all should be done to save native organ function, and all salvage procedures and psychological testing must be robust before considering this route. However, within the group that proceeds to nephrectomy, some cases may have the potential to generate a new pool of donor organs suitable for transplant, helping to tackle the organ deficit in renal transplantation.
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Affiliation(s)
- Shamik Dholakia
- From the Nuffield Department of Surgical Science, Oxford Transplant Unit, University of Oxford, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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12
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Tenenbaum EM. Swaps and Chains and Vouchers, Oh My!: Evaluating How Saving More Lives Impacts the Equitable Allocation of Live Donor Kidneys. AMERICAN JOURNAL OF LAW & MEDICINE 2018; 44:67-118. [PMID: 29764323 DOI: 10.1177/0098858818763812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Live kidney donation involves a delicate balance between saving the most lives possible and maintaining a transplant system that is fair to the many thousands of patients on the transplant waiting list. Federal law and regulations require that kidney allocation be equitable, but the pressure to save patients subject to ever-lengthening waiting times for a transplant has been swinging the balance toward optimizing utility at the expense of justice. This article traces the progression of innovations created to make optimum use of a patient's own live donors. It starts with the simplest - direct donation by family members - and ends with voucher donations, a very recent and unique innovation because the donor can donate 20 or more years before the intended recipient is expected to need a kidney. In return for the donation, the intended recipient receives a voucher that can be redeemed for a live kidney when it is needed. Other innovations that are discussed include kidney exchanges and list paired donation, which are used to facilitate donor swaps when donor/recipient pairs have incompatible blood types. The discussion of each new innovation shows how the equity issues build on each other and how, with each new innovation, it becomes progressively harder to find an acceptable balance between utility and justice. The article culminates with an analysis of two recent allocation methods that have the potential to save many additional lives, but also affirmatively harm some patients on the deceased donor waiting list by increasing their waiting time for a life-saving kidney. The article concludes that saving additional lives does not justify harming patients on the waiting list unless that harm can be minimized. It also proposes solutions to minimize the harm so these new innovations can equitably perform their intended function of stimulating additional transplants and extending the lives of many transplant patients.
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Affiliation(s)
- Evelyn M Tenenbaum
- Professor of Law, Albany Law School and Professor of Bioethics, Albany Medical College. Special thanks to Darren O'Connor, David Conti, Timothy Lytton, Nadia Sawicki, Jed Adam Gross, and Bridget Cuccia for their editing suggestions and invaluable comments. I owe everlasting gratitude to my fantastic research assistants Erin Kilmer, Emily Phillips, and Alexandra Newcomb for their tireless research assistance and enormous help in getting this article out the door. This article is dedicated to my sister Judy Tenenbaum, the strongest person I know, to thank her for her consistent support, wonderful sense of humor, and unique ability to give me perspective
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Asim M, Al-Maslamani Y, Al-Malki H. Safe and ethical living kidney donation in Qatar: A national health system's approach. Qatar Med J 2017; 2017:3. [PMID: 28795019 PMCID: PMC5526057 DOI: 10.5339/qmj.2017.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 06/06/2017] [Indexed: 11/18/2022] Open
Abstract
The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys. The deceased donor kidney program has yet to achieve its full potential; hence, living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however, raises a number of social, ethical, and legal concerns surrounding informed consent, voluntarism, psychosocial evaluation, perioperative care, and long-term follow-up of living kidney donors. Many of these concerns become heightened in a multicultural, multilingual society within a Gulf country such as Qatar. This article provides an insight into the challenges that living kidney donation poses in a multiethnic society with significant socioeconomic divides. It also discusses the remedial measures that the Qatari government, healthcare authorities, and transplant community have adopted to address these issues.
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Affiliation(s)
- Muhammad Asim
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Hassan Al-Malki
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Live Donors of the Initial Observational Study of Uterus Transplantation—Psychological and Medical Follow-Up Until 1 Year After Surgery in the 9 Cases. Transplantation 2017; 101:664-670. [DOI: 10.1097/tp.0000000000001567] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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15
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Abstract
Living donation is an increasingly common option offered to patients in most transplant programs. Staff involved in the education, assessment, and care of this patient group is faced with increasingly complicated assessments both medically and psychologically. Supporting arguments for dedicated care teams for living organ donors include the large number of transplantations performed using living donors, the continued need to promote living organ donation, and the growing complexity of both medical and psychological factors in donor assessments. In addition, there is a need to implement the standards proposed by the 2000 Consensus Group, as well as to develop a body of evidence-based research related both to short- and long-term issues for this patient group. The ethical issues related to simultaneous involvement with both donors and recipients, and a need to ensure confidentiality are additional supporting arguments for the need to provide separate care providers for donors and recipients.
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Affiliation(s)
- Brenda McQuarrie
- Multi-Organ Transplant Program, University Health Network, Toronto, Ontario
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O'Dell MI, Wright L. Electronic Psychosocial Evaluation Tool: Use in a Living Donor Organ Transplant Program. Prog Transplant 2016; 13:97-104. [PMID: 12841515 DOI: 10.1177/152692480301300205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychosocial evaluation of potential organ donors ensures that these patients are prepared for donation and that their psychosocial issues have been addressed. The determination that the decision to donate an organ has been made voluntarily by a competent individual is a primary concern for living donor transplant programs, which must work to the highest ethical standard in this unique area of medicine. Identification of potential vulnerabilities on the part of the donor permits monitoring and/or intercession both before and after donation. Ensuring the confidentiality of patient information is important and represents a cornerstone of social work practice. At our institution, social workers have developed an electronic recording tool for use in evaluating organ donors; this tool is designed to maximize quality and ease of information gathering, ensure standardization of practice across programs, simplify record keeping, and enhance communication while minimizing time investment and ensuring patient confidentiality.
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Abstract
As a result of the cadaveric organ shortage, the number of centers performing living donor liver transplantation has increased. Living donor liver transplantation provides immediate organ availability and avoids the risk of life-threatening complications that occur with long waiting times for cadaveric organs; however, it puts a healthy person at risk for little personal gain. A standardized approach to donor evaluation ensures safety to potential donors. Careful medical (physical examination as well as laboratory and radiological evaluation) and psychological evaluation is imperative to reduce donor complications and ensure good outcomes in recipients. A social worker and psychiatrist assess for mental competency, provide emotional support, and can serve as independent donor advocates. Informed understanding and consent are crucial aspects of the evaluation and include ensuring that the donor understands all potential complications and is free of coercion. Safety of the donor must be the highest priority.
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Affiliation(s)
- Dianne LaPointe Rudow
- Center for Liver Disease and Transplantation, New York Presbyterian Hospital Center, Columbia University, New York, NY, USA
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Spiers J, Smith JA, Drage M. A longitudinal interpretative phenomenological analysis of the process of kidney recipients’ resolution of complex ambiguities within relationships with their living donors. J Health Psychol 2016; 21:2600-2611. [DOI: 10.1177/1359105315581070] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Much previous research into living kidney donation has focused on the decision-making of the donor, despite evidence suggesting this may be a more psychologically challenging time for the recipient. This longitudinal study explores the experiences of four recipients of kidneys from living donors throughout the transplant process. Transcripts were analysed using interpretative phenomenological analysis. Three themes arose from the data, which were as follows: changing perceptions of relationships with kidney donors; upbeat, temporal strategies for remaining positive and journey of the self. Findings from the first theme are presented in detail here. It was found that each participants’ relationship with their donor grew and developed in different ways, presenting their own complex challenges in terms of developing relationships and ambiguity around the decision to use the chosen donor.
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Abstract
Adult living donor liver transplantation has developed as a direct result of the critical shortage of deceased donors. Recent regulations passed by New York State require transplant programs to appoint an Independent Donor Advocacy Team to evaluate, educate, and consent to all potential living liver donors. Ethical issues surround the composition of the team, who appoints them, and the role the team plays in the process. Critics of living liver donation have questioned issues surrounding motivation and the ability of donors to provide true informed consent during a time of family crisis. This article will address issues surrounding the controversies and discuss how using the team can effectively evaluate and educate potential living liver donors and improve practice to ensure safety of living donors.
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Abstract
In 2003, the first 3-way living kidney donor-swap was performed at Johns Hopkins Hospital in Baltimore, Md. Three new donor protocols including paired donation now allow unrelated individuals to serve as donors. Some ethicists have suggested that emotionally unrelated individuals not be permitted to donate because they will not experience the same satisfaction that a family member who is a donor experiences. Others who frame living donation as an autonomous choice do not see emotionally unrelated or even nondirected donation as ethically problematic. This article uses an ethical framework of principlism to examine living donation. Principles salient to living donation include autonomy, beneficence, and nonmaleficence. The following criteria are used to evaluate autonomous decision making by living donors, including choices made (1) with understanding, (2) without influence that controls and determines their action, and (3) with intentionality. Empirical work in these areas is encouraged to inform the ethical analysis of the new living donor protocols.
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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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Schnurman KK, Zilberfein F, Augurt A, Brosnan M, Song YM. Social Work Interventions with Living Related Liver Donors: The Implications for Practice. Prog Transplant 2016; 15:353-62. [PMID: 16477818 DOI: 10.1177/152692480501500407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Living related liver donations are increasingly used to address the lack of organs available to patients faced with end-stage liver disease. A significant need exists for enhanced psychosocial intervention for donors. We sought to explore donor reactions by assessing psychosocial issues after donation. A descriptive review of donors was undertaken. The overall incidence of psychosocial issues after donation was examined by using a uniform interview questionnaire and by anecdotal case studies. Responses tend to indicate a general positive reaction to donation; yet, findings suggest a need for more preparation in the predonor stage, 100% social work follow-up after donation to provide needed support services, and inclusion of the donor as a critical partner in organ transplant treatment. A more extensive study drawing on the questionnaire may offer a standardized approach to the treatment of organ donors.
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Tenenbaum EM. BARTERING FOR A COMPATIBLE KIDNEY USING YOUR INCOMPATIBLE, LIVE KIDNEY DONOR: LEGAL AND ETHICAL ISSUES RELATED TO KIDNEY CHAINS. AMERICAN JOURNAL OF LAW & MEDICINE 2016; 42:129-169. [PMID: 27263265 DOI: 10.1177/0098858816644719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Kidney chains are a recent and novel method of increasing the number of available kidneys for transplantation and have the potential to save thousands of lives. However, because they are novel, kidney chains do not fit neatly within existing legal and ethicalframeworks, raising potential barriers to their full implementation. Kidney chains are an extension of paired kidney donation, which began in the United States in 2000. Paired kidney donations allow kidney patients with willing, but incompatible, donors to swap donors to increase the number of donor/recipient pairs and consequently, the number of transplants. More recently, transplant centers have been using non-simultaneous, extended, altruistic donor ("NEAD") kidney chains--which consist of a sequence of donations by incompatible donors--to further expand the number of donations. This Article fully explains paired kidney donation and kidney chains and focuses on whether NEAD chains are more coercive than traditional kidney donation to a family member or close friend and whether NEAD chains violate the National Organ Transplant Act's prohibition on the transfer of organs for valuable consideration.
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Agerskov H, Ludvigsen MS, Bistrup C, Pedersen BD. Relieved or disappointed--experiences of accepted and rejected living kidney donors: a prospective qualitative study. J Clin Nurs 2015; 24:3519-27. [PMID: 26467258 DOI: 10.1111/jocn.13012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2015] [Indexed: 12/01/2022]
Abstract
AIM AND OBJECTIVES To investigate the perceived experiences and considerations among potential kidney transplantation donors in relation to acceptance or rejection as donors. BACKGROUND Kidney transplantations are successfully performed in all Western countries, but the prevalence of patients waiting for organs from deceased donors far exceeds the number of organs available. This shortfall has promoted donation by living donors, who enter the donation process with feelings of hope, concern and patience to be accepted or rejected for donation. DESIGN A phenomenological-hermeneutic approach was applied in the study. METHODS Semi-structured interviews were conducted with 16 participants. Data were interpreted and discussed in accordance with Ricoeur's theory of interpretation involving: naïve reading, structural analysis, critical interpretation and discussion. RESULTS Accepted donors experienced relief and delight. Reflections were made on being prepared for donation and on the risks involved. Relationships between donors and recipients became closer. Rejected donors experienced frustration and disappointment, including anxiety about the recipient's prospects. Rejected donors reflected on the reason for rejection, and this could include considerations about changes to their own lifestyle. Reactions from relatives had an impact on donors. CONCLUSIONS The study concluded that both the accepted and rejected donors were vulnerable and in need of attention, engagement, support and care. The study draws attention to the need for healthcare professionals to be open and sensitive to the donors' descriptions of their unique experiences of being accepted or rejected for kidney donation. RELEVANCE TO CLINICAL PRACTICE Nurses should be aware that dialogue with donors, including reflections on experiences, is important to reduce and alleviate vulnerability and to give the best possible support and attention, including the opportunity to promote optimal postdonation outcomes.
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Affiliation(s)
- Hanne Agerskov
- Research Unit of Nursing, University of Southern Denmark, Odense M, Denmark.,Department of Nephrology, Odense University Hospital, Odense C, Denmark
| | | | - Claus Bistrup
- Department of Nephrology, Odense University Hospital, Odense C, Denmark
| | - Birthe D Pedersen
- Research Unit of Nursing, University of Southern Denmark, Odense, Denmark
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26
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Watson JM, Behnke MK, Fabrizio MD, McCune TR. Recipient Graft Failure or Death Impact on Living Kidney Donor Quality of Life based upon the Living Organ Donor Network Database. J Endourol 2013. [DOI: 10.1089/end.2013-0189.ecc13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dew MA, Zuckoff A, DiMartini AF, DeVito Dabbs AJ, McNulty ML, Fox KR, Switzer GE, Humar A, Tan HP. Prevention of poor psychosocial outcomes in living organ donors: from description to theory-driven intervention development and initial feasibility testing. Prog Transplant 2012; 22:280-92; quiz 293. [PMID: 22951506 DOI: 10.7182/pit2012890] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
CONTEXT Although some living donors experience psychological, somatic, and interpersonal difficulties after donation, interventions to prevent such outcomes have not been developed or evaluated. OBJECTIVE To (1) summarize empirical evidence on psychosocial outcomes after donation, (2) describe a theoretical framework to guide development of an intervention to prevent poor outcomes, and (3) describe development and initial evaluation of feasibility and acceptability of the intervention. METHODS Based on a narrative literature review suggesting that individuals ambivalent about donation are at risk for poor psychosocial outcomes after donation, the intervention targeted this risk factor. Intervention structure and content drew on motivational interviewing principles in order to assist prospective donors to resolve ambivalence. Data were collected on donors' characteristics at our institution to determine whether they constituted a representative population in which to evaluate the intervention. Study participants were then recruited to assess the feasibility and acceptability of the intervention. They were required to have scores greater than 0 on the Simmons Ambivalence Scale (indicating at least some ambivalence about donation). RESULTS Our population was similar to the national living donor population on most demographic and donation-related characteristics. Eight individuals who had been approved to donate either a kidney or liver segment were enrolled for pilot testing of the intervention. All successfully completed the 2-session telephone-based intervention before scheduled donation surgery. Participants' ratings of acceptability and satisfaction were high. Open-ended comments indicated that the intervention addressed participants' thoughts and concerns about the decision to donate. CONCLUSIONS The intervention is feasible, acceptable, and appears relevant to donor concerns. A clinical trial to evaluate the efficacy of the intervention is warranted.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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28
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Altruistic kidney donation to a stranger: psychosocial and functional outcomes at two US transplant centers. Transplantation 2011; 91:772-8. [PMID: 21285916 DOI: 10.1097/tp.0b013e31820dd2bd] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The number of living kidney donors with no preexisting relationship to the recipient has increased sharply. This study compared the psychosocial and functional outcomes of these altruistic donors to a stranger (ADs) with donors with a longstanding relationship with the recipient (traditional donors [TDs]). METHODS ADs (n=39) and TDs (n=52), who were similar on age, sex, and year of donation, were recruited from two transplant programs in the United States. Participants completed validated measures of psychosocial and functional outcomes a median of 5 years after donation (range, 1-12 years). RESULTS ADs and TDs did not differ significantly in the total number of donation motives. Both were motivated by a desire to help, the benefits to the recipient outweighing the risks to the donor, a sense of moral duty, and imagining oneself in the position of the recipient. Psychological benefits were endorsed equally by both types of donors, although TDs reported higher Quid Pro Quo scores relative to ADs (P=0.04). ADs and TDs did not differ significantly on any of the Short Form-36, Version 2 scales (P values ranged from 0.19 to 0.85). Few donors (3 ADs and 1 TD) regretted their donation decision. CONCLUSION Overall, findings indicate that carefully screened ADs experience psychosocial and functional outcomes comparable with those of TDs and should not be systematically excluded from the opportunity to donate.
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Abstract
Since the inception of living donor kidney transplantation, physicians have expressed concern about the voluntariness of the donors and their ability to recuse themselves. The literature from the late 1960s and early 1970s reveals the practice of offering a false medical excuse, although more recent comments seem to focus more on a 'general statement of lack of suitability' or 'a blameless explanation'. Simmerling et al. argue that the provision of a medical excuse rests on deception, which is wrong on deontological grounds (that physicians should hold to a principle of veracity) and on consequential grounds (deception threatens to damage trust and the doctor-patient relationship and deception may have adverse impact on the donor's relationship with his family). In this paper I examine and reject these objections. I argue that a false medical excuse is morally unjustifiable, but the medical excuse understood as a 'general statement of lack of suitability' is morally permissible because it promotes donor autonomy (the donor's right to decide whether or not to donate), and protects and preserves the donor's rights to privacy and confidentiality (by affirming the donor as an independent patient).
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Affiliation(s)
- L F Ross
- Department of Pediatrics and the MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL
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The dilemma of unintentional discovery of misattributed paternity in living kidney donors and recipients. Curr Opin Organ Transplant 2009; 14:196-200. [PMID: 19469041 DOI: 10.1097/mot.0b013e328327b21f] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE OF REVIEW To discuss the issue of misattributed paternity and highlight the complex implications transplant centers must consider when this unsought information is discovered. Policies should be implemented to guide transplant centers in consistent and ethical treatment of this sensitive issue. Effective policy development will require close examination and transparent discussion by the transplant community. RECENT FINDINGS Despite the fact that little attention has been given to the discovery of misattributed paternity in the field of transplant, transplant centers do encounter this dilemma. The burden of deciding how to treat the information is significant and reaching consensus can be difficult. Recent findings suggest that policy implementation regarding this issue would help to guide practice for professionals who encounter discovery of this unsought information. SUMMARY This review explores the complex considerations that must occur when misattributed paternity is unintentionally uncovered in living donor-recipient pairs and recommends that the transplant community pursue policies to guide practice in the treatment of this issue.
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Gill P, Lowes L. The Kidney Transplant Failure Experience: A Longitudinal Case Study. Prog Transplant 2009; 19:114-21. [DOI: 10.1177/152692480901900204] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To explore participants' experiences of kidney transplant failure. Background Kidney transplants are effective and efficient but not without complications. About 7% to 12% of kidney transplants fail within a year, and rates of failure increase over time. Graft failure can have profound effects, often resulting in depression and, occasionally, suicidal feelings. Despite these issues, the personal dimensions of graft failure have been poorly researched. Methods One donor-recipient couple experienced irreversible graft rejection immediately after a kidney transplant. This article is a longitudinal case study of this family's experiences. Data were collected through 3 semistructured interviews, conducted before the transplant and at 3 and 10 months after the transplant. Interviews were recorded, transcribed verbatim, and data coded into categories arising from the participants' accounts. Results Transplantation represented a significant source of hope. Fear of transplant failure was a major concern, but was dealt with by using emotion-focused coping mechanisms. Graft rejection was devastating, causing feelings of grief, loss, suicide, and depression. Depression improved as physical health and a sense of personal control improved. The recipient felt inadequately prepared for graft failure and poorly supported by health professionals. Conclusion The primary source of grief and depression appeared to be related to the recipient's “loss of imagined future” (ie, the life that she anticipated after transplant). Study findings have potential implications for the provision of care, i nformation, and support for patients and their families before and after transplantation and for future related research.
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Affiliation(s)
- Paul Gill
- University of Glamorgan, Pontypridd (PG), Cardiff University, Cardiff (LL), United Kingdom
| | - Lesley Lowes
- University of Glamorgan, Pontypridd (PG), Cardiff University, Cardiff (LL), United Kingdom
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33
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Alcohol abstinence criteria for living liver donors and their organ recipients. Curr Opin Organ Transplant 2008; 13:207-10. [DOI: 10.1097/mot.0b013e3282f4cb03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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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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35
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Levenson J, Valverde R, Olbrisch M. Factitious wound infections in an altruistic living liver donor. Prog Transplant 2008. [DOI: 10.7182/prtr.18.1.h3t77704870q2040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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36
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Levenson JL, Valverde R, Olbrisch ME. Factitious Wound Infections in an Altruistic Living Liver Donor. Prog Transplant 2008; 18:22-4. [DOI: 10.1177/152692480801800106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of recurrent factitious wound infections in an altruistic living liver donor. Costs for the infections after donation were billed to the recipient, creating a threat to the recipient's lifetime benefits. This case illustrates the importance of obtaining previous medical records on living donors.
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Affiliation(s)
- James L. Levenson
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Rodolfo Valverde
- Virginia Commonwealth University School of Medicine, Richmond, Virginia
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37
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Schroder NM, McDonald LA, Etringer G, Snyders M. Consideration of Psychosocial Factors in the Evaluation of Living Donors. Prog Transplant 2008; 18:41-8; quiz 49. [DOI: 10.1177/152692480801800109] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Results of donor outcome studies indicate that most living donors report a positive psychosocial response to donation. However, negative psychosocial outcomes have also been reported. Evaluation guidelines have been proposed, although a standardized evaluation specific to living donors is not yet available. In an effort to determine what psychosocial factors should be considered in a comprehensive evaluation of living donors, an extensive literature review was undertaken that was focused on previously proposed guidelines for the psychosocial evaluation of living donors, research on outcomes among living donors, and other relevant psychosocial data.
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Affiliation(s)
- Nina M. Schroder
- University of Maryland Medical Center, Baltimore (NMS), University of North Carolina Hospitals, Chapel Hill (LAM), University of Utah Hospitals and Clinics, Salt Lake City (GE), Avera McKennan Transplant Institute, Sioux Falls, SD (MS)
| | - Laurie A. McDonald
- University of Maryland Medical Center, Baltimore (NMS), University of North Carolina Hospitals, Chapel Hill (LAM), University of Utah Hospitals and Clinics, Salt Lake City (GE), Avera McKennan Transplant Institute, Sioux Falls, SD (MS)
| | - Geri Etringer
- University of Maryland Medical Center, Baltimore (NMS), University of North Carolina Hospitals, Chapel Hill (LAM), University of Utah Hospitals and Clinics, Salt Lake City (GE), Avera McKennan Transplant Institute, Sioux Falls, SD (MS)
| | - Michele Snyders
- University of Maryland Medical Center, Baltimore (NMS), University of North Carolina Hospitals, Chapel Hill (LAM), University of Utah Hospitals and Clinics, Salt Lake City (GE), Avera McKennan Transplant Institute, Sioux Falls, SD (MS)
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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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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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Kranenburg L, Zuidema W, Erdman R, Weimar W, Passchier J, Busschbach J. The psychological evaluation of Samaritan kidney donors: a systematic review. Psychol Med 2008; 38:177-185. [PMID: 17617934 DOI: 10.1017/s0033291707000979] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Living kidney donation to a loved one has become common practice. Another type of living donation that is becoming more acceptable to the transplant community is 'Samaritan donation'. Samaritan kidney donors are willing to donate to patients they do not know. Until recently there has been great reluctance to accept the offers of Samaritan donors because it was feared that these donors might be mentally unstable. METHOD The purpose of this article is to review the literature about the psychological evaluation of potential Samaritan kidney donors for donor suitability. We have performed a systematic literature search in Pubmed, ISI Web of Science and PsycINFO. We compare and discuss how each study approaches the question about Samaritan donor selection. In addition, we have also screened the studies for reports of rejections of Samaritan donors on psychological grounds. RESULTS We have found five articles that at least in some detail describe the evaluation of potential Samaritan donors. For all five articles found, a consultation with either a psychiatrist or a psychologist formed a standard part of the donor evaluation procedure. This evaluation consisted of an interview, and in most instances, additional psychometric testing. According to the articles found, the two major criteria for donor rejection were psychopathology/psychological instability and motivational issues. Three studies reported on the rejection of potential donors on psychological grounds. CONCLUSIONS The evaluation of Samaritan kidney donors is a developing field in clinical medicine. Given the relatively low incidence of these types of donations, we recommend the exchange of experience between centres that run a Samaritan donor programme, in order to improve donor evaluation criteria.
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Affiliation(s)
- L Kranenburg
- Department of Medical Psychology and Psychotherapy, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Rodrigue JR, Pavlakis M, Danovitch GM, Johnson SR, Karp SJ, Khwaja K, Hanto DW, Mandelbrot DA. Evaluating living kidney donors: relationship types, psychosocial criteria, and consent processes at US transplant programs. Am J Transplant 2007; 7:2326-32. [PMID: 17845566 DOI: 10.1111/j.1600-6143.2007.01921.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We conducted a survey of 132 US kidney transplant programs to examine how they evaluate and select potential living kidney donors, focusing on donor-recipient relationships, psychosocial criteria, and consent processes. There is heterogeneity in donor-recipient relationships that are considered acceptable, although most programs (70%) will not consider publicly solicited donors. Most programs (75%) require a psychosocial evaluation for all potential living donors. Most programs agree that knowledge of financial reward (90%), active substance abuse (86%), and active mental health problems (76%) are absolute contraindications to donation. However, there is greater variability in how other psychosocial issues are considered in the selection process. Consent processes are highly variable across programs: donor and recipient consent for the donor evaluation is presumed in 57% and 76% of programs, respectively. The use of 13 different informed consent elements varied from 65% (alternative donation procedures) to 86% (description of evaluation, surgery and recuperative period) of programs. Forty-three percent use a 'cooling off' period. Findings demonstrate high variability in current practice regarding acceptable donor-recipient relationships, psychosocial criteria, and consent processes. Whether greater consensus should be reached on these donor evaluation practices, especially in the context of more expansive use of living donor kidney transplantation, is discussed.
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Affiliation(s)
- J R Rodrigue
- Department of Psychiatry, the Transplant Center, Beth Israel Deaconess Medical Center, Boston, MA, USA.
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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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Ramchandani D. Psychiatric Assessment of Living Organ Donors for Renal Transplantation: Utility of the Defensive Functioning Scale. Bull Menninger Clin 2006; 70:283-94. [PMID: 17166086 DOI: 10.1521/bumc.2006.70.4.283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The author addresses the need for clinical guidelines to assess subtle psychological characteristics of living organ donors in view of the continuing concern with issues of motivation, manipulation, and uncertain outcome. Since the traditional DSM diagnostic approach has failed to clarify these issues, the identification of the ego-defense mechanisms of six prospective donors and their utility in guiding the decision to accept or reject them is described.
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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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Schnurman K, Zilberfein F, Augurt A, Brosnan M, Song Y. Social work interventions with living related liver donors: the implications for practice. Prog Transplant 2005. [DOI: 10.7182/prtr.15.4.j456q6xmt1741033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Smith GC, Trauer T, Kerr PG, Chadban SJ. Prospective psychosocial monitoring of living kidney donors using the Short Form-36 health survey: results at 12 months. Transplantation 2004; 78:1384-9. [PMID: 15548979 DOI: 10.1097/01.tp.0000140967.34029.f1] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Lack of prospective psychosocial outcome studies on living kidney donors impedes identification of risk factors for poor outcome. METHODS Psychiatric assessment of living kidney donors was performed preoperatively and at 4 and 12 months postoperatively using a semistructured interview, the Short Form (SF)-36 Health Survey, and Patient Health Questionnaire psychiatric assessment. A total of 48 of 51 consecutive donors (94%) over a 5-year period were available for follow-up and completed all assessments. RESULTS At preoperative assessment, only 1 of the 48 donors (2%) had a Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition Axis I psychiatric disorder, but 15 (31%) developed a disorder during the 12 months, a 29% incidence. Disorders were depressive (12%), anxiety (6%), and adjustment (13%). Seven donors (15%) demonstrated a disorder at 12 months (depressive 10%, anxiety 2%, adjustment 2%). There was a corresponding decline in psychosocial function as measured by the SF-36 Mental Component Summary score; it decreased at both 4 and 12 months (P<0.01, P<0.05); for 19% of donors, this was a larger decrease than would be expected for the cohort (>2 standard error of measurement units). Scores for SF-36 scales of General Health and Vitality decreased significantly (P<0.05), as did those of Bodily Pain, indicating greater impairment from pain. Psychiatric disorder at 12 months was associated with donor psychosocial function (Mental Component Summary) and psychiatric disorder at 4 months (P<0.01), physical function (SF-36 Physical Component Summary score) at 4 and 12 months (P<0.01), and recipient psychiatric disorder at 12 months (P<0.05). CONCLUSIONS Donors should be alerted to possible psychosocial impairment, assessed for risk factors, and monitored for at least 12 months. Treatment should be available.
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Affiliation(s)
- Graeme C Smith
- Consultation-Liaison Psychiatry Service and Monash University Department of Psychological Medicine, Monash Medical Centre, Southern Health, Clayton VIC 3168, Australia.
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Fujita M, Slingsby BT, Akabayashi A. Three patterns of voluntary consent in the case of adult-to-adult living related liver transplantation in Japan. Transplant Proc 2004; 36:1425-8. [PMID: 15251350 DOI: 10.1016/j.transproceed.2004.04.088] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
To elucidate the psychosocial aspects of the donors' decisions to engage in adult-to-adult living related liver transplantation, we interviewed a total of five institutional ethics committee members who had experience with reassessing informed consent prior to surgery. Qualitative analysis revealed several nuances of voluntary consent consisting of three patterns: "unconditional consent" is consent from the bottom of one's heart to save a family member's life; "pressured consent" describes a donor who feels implicit pressure to donate despite fear; and "ulterior-motivated consent" defines a donor who has a hidden motive. This study diverges from previous work in that it employs a qualitative approach to deconstructing the psychosocial intricacies of the informed consent process in adult-to-adult LRLT. This initial study raises several questions on the meaning of voluntary informed consent in adult-to-adult living related liver transplantation.
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Affiliation(s)
- M Fujita
- Biomedical Ethics, School of Public Health, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Smith GC, Trauer T, Kerr PG, Chadban SJ. Prospective psychosocial monitoring of living kidney donors using the SF-36 health survey. Transplantation 2003; 76:807-9. [PMID: 14501858 DOI: 10.1097/01.tp.0000084527.65615.d3] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Psychosocial assessment and monitoring of living kidney donors is not yet standard practice, despite calls for it in the literature. METHODS Psychosocial assessment of living kidney donors was performed preoperatively and 4 months postoperatively, using the SF-36 Health Survey, the Patient Health Questionnaire psychiatric assessment, and semistructured interview. RESULTS Assessment was acceptable to the majority of donors; 92% (44) of 48 consecutive donors completed both assessments. Preoperatively, both physical function (SF-36 Physical Component Score [PCS]) and psychosocial function (SF-36 Mental Component Score [MCS]) were significantly higher than community (state of Victoria) norms. Postoperatively, PCS and MCS fell significantly, but not below the Victorian norm. Seven donors (16%) developed adjustment disorder or anxiety disorder; their MCS were significantly lower than those without psychiatric disorder. CONCLUSIONS It is concluded that routine psychosocial assessment performed by a psychiatrist, including the use of questionnaires, is acceptable to donors and identifies those impaired. Potential donors need to be well prepared for such assessment and well educated about the extent of physical and psychosocial impairment that might occur in the postoperative period.
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Affiliation(s)
- Graeme C Smith
- Monash University, Department of Psychological Medicine, Monash Medical Centre, Clayton, Victoria, Australia.
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