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Mental Health and Well-Being of Solid Organ Transplant Donors. The Forgotten Sacrifices. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In light of a global organ shortage, living donor transplantation has become increasingly relevant as an alternative to deceased donor transplantation. While current research has revolved around the medical aspects of transplantation, there remains a paucity of literature regarding the quality of life (QOL) of living donors. Hence, this review aims to provide a comprehensive outline of the current landscape of living liver and kidney transplantation, with a focus on the mental health and wellbeing of donors. As highlighted in previous studies, organ donation has a significant impact on both physical and mental aspects of donor wellbeing, with marked deteriorations occurring in the short term. Furthermore, other qualitative aspects such as financial burden contribute greatly to donor distress, reflecting a need for improved donor care. To address these pertinent issues, recommendations for a successful transplant program are detailed in this review, which encompasses psychological and social aspects of donor care throughout the donation process. Further research can be done on the impact of recipient deaths on donor QOL and appropriate interventions. Overall, given the selfless sacrifices of living donors, the care of their mental wellbeing is essential. Therefore, greater emphasis should be placed on the provision of adequate psychosocial support for them.
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Przech S, Garg AX, Arnold JB, Barnieh L, Cuerden MS, Dipchand C, Feldman L, Gill JS, Karpinski M, Knoll G, Lok C, Miller M, Monroy M, Nguan C, Prasad GVR, Sarma S, Sontrop JM, Storsley L, Klarenbach S. Financial Costs Incurred by Living Kidney Donors: A Prospective Cohort Study. J Am Soc Nephrol 2018; 29:2847-2857. [PMID: 30404908 DOI: 10.1681/asn.2018040398] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/07/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Approximately 40% of the kidneys for transplant worldwide come from living donors. Despite advantages of living donor transplants, rates have stagnated in recent years. One possible barrier may be costs related to the transplant process that potential willing donors may incur for travel, parking, accommodation, and lost productivity. METHODS To better understand and quantify the financial costs incurred by living kidney donors, we conducted a prospective cohort study, recruiting 912 living kidney donors from 12 transplant centers across Canada between 2009 and 2014; 821 of them completed all or a portion of the costing survey. We report microcosted total, out-of-pocket, and lost productivity costs (in 2016 Canadian dollars) for living kidney donors from donor evaluation start to 3 months after donation. We examined costs according to (1) the donor's relationship with their recipient, including spousal (donation to a partner), emotionally related nonspousal (friend, step-parent, in law), or genetically related; and (2) donation type (directed, paired kidney, or nondirected). RESULTS Living kidney donors incurred a median (75th percentile) of $1254 ($2589) in out-of-pocket costs and $0 ($1908) in lost productivity costs. On average, total costs were $2226 higher in spousal compared with emotionally related nonspousal donors (P=0.02) and $1664 higher in directed donors compared with nondirected donors (P<0.001). Total costs (out-of-pocket and lost productivity) exceeded $5500 for 205 (25%) donors. CONCLUSIONS Our results can be used to inform strategies to minimize the financial burden of living donation, which may help improve the donation experience and increase the number of living donor kidney transplants.
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Affiliation(s)
- Sebastian Przech
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Amit X Garg
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jennifer B Arnold
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Lianne Barnieh
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Meaghan S Cuerden
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Christine Dipchand
- Division of Nephrology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Liane Feldman
- Department of Surgery, McGill University Health Centre, Montreal, Quebec, Canada
| | - John S Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Karpinski
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Greg Knoll
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Charmaine Lok
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Miller
- Division of Nephrology and Transplantation, McMaster University, Hamilton, Ontario, Canada
| | - Mauricio Monroy
- Department of Surgery, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada
| | - Chris Nguan
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - G V Ramesh Prasad
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada; and
| | - Sisira Sarma
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Jessica M Sontrop
- Department of Medicine and Department of Clinical Epidemiology and Biostatistics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Leroy Storsley
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Scott Klarenbach
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Abstract
The use of living donors with intestinal transplantation is controversial because it may not significantly improve candidate access to organs when intestine-only grafts are needed, and may involve excessive donor risk when combined liver-intestine grafts are required. Although limited data are available for comparison at this time, graft and patient survival rates for intestinal transplantations using living donors are no different than for deceased donor transplantations. Potential benefits that may be provided to the intestine transplant recipient through the use of living donors include better HLA matching, shorter ischemia times, better bowel preparation, and better opportunities for introducing immunomodulatory strategies. Conversely, living intestine donors are at risk for mortality, significant morbidity, financial loss, and psychologic trauma. The long-term outcomes of living intestine donors have not yet been reported. Ultimately, these data are essential before the wider use of living donors can be advocated for intestinal transplantation.
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Affiliation(s)
- Jonathan Fryer
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill., USA
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Rodrigue JR, Cross NJ, Newman RC, Widows MR, Guenther RT, Kaplan B, Morgan MA, Howard RJ. Patient-Reported Outcomes for Open versus Laparoscopic Living Donor Nephrectomy. Prog Transplant 2016; 16:162-9. [PMID: 16789708 DOI: 10.1177/152692480601600213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Rates of living kidney donation have increased dramatically in recent years, in large part because of improved surgical techniques such as laparoscopic nephrectomy. Objective To compare patient-reported outcomes of laparoscopic nephrectomy versus open donor nephrectomy in 84 adult live kidney donors. Outcome Measures Outcomes included perceptions of pain and surgical scarring, number of surgical/medical complications, hospital length of stay, physical health problems related to donation, return to work, financial impact, health-related quality of life, and satisfaction with the donation experience. Results and Conclusion The 2 groups did not differ significantly in pain perceptions, number of surgical/medical complications, physical health problems, financial impact, health-related quality of life, or overall satisfaction. However, laparoscopic nephrectomy donors had significantly fewer hospital days and faster return to work time than open donor nephrectomy donors. The majority of donors report excellent health-related quality of life and no complications in the months following surgery. In addition, it appears that laparoscopic nephrectomy, in comparison to open donor nephrectomy, may reduce barriers to living kidney donation by reducing hospital length of stay and time away from work. Being able to return to work much sooner after surgery may significantly reduce the indirect costs (ie, lost wages) associated with living donation.
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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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Clarke KS, Klarenbach S, Vlaicu S, Yang RC, Garg AX. The direct and indirect economic costs incurred by living kidney donors-a systematic review. Nephrol Dial Transplant 2006; 21:1952-60. [PMID: 16554329 DOI: 10.1093/ndt/gfl069] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the many benefits of living donor kidney transplantation, economic consequences can result for donors. We reviewed studies which quantified the direct and indirect costs incurred by living kidney donors, in order to understand the strengths and limitations of existing literature. METHODS We identified relevant studies in MEDLINE, EMBASE and ECONOLIT bibliographic databases, in the Science Citation Index and study reference lists. Any study which reported at least one cost relevant to donors was included. The accuracy of abstracted data was verified by two reviewers and reported in year 2004 US dollars. RESULTS Thirty-five studies from 12 countries described costs incurred by individuals who donated between the years 1964 and 2003. No study comprehensively quantified all relevant expenses-the sum of select costs considered in one US study averaged Dollars 837 per donor and ranged from Dollars 0 to 28,906. Travel and/or accommodation costs were incurred by 9-99% of donors, and were higher in countries with a larger land mass. Post-discharge analgesics were required by 4-24% of donors, but prescription costs were not reported. Between 14 and 30% of donors incurred costs for lost income, with an average loss of Dollars 3386 in one study from the UK and Dollars 682 in another study from the Netherlands. Costs for dependent care were incurred by 9-44% of donors, while costs for domestic help were incurred by 8% of donors. CONCLUSIONS Donors incur many types of costs attributable to kidney donation and the total costs are certainly higher than previously reported. To guide informed consent and fair reimbursement policies, further data on all relevant costs, preferably from a detailed prospective multi-centre cohort study, are required.
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