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Marcus K, Berner D, Hadaya K, Hurst S. Anonymity in Kidney Paired Donation: A Systematic Review of Reasons. Transpl Int 2023; 36:10913. [PMID: 36819123 PMCID: PMC9931741 DOI: 10.3389/ti.2023.10913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
The objective of this study was to investigate reasons for or against anonymity that are pertinent to kidney paired donations (KPD). We conducted a systematic review of reasons using PubMed and Google Scholar until May 2022 and through snowballing. Inclusion criteria were publications that: 1) discussed organ donation anonymity; 2) was peer-reviewed; 3) presented at least one reason on anonymity. Exclusion criteria: 1) not published in a scientific journal; 2) grey literature and dissertations. Four researchers independently reviewed and selected papers based on the criteria, extracted text passages and coded them into narrow and broad reason types, selected reasons that were valid for kidney paired donations. 50 articles were included, 62 narrow reasons (n = 24 for; n = 38 against) and 13 broad reasons were coded. Broad reasons were: protection against harm, general benefits, gratitude, curiosity, unrealistic to implement, fundamental rights, respect people's wishes, professional neutrality, timing is important, information disclosure, altruism, reciprocity and donation pool. We did not find reasons that justify legal prohibition of donor-recipient interactions for KPD, if they consented to meet. Professional counselling, follow-up and careful evaluations to prevent potential harm.
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Affiliation(s)
- Kailing Marcus
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Delphine Berner
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karine Hadaya
- Service of Nephrology and Hypertension, Geneva University Hospitals and Clinique des Grangettes-Hirslanden, Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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2
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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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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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Weng LC, Huang HL, Tsai HH, Lee WC. Predictors of decision ambivalence and the differences between actual living liver donors and potential living liver donors. PLoS One 2017; 12:e0175672. [PMID: 28520727 PMCID: PMC5435180 DOI: 10.1371/journal.pone.0175672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 03/29/2017] [Indexed: 01/10/2023] Open
Abstract
Background The decision to become a living liver donor is a stressful event. Ambivalence in decision making may result in psychological distress. Thus, the purpose of this study was to provide a description of the ambivalence of potential living liver donors, to examine the predictors of ambivalence, and to compare the ambivalence of potential living liver donors with that of actual living liver donors. Methods This descriptive and correlational study was conducted in a medical center from August 2013 to December 2015. Self-reported questionnaires were used to collect data. A total of 263 potential living liver donors who were assessed for donation to their parents were included in this study. Results The mean age of the total sample was 30.7 years (SD = 6.39, range = 20–47), and males comprised 53.6% of the sample. The majority of the potential donors had a college education (70.8%) and were single (63.5%). Of the total sample, the mean score for ambivalence was 4.27 (SD = 1.87, range = 0–7). Multivariate analysis revealed that the Mental Component Summary (MCS) of quality of life (β = -0.24, p < 0.01), family support (β = -0.17, p = 0.007), and intimacy (β = -0.13, p = 0.04) were significant protective predictors of ambivalence. Actual living liver donors had significantly lower ambivalence (3.82 versus 4.60), higher intimacy with recipients (3.55 versus 3.34), higher MCS (45.26 versus 42.80), and higher family support (34.39 versus 29.79) than did the remaining potential living liver donors. Conclusion Ambivalence is common in potential living liver donors. The MCS of quality of life, family support, and intimacy were protective predictors in terms of ambivalence. Future research should explore other factors and design interventions targeted toward reducing ambivalence, promoting family support, and enhancing the mental dimensions of quality of life in potential living liver donors.
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Affiliation(s)
- Li-Chueh Weng
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of General Surgery, Chang Gung Medical Foundation-Linkuo, Taoyuan, Taiwan
- * E-mail:
| | - Hsiu-Li Huang
- Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsiu-Hsin Tsai
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Medical Foundation-Linkuo, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Department of General Surgery, Chang Gung Medical Foundation-Linkuo, Taoyuan, Taiwan
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5
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Spike J, Karff Chair S. Personal identity is the philosophical penumbra in which capacity must be assessed. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jemep.2016.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Connaughton DM, Harmon G, Cooney A, Williams Y, O'Regan J, O'Neill D, Cunningham P, Counihan A, O'Kelly P, McHale S, Denton M, O'Seaghdha CM, Magee C, Conlon P, Little D, Keogan M, de Freitas DG. The Irish living kidney donor program - why potential donors do not proceed to live kidney donation? Clin Transplant 2015; 30:17-25. [PMID: 26426147 DOI: 10.1111/ctr.12641] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Living donation is not only a method to increase access to kidney transplantation but can also offer superior outcomes. We report the experience of the living donor (LD) program in the Republic of Ireland and explore reasons why potential donors do not proceed to live donation. METHODS Retrospective cohort study of all potential donors from January 2000 to March 2014 who presented wishing to undergo donor work-up and their subsequent outcomes. RESULTS A total of 956 donors for 496 recipients contacted the live kidney donation program of which 883 potential donors proceeded to the initial stage of assessment. The donor dropout rate at this stage was 64.2% (614/956 potential donors did not proceed to further evaluation). Thereafter, 269 (28.1%) donors underwent further assessment by the multidisciplinary team. In total, 93 (9.7%) donors were declined following this assessment with 176 (18.4%) donors ultimately proceeding to live kidney donation. The major reason for declining a donor was a medical contraindication (n = 63, 67.7%). In term of recipients, 54.2% (n = 269/496) had a potential donor proceed for further assessment of which 65.4% (n = 176/269) ultimately proceeding to live donation. CONCLUSION Further evaluation of the declined donor group is warranted to allow for expansion of the LD program.
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Affiliation(s)
- Dervla M Connaughton
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Grainne Harmon
- The National Histocompatibility and Immunogenetics Service for Solid Organ Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Anne Cooney
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Yvonne Williams
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - John O'Regan
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Derek O'Neill
- The National Histocompatibility and Immunogenetics Service for Solid Organ Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Phyllis Cunningham
- Transplant Coordinator Services, Department of Kidney Transplantation and Urology, Beaumont Hospital, Dublin, Ireland
| | - Aileen Counihan
- Transplant Coordinator Services, Department of Kidney Transplantation and Urology, Beaumont Hospital, Dublin, Ireland
| | - Patrick O'Kelly
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Siobhan McHale
- Department of Psychiatry, Beaumont Hospital, Dublin, Ireland
| | - Mark Denton
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Conall M O'Seaghdha
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Colm Magee
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Peter Conlon
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Dilly Little
- Department of Kidney Transplantation and Urology, Beaumont Hospital, Dublin, Ireland
| | - Mary Keogan
- The National Histocompatibility and Immunogenetics Service for Solid Organ Transplantation, Beaumont Hospital, Dublin, Ireland
| | - Declan G de Freitas
- Department of Nephrology and Transplantation, Beaumont Hospital, Dublin, Ireland
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7
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Chen P, Luo Q, Peng L. Anxiety and decreased social support underline poorer quality of life of parent living kidney donors. Asia Pac Psychiatry 2015; 7:197-205. [PMID: 23857596 DOI: 10.1111/appy.12087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 04/15/2013] [Indexed: 12/12/2022]
Abstract
INTRODUCTION A growing body of published work suggests that the parent-child relationship can be inherently coercive, such that the expectation that a living parent will not hesitate to donate a kidney to their children, makes informed consent difficult if not impossible to ascertain. The present study was designed to explore whether the emotional response and social resources have a similar effect on health-related quality of life among parent and sibling living kidney donors. METHODS This was a cross-sectional study. A total of 98 living kidney donors (60 parent donors, 38 sibling donors) completed an assessment including emotional response, social support and quality of life. RESULTS Depression, anxiety, subjective social support and quality of life scores were much poorer for parent than sibling donors. Parent donors also showed more anxiety and poorer physical functioning than their counterparts in the general population. Hierarchical multiple regression analyses suggested that anxiety and decreased social support in the parent group were negatively associated with physical and mental function. In the sibling group, the main indicator of improved physical state was higher education level. DISCUSSION Current results raised new concerns for the quality of life of parent donors as emotional response and social support differentially affected parent versus sibling quality of life. Therefore, stricter standards for physical selection, as well as emotional and supportive intervention, are needed for parent donors.
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Affiliation(s)
- Pinhong Chen
- Institute of Developmental Psychology, Beijing Normal University, Beijing, China
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8
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The Live Donor Assessment Tool: A Psychosocial Assessment Tool for Live Organ Donors. PSYCHOSOMATICS 2015; 56:254-61. [DOI: 10.1016/j.psym.2015.02.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/04/2015] [Accepted: 02/05/2015] [Indexed: 11/16/2022]
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9
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10
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The evolving approach to ethical issues in living donor kidney transplantation: A review based on illustrative case vignettes. Transplant Rev (Orlando) 2014; 28:134-9. [DOI: 10.1016/j.trre.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 03/31/2014] [Accepted: 04/05/2014] [Indexed: 11/23/2022]
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11
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Abstract
The ethics of the clinical practice of transplanting human organs for end-stage organ disease is a fascinating topic. Who is the "owner" of the transplantable organs of a deceased, brain-dead patient? Who should have a right to receive these organs? Who set the boundaries between a living donor's autonomy and a "paternalistic" doctor? What constitutes a proper consent? These questions are only some of the ethical issues that have been discussed in the last 60 years. All of these ethical issues are intensified by the fact that supply of human organs does not match demand, and that, as a consequence, living-donor organ transplantation is widely utilized. The aim of this article is not to be exhaustive but to present the general ethical principles of beneficence, nonmaleficence, and justice as applied to organ transplantation. Moreover, the topic of reimbursement for organ donation is also discussed.
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Affiliation(s)
- Giuliano Testa
- Annette C. and Harold C. Simmons Transplant Institute, Baylor University Medical Center at Dallas, 3410 Worth Street, Suite 950, Dallas, TX, 75246, USA,
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12
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Siskind E, Alex A, Alexander M, Akerman M, Mathew C, Fishbane L, Thomas J, Israel E, Fana M, Evans C, Godwin A, Agorastos S, Mellace B, Rosado J, Rajendran PP, Krishnan P, Ramadas P, Flecha A, Kiernan L, Morgan RM, Ali N, Sachdeva M, Calderon K, Hong S, Kaur J, Basu A, Nicastro J, Coppa G, Bhaskaran M, Molmenti E. Factors associated with completion of pre-kidney transplant evaluations. Int J Angiol 2014; 23:23-8. [PMID: 24627614 DOI: 10.1055/s-0033-1358661] [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] [Indexed: 10/25/2022] Open
Abstract
This study sought to examine various factors that may prevent transplant candidates from completing their transplant workup prior to listing. We reviewed the records of 170 subjects (cases = 100, controls 70) who were either on dialysis or had less than 20 mL/min creatinine clearance and were therefore candidates for preemptive transplantation. Approximately, 56% of preemptive patients completed their workup, while only 36% of patients on dialysis completed their workup. Our data revealed that factors contributing toward completion of workup included intrinsic motivation (four times more likely), lack of specific medical comorbidities (three times more likely), and preemptive status (two times more likely). Among patients on dialysis, intrinsic motivation (five times more likely) and absence of cardiovascular complications (four times more likely) were associated with completion. When comparing patients on dialysis to patients not on dialysis, there were significant differences between the two groups in distance from home to the transplant center, level of education, and presence of medical comorbidities. We believe that targeted interventions such as timely referral, providing appropriate educational resources, and development of adequate support systems, have the potential to improve workup compliance of patients with advanced chronic kidney disease, including those on dialysis.
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Affiliation(s)
- Eric Siskind
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Asha Alex
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Mohini Alexander
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Meredith Akerman
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Christine Mathew
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Lara Fishbane
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Jisha Thomas
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Ezra Israel
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Melissa Fana
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Cory Evans
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Andrew Godwin
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Stergiani Agorastos
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Barbara Mellace
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Jesus Rosado
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Prejith P Rajendran
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Prathik Krishnan
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Poornima Ramadas
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Antonette Flecha
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Lisa Kiernan
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Ruth M Morgan
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Nicole Ali
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Mala Sachdeva
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Kellie Calderon
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Susana Hong
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Jasmeet Kaur
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Amit Basu
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Jeffrey Nicastro
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Gene Coppa
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Madhu Bhaskaran
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
| | - Ernesto Molmenti
- Departments of Surgery and Medicine, Hofstra North Shore, Long Island Jewish School of Medicine, New York
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Mantzari E, Vogt F, Marteau TM. Does incentivising pill-taking 'crowd out' risk-information processing? Evidence from a web-based experiment. Soc Sci Med 2014; 106:75-82. [PMID: 24534735 PMCID: PMC3969102 DOI: 10.1016/j.socscimed.2014.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 01/06/2014] [Accepted: 01/15/2014] [Indexed: 11/26/2022]
Abstract
The use of financial incentives for changing health-related behaviours raises concerns regarding their potential to undermine the processing of risks associated with incentivised behaviours. Uncertainty remains about the validity of such concerns. This web-based experiment assessed the impact of financial incentives on i) willingness to take a pill with side-effects; ii) the time spent viewing risk-information and iii) risk-information processing, assessed by perceived-risk of taking the pill and knowledge of its side-effects. It further assesses whether effects are moderated by limiting cognitive capacity. Two-hundred and seventy-five UK-based university staff and students were recruited online under the pretext of being screened for a fictitious drug-trial. Participants were randomised to the offer of different compensation levels for taking a fictitious pill (£0; £25; £1000) and the presence or absence of a cognitive load task (presentation of five digits for later recall). Willingness to take the pill increased with the offer of £1000 (84% vs. 67%; OR 3.66, CI 95% 1.27-10.6), but not with the offer of £25 (79% vs. 67%; OR 1.68, CI 95% 0.71-4.01). Risk-information processing was unaffected by the offer of incentives. The time spent viewing the risk-information was affected by the offer of incentives, an effect moderated by cognitive load: Without load, time increased with the value of incentives (£1000: M = 304.4sec vs. £0: M = 37.8sec, p < 0.001; £25: M = 66.6sec vs. £0: M = 37.8sec, p < 0.001). Under load, time decreased with the offer of incentives (£1000: M = 48.9sec vs. £0: M = 132.7sec, p < 0.001; £25: M = 60.9sec vs. £0: M = 132.7sec, p < 0.001), but did not differ between the two incentivised groups (p = 1.00). This study finds no evidence to suggest incentives "crowd out" risk-information processing. On the contrary, incentives appear to signal risk, an effect, however, which disappears under cognitive load. Although these findings require replication, they highlight the need to maximise cognitive capacity when presenting information about incentivised health-related behaviours.
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Affiliation(s)
- Eleni Mantzari
- Health Psychology Section, King's College London, London, UK
| | - Florian Vogt
- Institute of Pharmaceutical Science, King's College London, London, UK
| | - Theresa M Marteau
- Health Psychology Section, King's College London, London, UK; Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK.
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14
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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 on the Living Organ Donor Network Database. J Endourol 2013; 27:1525-9. [DOI: 10.1089/end.2013.0189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Justin M. Watson
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, Virginia
| | - Martha K. Behnke
- Hume-Lee Transplant Center, VCU Health System, Richmond, Virginia
| | - Michael D. Fabrizio
- Department of Urology, Eastern Virginia Medical School, Virginia Beach, Virginia
| | - Thomas R. McCune
- Kidney/Pancreas Transplant Program, Sentara Norfolk General Hospital, Norfolk, Virginia
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15
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Dew MA, DiMartini AF, Dabbs AJD, Zuckoff A, Tan HP, McNulty ML, Switzer GE, Fox KR, Greenhouse JB, Humar A. Preventive intervention for living donor psychosocial outcomes: feasibility and efficacy in a randomized controlled trial. Am J Transplant 2013; 13:2672-84. [PMID: 23924065 PMCID: PMC3837427 DOI: 10.1111/ajt.12393] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/18/2013] [Accepted: 06/20/2013] [Indexed: 01/25/2023]
Abstract
There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes-psychosocial variables in somatic, psychological and family interpersonal relationship domains-were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial.
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Affiliation(s)
- Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA
| | - Andrea F. DiMartini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Annette J. DeVito Dabbs
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA
| | - Allan Zuckoff
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA
| | - Henkie P. Tan
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mary L. McNulty
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Galen E. Switzer
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
- Center for Health Equity Research and Promotion, Veterans Administration Pittsburgh Healthcare System, Pittsburgh, PA
| | - Kristen R. Fox
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Joel B. Greenhouse
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
- Department of Statistics, Carnegie Mellon University, Pittsburgh, PA
| | - Abhinav Humar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, Pittsburgh, PA
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Quintin J. Organ transplantation and meaning of life: the quest for self fulfilment. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2013; 16:565-574. [PMID: 23014955 PMCID: PMC3696169 DOI: 10.1007/s11019-012-9439-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Today, the frequency and the rate of success resulting from advances in medicine have made organ transplantations an everyday occurrence. Still, organ transplantations and donations modify the subjective experience of human beings as regards the image they have of themselves, of body, of life and of death. If the concern of the quality of life and the survival of the patients is a completely human phenomenon, the fact remains that the possibility of organ transplantation and its justification depend a great deal on the culture in which we live. The exploration of the philosophical tradition allows for a reconsideration of organ transplantation. If we listen to people who have experienced the decline of one of their organs and their own rebirth through the organ of someone else, we arrive at the conclusion that they went through an extreme experience in which nothing appeared as before. All those experiences intensify philosophical questionings on the meaning of life with respect to self fulfilment. The concept of nature as the experience of others can be an authentic source from which to nourish our thoughts about organ transplantation. However, and this is our hypothesis, we need something more if we are to decide something about our own life. We need a hermeneutical stance in relation to ourselves and to our world. Philosophical counselling, as a long established tradition originating with Pythagoras and later reframed by the German philosopher Achenbach could be useful in inspiring a reflection on the good life, chiefly as it takes the form of a Socratic dialogue.
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Affiliation(s)
- Jacques Quintin
- Université de Sherbrooke, 97 Heneker, Sherbrooke, QC J1J 3G2, Canada.
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17
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Duerinckx N, Timmerman L, Van Gogh J, van Busschbach J, Ismail SY, Massey EK, Dobbels F. Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review. Transpl Int 2013; 27:2-18. [DOI: 10.1111/tri.12154] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 03/18/2013] [Accepted: 06/28/2013] [Indexed: 01/10/2023]
Affiliation(s)
- Nathalie Duerinckx
- Health Services and Nursing Research; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
- Heart Transplant Program; University Hospitals of Leuven; Leuven Belgium
| | - Lotte Timmerman
- Internal Medicine, Nephrology & Transplantation; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Johan Van Gogh
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Jan van Busschbach
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Sohal Y. Ismail
- Section Medical Psychology and Psychotherapy; Department of Psychiatry; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Emma K. Massey
- Internal Medicine, Nephrology & Transplantation; Erasmus Medical Centre; Rotterdam The Netherlands
| | - Fabienne Dobbels
- Health Services and Nursing Research; Department of Public Health and Primary Care; KU Leuven; Leuven Belgium
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18
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Bilgel F. The effectiveness of transplant legislation, procedures and management: Cross-country evidence. Health Policy 2013; 110:229-42. [DOI: 10.1016/j.healthpol.2012.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 11/09/2012] [Accepted: 12/31/2012] [Indexed: 10/27/2022]
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19
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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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20
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Givens L, Hong BA, Wellen JR, Werner NJ, Kodner IJ, Vijayan A, Keune JD. A living donor with low intelligence: Can we obtain informed consent? Surgery 2012. [DOI: 10.1016/j.surg.2012.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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21
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Gordon EJ. Informed consent for living donation: a review of key empirical studies, ethical challenges and future research. Am J Transplant 2012; 12:2273-80. [PMID: 22594620 DOI: 10.1111/j.1600-6143.2012.04102.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Given the organ scarcity, live organ donation is increasingly considered a viable alternative for kidney and liver transplantation. Yet living donation challenges the ethical principle of nonmaleficence by subjecting healthy individuals to medical, psychosocial and unknown risks. Therefore, transplant providers, policy-makers and donors are committed to ensuring that prospective donors provide adequate informed consent to undergo the procedure. Informed consent for living donation is ethically required as a means of demonstrating respect for donor's autonomy and protecting their safety. However, all elements of informed consent are fraught with difficulties due to the unique nature of the donation process and outcome. This paper reviews empirical research on informed consent for live kidney donors (LKD) and live liver donors (LLD) for both adult and pediatric recipients. As this review shows, studies that empirically assessed the quality of informed consent elements reveal considerable variability and deficiencies across the informed consent process, suggesting the need for improvement. This review highlights challenges to each element of consent for both LKDs and LLDs, and situates trends within broader policy contexts, ethical debates and avenues for future innovative research.
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Affiliation(s)
- E J Gordon
- Institute for Healthcare Studies, Comprehensive Transplant Center, Northwestern University Transplant Outcomes Research Collaborative, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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22
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23
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Nishimura K, Kobayashi S, Ishigooka J. Psychiatric history in living kidney donor candidates. Curr Opin Organ Transplant 2012; 17:193-7. [DOI: 10.1097/mot.0b013e3283510885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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24
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Oustecky DH, Riera AR, Rothstein KD. Long-term management of the liver transplant recipient: pearls for the practicing gastroenterologist. Gastroenterol Clin North Am 2011; 40:659-81. [PMID: 21893279 DOI: 10.1016/j.gtc.2011.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Liver transplantation is becoming more common and patients are surviving longer after transplantation. Special care must be paid to the long-term management of these patients because they are at increased risk for medical problems, malignancies, and adverse effects from immunosuppression. A stable and continuing relationship must be developed between the physician and the patient to optimize the long-term outcomes for these individuals.
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Affiliation(s)
- David H Oustecky
- Drexel University College of Medicine, Department of Gastroenterology and Hepatology, Mail Stop 913, 219 N. Broad Street, 5th Floor, Philadelphia, PA 19107, USA
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25
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26
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Oliveira B, Mascarenhas C, Cardoso G, Sá J, Casal M. Assessment of the Degree of Satisfaction Among Living Kidney Donors. Transplant Proc 2011; 43:43-7. [DOI: 10.1016/j.transproceed.2010.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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27
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Papachristou C, Marc W, Frommer J, Klapp BF. Decision-Making and Risk-Assessment in Living Liver Donation: How Informed Is the Informed Consent of Donors? A Qualitative Study. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70702-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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28
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Epstein M, Danovitch G. Is altruistic-directed living unrelated organ donation a legal fiction? Nephrol Dial Transplant 2008; 24:357-60. [PMID: 19056780 DOI: 10.1093/ndt/gfn669] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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29
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Gill P, Lowes L. Gift exchange and organ donation: Donor and recipient experiences of live related kidney transplantation. Int J Nurs Stud 2008; 45:1607-17. [DOI: 10.1016/j.ijnurstu.2008.03.004] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2007] [Revised: 03/17/2008] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
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30
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Greif-Higer G, Wandel E, Otto G, Galle P, Beutel M. Psychological Conflicts Between Relatives During the Long-Term Course After Successful Living Organ Donation. Transplant Proc 2008; 40:902-6. [DOI: 10.1016/j.transproceed.2008.03.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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31
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Erim Y, Beckmann M, Valentin-Gamazo C, Malago M, Frilling A, Schlaak J, Gerken G, Broelsch CE, Senf W. Selection of Donors for Adult Living-Donor Liver Donation: Results of the Assessment of the First 205 Donor Candidates. PSYCHOSOMATICS 2008; 49:143-51. [DOI: 10.1176/appi.psy.49.2.143] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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Schroder N, McDonald L, Etringer G, Snyders M. Consideration of psychosocial factors in the evaluation of living donors. Prog Transplant 2008. [DOI: 10.7182/prtr.18.1.w74205541n135284] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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33
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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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34
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Abstract
In a recent opinion piece, Nancy Scheper-Hughes provides a sweeping indictment of living organ donation, even in cases where the gift is directed to a close family member. She describes the process with caustic powerful phrases such as "sacrificial violence" and a "call to 'self-sacrifice.'" She concludes that living organ donation "should be consigned to a back seat as an exceptional back-up to deceased donation." But her conclusions are based on anecdotes and data that are not representative of donor practice and motivation in the United States and other developed countries. At reputable transplant centers great care is taken to identify genuine volunteers and to protect their interests. Under these circumstances living organ donation remains a generally safe and beneficial procedure for the donor as well as the recipient, and a wonderful example of the goodness of people.
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Affiliation(s)
- Aaron Spital
- Mount Sinai School of Medicine, New York, NY, USA.
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35
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Dew MA, Jacobs CL, Jowsey SG, Hanto R, Miller C, Delmonico FL. Guidelines for the psychosocial evaluation of living unrelated kidney donors in the United States. Am J Transplant 2007; 7:1047-54. [PMID: 17359510 DOI: 10.1111/j.1600-6143.2007.01751.x] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Under the auspices of the United Network for Organ Sharing, the American Society of Transplant Surgeons and the American Society of Transplantation, a meeting was convened on May 25, 2006, in Washington, DC, to develop guidelines for the psychosocial evaluation of prospective living kidney donors who have neither a biologic nor longstanding emotional relationship with the transplant candidate. These 'unrelated' donors are increasingly often identified by transplant candidates via the Internet, print media and other public appeals. The expansion of living donor kidney transplantation to include significant numbers of donors with little to no preexisting relationship to the candidate has caused concern in the medical community regarding such psychosocial factors as donor psychological status, motivation, knowledge about donation and the potential for undue pressure to donate under some circumstances. Therefore, experts in mental health; psychosocial, behavioral and transplant medicine; and medical ethics met to specify (a) characteristics of unrelated donors that increase their risk for, or serve as protective factors against, poor donor psychosocial outcomes, (b) basic principles underlying informed consent and evaluation processes pertinent to these donors and (c) the process and content of the donor psychosocial evaluation. The meeting deliberations resulted in the recommendations made in this report.
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Affiliation(s)
- M A Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA, USA.
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36
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Abstract
OBJECTIVES The purpose of this study was to investigate the attitudes and characteristics of donors for living donor liver transplantation (LDLT). METHODS This retrospective study was performed by a mailing or by telephone using a questionnaire. LDLT donors were recruited from a teaching hospitals located in a metropolitan area of northern Taiwan. The 11-item attitude questionnaire was specifically developed from the literature review with coordinator, physician, and donor feedback. Donors were asked to rate the queries on a 5-point Likert intensity scale. RESULTS The 47 LDLT donors included 28 (60%) women and 19 (40%) men. Most of the LDLT donors were aged less than 30 years old (n = 24, 51%) with (n = 12, 26%) between 31 and 40 years, and 11 (23%) more than 41 years. Self-perceived health status was poor (n = 4, 9%), not bad (n = 22, 47%), good (n = 19, 40%), or very good (n = 2, 4%). The top five LDLT donor attitudes were recognition of liver donation (n = 42, 89%), recognition of brain donation (n = 41, 88%), a hero (n = 35, 75%), honor to be a donor (n = 35, 5%), and improved relationship with recipient after donation (n = 33, 70%). The best person to suggest organ donation to a family was ranked as the doctors related to transplantation (n = 41, 88%), transplantation nurse coordinator (n = 40, 85%), social worker (n = 23, 49%), and doctor unrelated to transplantation (n = 17, 17%). CONCLUSION This study revealed positive attitudes toward donation. Some data afford insight to the decision-making procedure. Donor concerns may help professionals provide better interventions in the future.
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Affiliation(s)
- S-C Chen
- Department of Nursing, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan
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37
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38
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Jendrisak MD, Hong B, Shenoy S, Lowell J, Desai N, Chapman W, Vijayan A, Wetzel RD, Smith M, Wagner J, Brennan S, Brockmeier D, Kappel D. Altruistic living donors: evaluation for nondirected kidney or liver donation. Am J Transplant 2006; 6:115-20. [PMID: 16433765 DOI: 10.1111/j.1600-6143.2005.01148.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A program was established within our regional procurement organization to permit evaluation of altruistic living donors (LD) interested in nondirected kidney or liver segment donation prior to transplant center referral. During the initial 30 months of program operations, 731 donor inquiries were received of which 131 individuals called back after review of mailed information materials. Forty-seven candidates initiated and 19 completed the evaluation process. Seven underwent donation to include six kidneys and one liver segment, five are actively pending donation, five were excluded from donation following transplant center evaluation and two took no further action after their intended liver recipients received deceased donor (DD) transplants. Psychological evaluation of these 19 candidates found them to be free of psychopathology, highly cooperative and self-directed. They did not exhibit attention-seeking or religious motivations for their actions. All seven donors and recipients continue to do well postoperatively. This evaluation program has made possible large-scale screening and education of prospective altruistic LD within the general population and also provides a unique opportunity to further our understanding of those individuals interested in living-nondirected donation.
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Affiliation(s)
- M D Jendrisak
- Department of Surgery, Division of Abdominal Transplant, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8109, St. Louis, MO 63110, USA.
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39
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40
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Abstract
Organ transplantation centers have expanded and increased in the last 20 years as transplant recipient outcomes have improved steadily and transplantation has moved from experimentation to treatment of choice for several indications. Transplantation presents difficult ethical and legal challenges for the transplant community and society. These include declarations of death, consent to donation and allocation of a scarce societal resource, i.e. transplantable organs. Policy and practice reflect the law, societal beliefs and prevailing values. A bioethicist contributes to a transplant team by clarifying values held by various stakeholders or embodied in decisions and policies, conducting clinical consultations, developing and interpreting policy and researching the ethics of innovations for rationing and increasing available supply of organs for transplantation. The bioethicist's interdisciplinary education, preparation, experience and familiarity with ethics, law, sociology and philosophy and skills of mediation, communication and ethical analysis contribute to addressing and resolving many issues in transplantation. This paper outlines the various roles of a bioethicist on a transplantation service, using case examples to illustrate some of the ethical issues.
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Affiliation(s)
- Linda Wright
- Toronto General Hospital, 11C1270, University Health Network, Toronto, Ontario, Canada.
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41
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Andersen MH, Mathisen L, Øyen O, Wahl AK, Hanestad BR, Fosse E. Living donors' experiences 1 wk after donating a kidney. Clin Transplant 2005; 19:90-6. [PMID: 15659140 DOI: 10.1111/j.1399-0012.2004.00304.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In Norway living kidney donors account for approximately 40% of all renal transplants. There is a shortage of information about how living kidney donors experience the donation process during the initial recovery from surgery. The aim of this study was to explore physical and psychosocial issues related to the experiences of living kidney donors 1 wk after open donor nephrectomy. A total of 12 living kidney donors participated in the study. Data were collected by individual in-depth interviews and analysed using empirical phenomenological method. Being a living kidney donor is a complex experience. The informants expressed strong feelings of responsibility and obligation concerning the recipients and had a positive attitude towards the donation. On the other hand, the donors experienced it strange to be a fit individual and go through a major operation. Several of the donors reported that it was painful to go through donor surgery and regarded the recovery period as troublesome. Some donors also reported the double role of being both a patient and a relative to be a stressful experience. This study reveals the importance of being aware of the complex situation of living kidney donors. Health professionals need to understand the nature of the donation process and the donors' needs. It is essential to focus on physical, mental and interpersonal factors when counselling potential living kidney donors.
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42
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Surman OS, Fukunishi I, Allen T, Hertl M. Live Organ Donation: Social Context, Clinical Encounter, and the Psychology of Communication. PSYCHOSOMATICS 2005; 46:1-6. [PMID: 15765814 DOI: 10.1176/appi.psy.46.1.1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Organ transplantation is increasingly available to the thousands of patients who suffer from end-organ failure. There has been an attendant increase in demand for living donor participation. This combined with a bioethical focus on autonomy increases the burden of decision on donor candidates. The authors review the history of living donor participation in organ transplantation and explore the psychological dynamics of the clinical encounter between donor and transplant surgeon. The field of communication psychology lends to the understanding of coercion and to the importance of donors possessing a status of patient-hood in the classical Hippocratic condition.
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Affiliation(s)
- Owen S Surman
- Departments of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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43
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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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44
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Schauenburg H, Biller-Andorno N. [Decision-making capacity and informed consent in living organ donation--difficult constellations in the psychosomatic and medico-ethical assessment of potential donors]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2003; 49:164-74. [PMID: 12748911 DOI: 10.13109/zptm.2003.49.2.164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Organ donation from relatives or other persons with a close relationship to the patient has become a fairly routine procedure in many countries. However, donors should be chosen carefully not only to avoid medical or psychosocial risks but also ethically questionable outcomes. Prerequisites for living organ donation are reported together with a short review of the known risks for donors. Under the central maxim of averting harm for the donor, six cases are described to illustrate typical difficulties in the psychosomatic-ethical consultation-liaison service, and our own procedures are discussed. Suggestions are made as to how to approach the information, evaluation and selection of potential donors.
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Affiliation(s)
- Henning Schauenburg
- Klinik für Psychosomatik und Psychotherapie, Von-Siebold-Str. 5, 37075 Göttingen, Germany.
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45
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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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46
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O'Dell MI, Wright L. Electronic psychosocial evaluation tool: use in a living donor organ transplant program. Prog Transplant 2003. [PMID: 12841515 DOI: 10.7182/prtr.13.2.u062300815v72438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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
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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Surman OS, Cosimi AB, Fukunishi I, Kawaii T, Findley J, Kita Y, Makuuchi M. Some Ethical and Psychiatric Aspects of Right-Lobe Liver Transplantation in the United States and Japan. PSYCHOSOMATICS 2002; 43:347-53. [PMID: 12297602 DOI: 10.1176/appi.psy.43.5.347] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cadaver sources are insufficient for the increasing demand for liver transplantation. Right-lobe liver transplantation from living donors is fully developed in Japan and has been rapidly increasing in the United States during the past 2 years, although donor risk is greater than in other types of solid organ transplantation. The authors examine the psychiatric and ethical aspects of right-lobe liver transplantation in light of cultural differences between the United States and Japan.
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Affiliation(s)
- Owen S Surman
- Transplant Unit and the Department of Psychiatry, Massachusetts General Hospital, MA 02114-3117, USA.
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Olbrisch ME, Benedict SM, Ashe K, Levenson JL. Psychological assessment and care of organ transplant patients. J Consult Clin Psychol 2002; 70:771-83. [PMID: 12090382 DOI: 10.1037/0022-006x.70.3.771] [Citation(s) in RCA: 115] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Organ transplant has been developed in animal models over the past 100 years. The major limiting factor in transplant medicine is the shortage of donor organs. This shortage creates pressure for fair and efficient allocation of organs, with expectations that those involved in transplantation will strive to achieve optimal outcomes and ensure just access. This article reviews the major types of transplants and the illnesses and behavioral comorbidities that lead to these procedures, the psychological assessment of transplant candidates, the adaptive tasks required of the transplant recipient at various stages of the transplant process, and relevant psychological interventions. Liaison with others on the transplant team and ethical issues of concern to psychologists who work with transplant patients, including living organ donors, are also discussed. Finally, new developments in transplant and suggestions for future psychological research in organ transplant are presented.
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Affiliation(s)
- Mary Ellen Olbrisch
- Department of Psychiatry, Medical College of Virginia, Virginia Commonwealth University, Richmond 23298-0268, USA.
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Wright L, MacRae S, Gordon D, Elliot E, Dixon D, Abbey S, Richardson R. Disclosure of misattributed paternity: issues involved in the discovery of unsought information. Semin Dial 2002; 15:202-6. [PMID: 12100459 DOI: 10.1046/j.1525-139x.2002.00541.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Kidney transplantation from living donors is generally a safe, effective form of renal replacement therapy. When evaluating potential living donors and their intended recipients, a careful assessment process is followed in order to ensure that ethical standards are upheld. During this assessment, important medical information with serious consequences, which was not being sought as part of the donor/recipient evaluation, may be discovered. The information may or may not be relevant to the decision to donate. However, such a discovery raises the difficult questions of whether or not there is an obligation to disclose the information, to whom does the information belong, and what process should be used to resolve the issue? We present a case that forced us to confront these questions and raised issues of truth telling, autonomy, paternalism, confidentiality, and the nature of the relationship between patients and health care professionals.
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Affiliation(s)
- Linda Wright
- Multi Organ Transplant Programme, Toronto General Hospital, University Health Network, Ontario, Canada.
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