As results from single center (mostly kidney) donor studies demonstrate interpersonal relationship and financial strains for some donors, we conducted a liver donor study involving nine centers within the A2ALL-2 Consortium. Among other initiatives A2ALL-2 examined the nature of these outcomes following donation. Using validated measures, donors were prospectively surveyed pre-donation, and 3, 6, 12, and 24 months post-donation. Repeated measures regression models were used to examine social relationship and financial outcomes over time and identify relevant predictors. Of 297 eligible donors, 271 (91%) consented and were interviewed at least once. Relationship changes were overall positive across post-donation time points, with nearly one-third reporting improved donor family and spousal/partner relationships and >50% reporting improved recipient relationships. However, the majority of donors reported cumulative out-of-pocket medical and non-medical expenses, which were judged burdensome by 44% of donors. Lower income predicted burdensome donation costs. Those who anticipated financial concerns and who held non-professional positions before donation were more likely to experience adverse financial outcomes. These data support the need for initiatives to reduce financial burden.

While single-center and cross-sectional studies have suggested modest impact of liver donation on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. We conducted one of the largest, prospective, multi-center studies of psychological outcomes in living liver donors within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL-2) Consortium. 271 (91%) of 297 eligible donors were interviewed at least once at pre-donation, 3-, 6-, 12- and 24-months post-donation using validated measures. We found that living liver donors reported low rates of major depressive (0–3%), alcohol abuse (2–5%), and anxiety syndromes (2–3%) at any given assessment in their first two years after donation. Between 4.7–9.6% of donors reported impaired mental well-being at various time points. We identified significant predictors for donors’ perceptions of being better people and experiencing psychological growth following donation, including age, gender, relationship to recipient, ambivalence and motivation regarding donation, and feeling that donation will make life more worthwhile. Our results highlight the need for close psychosocial monitoring for those donors whose recipients died (n=27), some of whom experienced guilt and concerns of responsibility. Careful screening and targeted, data-driven follow-up holds promise for optimizing psychological outcomes following this procedure for potentially vulnerable donors.