Emotional Well-Being of Living Kidney Donors: Findings From the RELIVE Study

Abstract

Following kidney donation, short-term quality of life outcomes compare favorably to US normative data but long-term effects on mood are not known. In the Renal and Lung Living Donors Evaluation Study (RELIVE), records from donations performed 1963–2005 were reviewed for depression and antidepressant use pre-donation. Post-donation, in a cross-sectional cohort design 2010–2012, donors completed the Patient Health Questionnaire (PHQ-9) depression screening instrument, the Life Orientation Test-Revised, 36-Item Short Form Health Survey, and donation experience questions. Of 6,909 eligible donors, 3,470 were contacted and 2,455 participated (71%). The percent with depressive symptoms (8%; PHQ-9>10) was similar to National Health and Nutrition Examination Survey participants (7%, p=0.30). Pre-donation psychiatric disorders were more common in unrelated than related donors (p=0.05). Post-donation predictors of depressive symptoms included non-white race OR=2.00, p=0.020), younger age at donation (OR=1.33 per 10 years, p-0.002), longer recovery time from donation (OR=1.74, p=0.0009), greater financial burden (OR=1.32, p=0.013), and feeling morally obligated to donate (OR=1.23, p=0.003). While cross-sectional prevalence of depression is comparable to population normative data, some factors identifiable around time of donation, including longer recovery, financial stressors, younger age, and moral obligation to donate may identify donors more likely to develop future depression, providing an opportunity for intervention.

The Psychosocial and Independent Living Donor Advocate Evaluation and Post-surgery Care of Living Donors

“…One percent reported that kidney donation affected their health in a negative way. Predictors of depression post-kidney donation included, non-white race, younger age, longer recovery post-donation, greater financial burden and feelings of moral obligation (11). …”

“…Since a large percentage of ILDA’s also perform the psychosocial evaluation, it has recently been recommended that the documentation for the psychosocial evaluation is separate from the ILDA evaluation (11). The documentation of psychosocial evaluation should be included in the potential donor’s medical record.…”

“…Centers across the county utilize various professionals as ILDAs including social workers, physicians, psychologists, registered nurses, clergy, and ethicists to fulfill this requirement (11). From whichever discipline the ILDA represents, the role evolves around protecting and promoting the rights of the living donors.…”

“…Although not consistent across transplant centers, the ILDA may attend the living donor portion of the selection committee meeting (11). Most multidisciplinary meetings include presentation of both the prospective donors and transplant candidates so the ILDA optimally would only be present for the discussion of living donor presentations (11).…”

“…Most multidisciplinary meetings include presentation of both the prospective donors and transplant candidates so the ILDA optimally would only be present for the discussion of living donor presentations (11). To maintain confidentiality, the ILDA may simply state whether there was a contraindication for living donation surgery or not from the ILDA perspective.…”