Guidelines for the Psychosocial Evaluation of Living Unrelated Kidney Donors in the United States

Abstract

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.

Emotional and Financial Experiences of Kidney Donors over the Past 50 Years

“…Unrelated donors felt pressure not to donate. Resistance to donation by others may occur when individuals don't know their recipient or are without direct attachment or benefit (31,32). Assessing levels of pressure in these two groups might be heightened.…”

Assessing the Motives of Living, Non-Related Donors

“…The transplant team must assess the potential donor to rule out "high-risk" candidates for a current or prior psychiatric history (including substance abuse or dependence), financial problems that might result in extortion of the recipient, impaired cognition that might compromise the donor's ability to understand the nature of the surgical procedure and the potential for complications, ambivalence about donating, unrealistic expectations about the donation, a self-centered motivation (as described above), and lack of a stable support system for the donor during the recovery process [4,5]. Thus, Dr. Tan's concerns are pertinent regarding Carolyn's donation as a remedy for depression, a means for seeking media attention, or a hope of being involved in the life of the recipient.…”

Live Donor Kidney Transplantation Pearls: A Practical Review

“…The evaluation should explore the ability of the donor to cover financial obligations for expected and unexpected donation-related expenses. The donor should be able to afford time away from work mainly for unplanned extended recovery time [42]. Renal transplantation in elderly patients with end stage kidney disease follows the same previous work up with more meticulous screen for cardiovascular disease and cancer.…”