Long-Term Follow-Up of Living Kidney Donors: Quality of Life After Donation1

Abstract

The University of Minnesota has been a strong advocate of living donor kidney transplants. The benefits for living donor recipients have been well documented. The relative low risk of physical complications during donation has also been well documented. Less well understood is the psychosocial risk to donors. Most published reports have indicated an improved sense of well-being and a boost in self-esteem for living kidney donors. However, there have been some reports of depression and disrupted family relationships after donation, even suicide after a recipient's death. To determine the quality of life of our donors, we sent a questionnaire to 979 who had donated a kidney between August 1, 1984, and December 31, 1996. Of the 60% who responded, the vast majority had an excellent quality of life. As a group, they scored higher than the national norm on the SF-36, a standardized quality of life health questionnaire. However, 4% were dissatisfied and regretted the decision to donate. Further, 4% found the experience extremely stressful and 8% very stressful. We used multivariate analysis to identify risk factors for this poor psychosocial outcome and found that relatives other than first degree (odds ratio=3.5, P=0.06) and donors whose recipient died within 1 year of transplant (odds ratio=3.3, P=0.014) were more likely to say they would not donate again if it were possible. Further, donors who had perioperative complications (odds ratio=3.5, P=0.007) and female donors (odds ratio=1.8, P=0.1) were more likely to find the overall experience more stressful. Overall, the results of this study are overwhelmingly positive and have encouraged us to continue living donor kidney transplants.

Impact of Liver Donation on Quality of Life and Physical and Psychological Distress

“…Первые работы, посвященные КЖ при-жизненного органного донора, проводились в конце 1990-х годов и были посвящены донорам почки. Ре-зультаты исследований показали высокие парамет-ры КЖ прижизненных доноров в послеоперацион-ном периоде [35,36].…”

Psychosocial care of living kidney donors

“…2,3,10,15 Studies have also consistently found that a small proportion of donors (<10%) regretted their decision to donate or would not donate again. 2,3,9,11,12 The proportion of donors who felt pressure to donate their kidney varied across studies. The major concerns of donors related to postoperative pain (with some donors reporting the surgery as the most painful experience ever encountered), length of recovery, recipient wellbeing, health, employment issues, financial problems, health risks and lifestyle restrictions.…”

“…1 Live donors are not only at risk of physical adverse events including infection and loss of renal function in the remaining kidney but they may also experience psychosocial problems including anxiety, depression, regret and financial hardship. 2,3 The psychosocial evaluation of donors (pre-and posttransplant) is widely advocated; 4 however, there is a paucity of data on the process and content of psychosocial evaluations. For example, there are no set standards regarding who should conduct psychosocial evaluations (physician, psychiatrist, psychologist, medical social worker), whether evaluations should be mandatory, at what stage of the work-up evaluations should be conducted, at what time interval repeat evaluations should be performed and what criteria need to be met.…”

Minors as Living Solid-Organ Donors

“…20 Still, the vast majority of donors understand this risk and do not regret their decision. [21][22][23] Another risk is the potential coercive nature of the request: how can children refuse when their parents are asking them to donate? 16,17 And, if a child does refuse, additional guilt may result.…”

“…[52][53][54] The minor needs to understand that the donated organ may fail or may be rejected by the recipient or that the original cause of the organ failure may recur and that the outcome is beyond his or her control. 19,21,53 The literature shows that many donors feel neglected after donation as the focus returns to the ill recipient. 52,55 Family members should be reminded that they need to be attentive to the needs of both the donor and the recipient.…”