Practices for Supporting and Confirming Decision-Making Involved in Kidney and Liver Donation by Related Living Donors in Japan: A Nationwide Survey

Abstract

This nationwide survey investigated the actual practices for supporting and confirming the decision-making involved in related living-organ donations in Japan, focusing on organ type and program size differences. Answers to a questionnaire survey were collected from 89 of the 126 (71%) kidney and 30 of the 35 (86%) liver transplantation programs in Japan that were involved in living-donor transplantations in 2013. In 70% of the kidney and 90% of the liver transplantation programs, all donors underwent ''third-party'' interviews to confirm their voluntariness. The most common third parties were psychiatrists (90% and 83%, respectively). Many programs engaged in practices to support decision-making by donor candidates, including guaranteeing the right to withdraw consent to donate (70% and 100%, respectively) and prescribing a set ''cooling-off period'' (88% and 100%, respectively).Most donors were offered care by mental health specialists (86% and 93%, respectively). Third parties were designated by more of the larger kidney transplant programs compared with the smaller programs.In conclusion, the actual practices supporting and confirming the decision to donate a living organ varied depending on the organ concerned and the number of patients in the program.Abbreviations: ILDA, independent living donor advocate; RTC, recipient transplant coordinator

Psychosocial evaluation of living liver donors—State of current practices in the United States

“…A survey of 30 out of 35 LDLT programs in Japan indicated that 83% of the responding programs include the psychiatrist performing the donor evaluation in standard postdonation follow-up and that 93% of LLDs are offered the care of the mental health specialist. [33] Most programs did not provide psychosocial follow-up for declined donors perhaps in the context of Mathur's findings that nondonors' quality of life was better than the living donors'. [34] Understanding the impact of donor decline will be critical as US LDLT programs re-evaluate risk assessment across all aspects of the donor evaluation (medical, anatomical, and psychosocial) in an attempt to safely expand LDLT, with the aim of offering transplant opportunity to more patients with end-stage liver disease.…”

“…This could be due to a perceived lack of need for mental health check-ins, lack of program resources, or reliance on community mental health services. A survey of 30 out of 35 LDLT programs in Japan indicated that 83% of the responding programs include the psychiatrist performing the donor evaluation in standard postdonation follow-up and that 93% of LLDs are offered the care of the mental health specialist 33 . Most programs did not provide psychosocial follow-up for declined donors perhaps in the context of Mathur’s findings that nondonors’ quality of life was better than the living donors’ 34 .…”