Preventive Intervention for Living Donor Psychosocial Outcomes: Feasibility and Efficacy in a Randomized Controlled Trial

Abstract

There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e., lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education), or (c) standard care only before donation. Ambivalence was reassessed post-intervention (before donation). Primary trial outcomes—psychosocial variables in somatic, psychological, and family interpersonal relationship domains—were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p=.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p=.038), lower rates of fatigue (p=.021) and pain (p=.016), shorter recovery times (p=.041), and fewer unexpected medical problems (p=.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p=.046) and fewer unexpected family-related problems (p=.045). They did not differ on depression, feelings about donation, or family relationship quality. The findings suggest the intervention merits testing in a larger, multisite trial.

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

“…New modalities including mindfulness-based stress reduction interventions, more frequent monitoring of mood symptoms post donation, and problem-solving strategies to address financial stressors potentially could help alleviate the stress of undergoing donor surgery. Additionally, interventions such as motivational interviewing to explore donor ambivalence, possibly related to social obligation as a motivation to donate, has resulted in improved outcomes in other donor populations (33). This may be especially valuable for donor advocates wishing to assist donors in assessing whether they have sufficiently considered the risks and benefits of donation, to balance feeling compelled to donate by societal values.…”

A Culturally Targeted Website for Hispanics/Latinos About Living Kidney Donation and Transplantation

“…17 Internet-based interventions effectively increase knowledge, behavior, and improve health across different patient populations. [33][34][35] For example, Dew et al's 36 Internet-based intervention improved psychosocial outcomes in transplant recipients and their families. Merion and colleagues 37 deployed an Internet-based educational intervention for US middleand high-school students that significantly increased their willingness to donate and join a deceased donor registry.…”

Informed Consent of Living Kidney Donors: Pitfalls and Best Practice

“…Of note, literature suggests that donors who describe ambivalence at the time of donation are at higher risk for a poor psychosocial outcome [24][25][26]. Best practice explores the prospective donor's readiness, or stage of decision making, as a process: the psychosocial provider (and/or the ILDA) conducts repeat assessment of the prospective donor's desire to proceed after s/he has completed medical evaluation, and been educated about individualized risk profile and LDT expected outcomes [25].…”

“…Influences affecting voluntary status, in Valapour et al's work, ran along a continuum ranging from persuasion to coercion [2,17]. Studies have repeatedly shown that LDs with the highest degree of (presumably, external) pressure around decisionmaking also had the highest rate of regret, or at least 'unsureness' about whether they would choose to donate again [26][27][28].…”