Psychological consultation before living kidney donation: finding out and handling problem cases

Abstract

The Heidelberg consultation setting has proven useful for allowing open discussion about critical issues. In problem cases, prescribing a moratorium instead of rejecting donation helps to relax consultation anxiety. Psychological support after transplantation seems to be indicated for a minority with typical first-year problems.

Similarity not favourability

“…On the other hand, using normative approval to encourage donation while living to a related recipient may contribute to an increased sense of pressure to donate and take away the capacity of the potential donor to give free and informed consent. Such a concern is particularly pertinent considering the automatic and emotional decision-making donors employ when the recipient of their organ is a family member (e.g., Burroughs et al, 2003;Simmons et al, 1971) although much research suggests that potential living related donors offer to donate because they want to help a family member (e.g., Rodrigue & Guenther, 2006;Waterman et al, 2006), experience psychological benefits from donation (e.g., increased self-worth or self-esteem; Jacobs et al, 1998;Stothers et al, 2005), and do not generally report feeling pressured to donate (e.g., Fehrman-Ekholm et al, 2000;Schweitzer et al, 2003).…”

“…Although most donors indicate it was their own decision to donate while living (Burroughs et al, 2003;Fehrman-Ekholm et al, 2000;Rodrigue & Guenther, 2006;Schweitzer Willingness to donate organs while living 4 et al, 2003;Waterman et al, 2006), a small number of donors report feeling pressured to donate (Fehrman-Ekholm et al, 2000;Schweitzer et al, 2003;Simmons, Hickey, Kjellstrand, & Simmons, 1971). …”

Prospective Psychosocial Monitoring of Living Kidney Donors Using the Short Form-36 Health Survey: Results at 12 Months

“…In our report on the 4-month outcome of a cohort of donors followed prospectively, 16% became psychiatric cases and there was a significant decline on measures of psychosocial function (4). Qualitative studies have helped identify the context of such problems and the complex ways in which they may be manifested (5)(6)(7). Psychosocial assessment and monitoring of living kidney donors is advocated in the literature but is not yet standard practice (5, 6, 8 -10).…”

Donor-recipient interaction: the Heidelberg model of evaluation and consultation

“…Our follow-up research shows that this is an unrealistic hope [3]. Anxious avoidance of thinking through complications and of discussing worst case scenarios.…”