Objectives & background
Anonymous live organ donors or unspecified donors are individuals willing to be organ donors for any transplant recipient with whom they have no biological or antecedent emotional relationship. Despite excellent recipient outcomes and the potential to help address organ scarcity, controversy surrounds the unconditional act of gifting one’s organs to an unrelated recipient. This qualitative systematic review provides insights into the first-hand experiences, motivations, and challenges that unspecified donors face.
Methods
A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO, and Web of Science database for qualitative literature regarding unspecified living donors’ motivations and experiences in liver and kidney transplantation. An inductive thematic analysis was conducted to generate themes and supportive subthemes.
Results
12 studies were included. The four major themes were (i) motivations, (ii) perception of risks, (iii) donor support, and (iv) benefits of donation. Unspecified donors demonstrated a deep sense of social responsibility but tended to underestimate health risks in favour of benefits for recipients. Despite the lack of emotional support from family and friends, the decision to donate was a resolute personal decision for donors. Majority benefitted emotionally and did not express regret.
Conclusion
This qualitative review bridges the gap in literature on unspecified living donor psychology and provides a comprehensive understanding of the decision-making matrix and experiences of donors.
Background
Methotrexate (MTX) and leflunomide are commonly used among patients with psoriasis and rheumatoid arthritis (RA) and are implicated in hepatotoxicity. We aimed to determine the prevalence of significant liver fibrosis and its risk factors in patients with psoriasis and RA. We also explored the role of novel serum biomarkers to identify significant liver fibrosis in these patients.
Methods
A total of 318 patients attending dermatology-rheumatology clinics in Queen Mary Hospital, with clinical diagnosis of psoriasis or RA were recruited from August 2020 to July 2022. Liver fibrosis was assessed by transient elastography (TE) and serum biomarkers for liver fibrosis, namely autotaxin and matrix metalloproteinase (MMP), were measured. Risk factors associated with significant liver fibrosis (defined as liver stiffness [LS] ≥7.1kPa) were analyzed by multivariate regression models.
Results
A total of 67 (21.1%) patients with psoriasis or RA had significant liver fibrosis. Body mass index (OR 1.14, 95%CI 1.04-1.24), diabetes mellitus (OR 1.93, 95%CI 1.25-2.98) and PASI (OR 1.13, 95%CI 1.05-1.27), but not cumulative dosage (CD) of MTX or leflunomide, were independently associated with significant liver fibrosis (all p<0.01). Serum MMP 3,8,9 and autotaxin levels were significantly higher among patients with advanced liver fibrosis (LS≥14 kPa). Serum autotaxin showed modest correlation with LS (r=0.31, p=0.026) and CD of MTX (r=0.30, p<0.001).
Conclusion
Significant liver fibrosis in patients with psoriasis and RA is related to the underlying metabolic risk factors and independent of MTX and leflunomide CD. Minimising hepatic risks by tight control of metabolic risk factors should be considered.
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