Consideration of Psychosocial Factors in the Evaluation of Living Donors

Schröder, Nina; McDonald, Laurie; Etringer, Geri; Snyders, Michele

doi:10.1177/152692480801800109

Cited by 21 publications

(20 citation statements)

References 51 publications

(155 reference statements)

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“…Perceptions of inadequate understanding have, however, been linked to deteriorating social relationships, including separations and divorce in the aftermath of donation (38,39). A recent review suggested that postdonation feelings of being inadequately informed were also associated with HRQOL generally, and with psychological well-being in particular (40). Given work in other patient populations suggesting that inadequate understanding about a medical procedure is linked to greater anxiety about undergoing the procedure and more somatic symptoms in its aftermath (41–43), living donors with lower levels of understanding may be at risk for heightened anxiety predonation, and they may have more worry about complications and long-term health effects postdonation.…”

Section: Evidence To Date On Psychosocial Outcomesmentioning

confidence: 99%

Psychosocial and Socioeconomic Issues Facing the Living Kidney Donor

Dew

Jacobs²

2012

Advances in Chronic Kidney Disease

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At the 2010 Conference on Living Kidney Donor Follow-up, a workgroup was convened to comment on the state of the evidence in four broad areas: (a) health-related quality of life postdonation; (b) donors’ financial and economic concerns; (c) outcomes issues specific to newer areas of donation, namely kidney exchange and anonymous (directed and nondirected) donation; and (d) the role of informed consent in relation to postdonation psychosocial outcomes. The workgroup sought to offer recommendations regarding research priorities for the next decade, and data collection strategies to accomplish the needed research. The workgroup concluded that there has been little consideration of the nature or predictors of any long-term psychosocial outcomes in living donors. In some areas (e.g., kidney exchange and anonymous donation) there is very limited information on outcomes even in the early aftermath of donation. Across all four psychosocial areas, prospective studies are needed that follow donors in order to examine the course of development and/or resolution of any donation-related difficulties. The formation of a national registry to routinely collect psychosocial follow-up data may be an efficient strategy to monitor donor outcomes in both the short-and long-term years after donation.

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Section: Evidence To Date On Psychosocial Outcomesmentioning

confidence: 99%

Psychosocial and Socioeconomic Issues Facing the Living Kidney Donor

Dew

Jacobs²

2012

Advances in Chronic Kidney Disease

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“…Currently, the conceptualization of optimal psychosocial health in LKDs includes perceived benefits of donation, decision stability, healthy donor-recipient relationship, and limited financial impact (Dew & Jacobs, 2012). Collectively, study findings and broader conceptualization of donor outcomes have led to improvements in informed consent (Parekh et al, 2008; Thiessen, Kim, Formica, Bia, & Kulkarni, 2013) and psychosocial evaluation (Dew et al, 2007; Schroder, McDonald, Etringer, & Snyders, 2008) processes for potential LKDs, as well as the inclusion of two psychosocial outcomes (donor work status, loss of insurance due to donation) as part of the UNOS-mandated LKD follow-up requirements.…”

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcomes Following Living Kidney Donation: A Single Center Experience

Rodrigue

Vishnevsky

Fleishman

et al. 2015

J Clin Psychol Med Settings

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This article describes the development and implementation of an initiative at one transplant center to annually assess psychosocial outcomes of living kidney donors. The current analysis focuses on a cohort of adults (n=208) who donated a kidney at BIDMC between September 2005 and August 2012, in which two post-donation annual assessments could be examined. One and two year post-donation surveys were returned by 59% (n=123) and 47% (n=98) of LKDs, respectively. Those who did not complete any survey were more likely to be younger (p=0.001), minority race/ethnicity (p<0.001), and uninsured at the time of donation (p=0.01) compared to those who returned at least one of the two annual surveys. The majority of donors reported no adverse physical or psychosocial consequences of donation, high satisfaction with the donation experience, and no donation decision regret. However, a sizable minority of donors felt more pain intensity than expected and recovery time was much slower than expected, and experienced a clinically significant decline in vitality. We describe how these outcomes are used to inform clinical practice at our transplant center as well as highlight challenges in donor surveillance over time.

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“…These residual feelings must be distinguished from what, in contrast, can be termed acute ambivalence, i.e., feelings of indecision so marked that it is determined in the psychosocial evaluation that the prospective donor is unable to give adequate informed consent to proceed. 7,10,11,95 Residual ambivalence, instead, pertains to feelings that remain shortly before donation, despite the fact that the donor intends to proceed with donation. While acute ambivalence, resulting in a rule-out of the individual as a donor, is uncommon (<2% of rule-outs), 96–99 some degree of residual ambivalence before donation has been noted in up to 75% of donors.…”

Section: Introductionmentioning

confidence: 99%

Prevention of Poor Psychosocial Outcomes in Living Organ Donors: From Description to Theory-Driven Intervention Development and Initial Feasibility Testing

et al. 2012

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Context Although some living donors experience psychological, somatic, and interpersonal difficulties postdonation, interventions to prevent such outcomes have not been developed or evaluated. Objective To (a) summarize empirical evidence on postdonation psychosocial outcomes, (b) describe a theoretical framework to guide development of an intervention to prevent poor outcomes and (c) describe development and initial evaluation of feasibility and acceptability of the intervention. Methods Based on a narrative literature review suggesting that individuals ambivalent about donation are at risk for poor postdonation psychosocial outcomes, the intervention targeted this risk factor. Intervention structure and content drew on motivational interviewing principles in order to assist prospective donors to resolve ambivalence. Data were collected on donor characteristics at our institution to determine whether they constituted a representative population in which to evaluate the intervention. Study participants were then recruited to assess intervention feasibility and acceptability. They were required to have scores > 0 on the Simmons Ambivalence Scale (indicating at least some ambivalence about donation). Results Our population was similar to the national living donor population on most demographic and donation-related characteristics. Eight individuals approved to donate either a kidney or liver segment were enrolled for intervention pilot testing. All successfully completed the 2-session telephone-based intervention before scheduled donation surgery. Participant ratings of acceptability and satisfaction were high. Open-ended comments indicated that the intervention addressed participants’ thoughts and concerns about the decision to donate. Conclusions The intervention is feasible, acceptable, and appears relevant to donor concerns. A clinical trial to evaluate intervention efficacy is warranted.

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Consideration of Psychosocial Factors in the Evaluation of Living Donors

Cited by 21 publications

References 51 publications

Psychosocial and Socioeconomic Issues Facing the Living Kidney Donor

Psychosocial and Socioeconomic Issues Facing the Living Kidney Donor

Patient-Reported Outcomes Following Living Kidney Donation: A Single Center Experience

Prevention of Poor Psychosocial Outcomes in Living Organ Donors: From Description to Theory-Driven Intervention Development and Initial Feasibility Testing

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