Social and Financial Outcomes of Living Liver Donation: A Prospective Investigation Within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2)

Abstract

As results from single center (mostly kidney) donor studies demonstrate interpersonal relationship and financial strains for some donors, we conducted a liver donor study involving nine centers within the A2ALL-2 Consortium. Among other initiatives A2ALL-2 examined the nature of these outcomes following donation. Using validated measures, donors were prospectively surveyed pre-donation, and 3, 6, 12, and 24 months post-donation. Repeated measures regression models were used to examine social relationship and financial outcomes over time and identify relevant predictors. Of 297 eligible donors, 271 (91%) consented and were interviewed at least once. Relationship changes were overall positive across post-donation time points, with nearly one-third reporting improved donor family and spousal/partner relationships and >50% reporting improved recipient relationships. However, the majority of donors reported cumulative out-of-pocket medical and non-medical expenses, which were judged burdensome by 44% of donors. Lower income predicted burdensome donation costs. Those who anticipated financial concerns and who held non-professional positions before donation were more likely to experience adverse financial outcomes. These data support the need for initiatives to reduce financial burden.

Long-Term Medical and Psychosocial Outcomes in Living Liver Donors

“…Concerning interpersonal issues, donor relationships with family or the recipient are only rarely worse postdonation (0–7%), with 26% to 56% of donors reporting improved relationships (26,37). Two studies examined interpersonal concerns related to surgical scarring and body image, with one noting that one quarter of donors experienced worsened body image (26), and the other noting discomfort in about two thirds of donors in exposing the scar in daily life (e.g.…”

“…From 55% to 65% of donors incurred out-of-pocket costs (26,36,37) and 15–37% report financial strains due to donation (33,36,37). Castedal et al (10) noted that 32% received only partial, if any, reimbursement for lost income.…”

“…Castedal et al (10) noted that 32% received only partial, if any, reimbursement for lost income. Problems obtaining or keeping insurances (health and/or life) are reported by 3% to 11% of donors (26,31,36,37). …”

“… LLS, left lateral segment; RL, right lobe; LL, left lobe. 1 Some studies also assessed generic health-related quality of life; these findings are summarized in Figure 1. 2 All studies were single-site except Dew et al (36) and DiMartini et al (37), which each included nine sites. Both reports describe data from the Adult to Adult Living Donor Transplantation Cohort study but assess independent cohorts.…”

“… 2 All studies were single-site except Dew et al (36) and DiMartini et al (37), which each included nine sites. Both reports describe data from the Adult to Adult Living Donor Transplantation Cohort study but assess independent cohorts.…”