Attitudes of donors towards organ transplantation in living related kidney transplantations

Living Kidney Donor Phenotype and Likelihood of Postdonation Follow-up

BACKGROUND

The Organ Procurement and Transplantation Network requires that United States transplant centers maintain follow-up with living donors for 2 years postdonation, but lack of donor follow-up is pervasive. Donor characteristics, including younger age, minority race, and lower education, have been associated with incomplete follow-up, but it is unknown whether altruistic donors, having no previous connection to their recipient, differ from traditional donors in their likelihood of follow-up.

METHODS

Using the Scientific Registry of Transplant Recipients data, we examined all adult living kidney donors from 2005 to 2015 (n = 63 592) classified as altruistic or traditional, and compared likelihood of 6-month medical follow-up using modified Poisson regression.

RESULTS

Altruistic donors did not differ from traditional donors in likelihood of follow-up (adjusted relative risk [aRR], 1.02; 95% confidence interval [CI], 0.99-1.06). Among previously identified at-risk subgroups, however, altruistic donors were more likely to have follow-up than their traditional counterparts, including those who were younger (aRR, 1.04; 95% CI, 1.00-1.09), had less than college education (aRR, 1.05; 95% CI, 1.00-1.11), and were unmarried (aRR, 1.08; 95% CI, 1.04-1.12). Having medical follow-up at 6 months was significantly associated with having follow-up at 1 year (aRR, 1.84; 95% CI, 1.75-1.93) and 2 years (aRR, 1.63; 95% CI, 1.56-1.70) postdonation.

CONCLUSIONS

These data provide additional granularity on living donor phenotypes associated with short-term (6 month) postdonation follow-up, which is important given its association with future likelihood of follow-up. These findings offer the opportunity to tailor and direct educational efforts to increase living donor follow-up, particularly among groups at higher risk of loss to follow-up.

Living kidney donor decision making and communication

There is high demand for kidney donors in the United States, and it is widely accepted that living donation is optimal for individuals who need a kidney. Much research has focused on the potential recipient, but little has been studied about the communication and decision making of living kidney donors. Interviews assessed the communication and decision-making processes of 43 kidney donor volunteers. Almost all of the participants were not asked, but instead volunteered, to donate. The majority of donors reported having conversations with the recipient and speaking about their decisions with other individuals in their social networks besides the recipient. Some participants said that they stopped talking to others because of negative feedback. Future research should further examine the communication of donors with non-recipient others and potential methods of training recipients and donors to communicate effectively about the donation process.

Psychosocial aspects of living-related donor renal transplantation: Quality of life and mood in recipients, donors and controls

Due to the high frequency of living-related donor renal transplantation (LRDRT) in our country, we were concerned both about the recipient and the donor quality of life and psychological well-being. We investigated HRQL and mood in LRDRT recipients, donors, and controls using the Beck Depression Inventory, Beck Anxiety Inventory, and 36-item Short Form Health Survey. The recipient group consisted of 69 individuals who underwent renal transplantation between August 2002 and June 2004. The donor group consisted of 35 and the control group 45 healthy individuals. Multivariate analysis of variance and the post hoc (Tukey) test were used to assess and to analyze differences among and between the three groups. The depression scores of the recipients were higher than donors (P < 0.05) but were similar to controls. The recipient scores indicated poorer physical functioning (P < 0.001), greater physical limitation on roles (P < 0.001), and lower levels of general health (P < 0.01) compared to controls. The donor scores indicated higher vitality (P < 0.01), better social functioning (P < 0.05) and greater mental health (P < 0.01) than controls. Poorer health and mood status among the recipient group might reflect the various negative impacts of chronic debilitating disease. It is therefore recommended to screen recipients regularly for clinically relevant HRQL impairments after transplantation.

Intentions of becoming a living organ donor among Hispanics: a theory-based approach exploring differences between living and nonliving organ donation

This research examines perceptions concerning living (n = 1,253) and nonliving (n = 1,259) organ donation among Hispanic adults, a group considerably less likely than the general population to become donors. Measures are derived from the Theory of Planned Behavior (Ajzen, 1991) and Vested Interest Theory (Crano, 1983, 1997). A substantial percentage of respondents reported positive attitudes and high personal stake concerning organ donation. Mean differences in norms, attitudes, intentions, and assumed immediacy of payoff were found between living and nonliving donor groups, suggesting that these two donation formats are dissimilar and should be examined independently. Accordingly, separate hierarchical multiple regression models were estimated for living and nonliving donation. Analyses supported both theoretical frameworks: Constructs associated with Planned Behavior and Vested Interest independently contributed to donor intentions. The implications of these results, and our recommendations for future health campaigns, are presented in light of these theoretical models.

The dynamics of recipient-donor relationships in living kidney transplantation

Psychosocial issues in kidney transplant donors and recipients are a cause for concern. We reviewed studies that investigated psychosocial issues in donors and recipients of living kidney transplants. A variety of instruments were used for this purpose. However, there was a lack of consensus regarding the structure and method of psychosocial assessment in living kidney donors. We found that only a few centers currently carry out a systematic psychosocial follow-up of recipients and their donors. The majority of psychosocial studies were of living kidney donors, indicating a preference of researchers to study psychosocial issues in live kidney donors. We believe living kidney transplant recipients are also an important group, and more studies should be done to better understand the psychosocial issues in this group. The majority of studies were retrospective in nature. We also discuss relationships, interactions, and communication patterns that characterize living kidney donation. We place emphasis on understanding the relational history of donors and recipients to provide supportive intervention and enable the potential donor make an informed decision about surgery. We recommend comprehensive psychosocial screening before and after transplantation and donation. This may decrease psychological problems and increase satisfaction with the transplantation process. Furthermore, the transplant community will need to address the type of instruments, duration of follow-up, and funding sources to carry out our recommendations.

Psychosocial health of living kidney donors: a systematic review

Knowledge of the psychosocial benefits and harms faced by living kidney donors is necessary for informed consent and follow-up. We reviewed any English language study where psychosocial function was assessed using questionnaires in 10 or more donors after nephrectomy. We searched MEDLINE, EMBASE, Web of Science, Psych INFO, Sociological Abstracts and CINAHL databases and reviewed reference lists from 1969 through July 2006. Independently, two reviewers abstracted data on study, donor and control group characteristics, psychosocial measurements and their outcomes. Fifty-one studies examined 5139 donors who were assessed an average of 4 years after nephrectomy. The majority experienced no depression (77-95%) or anxiety (86-94%), with questionnaire scores similar to controls. The majority reported no change or an improved relationship with their recipient (86-100%), spouse (82-98%), family members (83-100%) and nonrecipient children (95-100%). Some experienced an increase in self-esteem. A majority (83-93%) expressed no change in their attractiveness. Although many scored high on quality of life measures, some prospective studies described a decrease after donation. A small proportion of donors had adverse psychosocial outcomes. Most kidney donors experience no change or an improvement in their psychosocial health after donation. Harms may be minimized through careful selection and follow-up.

Attitude of kidney patients on the transplant waiting list toward related-living donation. A reason for the scarce development of living donation in Spain

INTRODUCTION

Most Spanish transplant centers have on-going living kidney transplant programs. However, such transplants are not increasing as a proportion of the total number of kidney transplants. The objective of this study is to analyze the attitude of kidney patients on the kidney transplant waiting list toward living kidney donation.

MATERIALS AND METHODS

The patients studied were selected from those included on the kidney transplant waiting list from November 2003 until September 2005 (n = 221). Attitude toward living donation was evaluated using a psychosocial questionnaire. It was completed in a direct personal interview with an independent health-care worker from the Transplant Unit. Student's t-test and the chi-squared test were applied.

RESULTS

Two hundred and fourteen patients completed the questionnaire (97%), of which 35% would accept a related living kidney if it were offered to them, 60% would prefer to wait on the waiting list and the remaining 5% are undecided. Up to 66% (n = 134) of patients report that a member of their family or a friend have offered them an organ for donation. Eighty-nine percentage believe that there is some risk involved in living kidney donation, although it is not a factor that affects whether an organ would be accepted or not (p = 0.767). The psychosocial variables that affect attitude toward accepting a related living kidney are: (i) age: the youngest are those who are most likely to accept (40 vs. 45-yr-old; p = 0.010); (ii) descendents: patients without descendents are more likely to accept a living organ (56% vs. 27%; p < 0.000); (iii) marital status: a greater percentage of single respondents would be prepared to receive this type of transplant compared to the group of married respondents (55% vs. 30%. p = 0.007); and (iv) level of education: those with a higher level of education are more likely to accept a living organ (43% have secondary or university studies vs. 28% who only have primary education; p = 0.040).

CONCLUSION

Patients on the waiting list for a kidney transplant do not have a very favorable attitude toward receiving a related-living donor organ, although members of their family have offered them one of their organs. The profile of a patient who would accept a related-living donated kidney is a young, single person, without descendents, and with a high level of education.

Health-related quality of life of living kidney donors: review of the short form 36-health questionnaire survey

Kidney transplantation is the ultimate goal and the best treatment for most patients with end-stage renal disease. Organ shortage and steadily growing waiting time for a cadaver kidney transplant have forced the medical community to look for alternatives, such as living kidney donation. However, available data examining health-related quality of life (QOL) issues of living donors are currently limited. In addition, little information regarding factors associated with health-related QOL in living kidney donors is currently available and this issue remains controversial. This review article aims to summarize the data regarding health-related QOL of living kidney donors by using the Medical Outcomes Study Short Form.

Ethical and economical appreciation of living nonrelated donors renal transplantation from outside Turkey

For patients with chronic renal failure organ demand has increased all over the world. Serious ethical problems have appeared with attempts to increase the number of organs from both living and cadaveric donors. The demand for transplantable organs is greater than the supply. The increasing number of patients waiting for transplantation has forced them to illegally obtain organs from living nonrelated donors (LNRD). This effort can result in serious complications for both recipient and donor. According to our regulations, commercial transplantation has been prohibited in Turkey, because of the possibility of abuse by an organ trade. In this study, we examine the complication, economics, and ethics concerning six patients operated outside our country.

Pain experienced by laparoscopic donor nephrectomy patients in an academic medical setting

CONTEXT

Since 1996, 414 laparoscopic live donor nephrectomy procedures have been completed at our institution. Although this procedure has gained acceptance within the past 5 years, little is known about its nursing implications.

OBJECTIVE

The purpose of this performance improvement project was to identify pain management practices, satisfaction levels, and clinical outcomes among patients undergoing laparoscopic live donor nephrectomy.

PATIENTS

Data were collected for a convenience sample of 70 patients for 18 months.

INTERVENTION

Several pain management methods were used, including patient-controlled analgesia and intramuscular and oral medications.

RESULTS

Pain ratings ranged from 3.2 to 3.8 for the first 36 hours postoperatively. The mean pain level did not differ significantly between pain regimes. At discharge, patients perceived a mean overall pain level of 5.0 but anticipated a pain level of 6.1. A significant negative correlation between satisfaction and pain rating also was noted.

CONCLUSIONS

Opportunities exist to standardize current regimens of pain medications and address pain level and treatment 24 hours postoperatively.

Patients' attitudes about living donor transplantation and living donor nephrectomy

BACKGROUND

The growing shortage of organs available for transplantation has resulted in an increased use of living donors for kidney transplantation. The laparoscopic nephrectomy is a new procedure used to remove kidneys from donors. The study objective was to explore the attitudes of recipients and donors toward living donor kidney transplantation and the impact of the laparoscopic donor nephrectomy on donors' and recipients' acceptance of living donor kidney transplantation.

METHODS

Tailored self-administered questionnaires were mailed to kidney donors, potential donors, recipients and potential recipients who visited the University of Maryland School of Medicine Division of Transplantation between January 1998 and May 2001.

RESULTS

The laparoscopic donor nephrectomy helped recipients and potential recipients with their decision to accept a kidney from a living donor (recipients: 53% strongly agreed, 36% agreed; potential recipients: 42% strongly agreed, 46% agreed). To a lesser extent, the laparoscopic donor nephrectomy assisted donors and potential donors with their decision to donate (donors: 19% strongly agreed, 20% agreed; potential donors: 20% strongly agreed, 20% agreed). Potential recipients and recipients identified 2 barriers to accepting living donor kidney transplantation: they were unwilling to accept a kidney if it meant this would financially burden their donors, and they worried that their donors might succumb to a future kidney problem.

CONCLUSION

Overall, the study found a positive attitude toward living donor kidney transplantation and laparoscopic donor nephrectomy. This new surgical procedure seemed to positively influence recipients and potential recipients to accept a kidney. In contrast, it had less impact on donors' and potential donors' willingness to give their kidney.

Quality of life of living kidney donors: the short-form 36-item health questionnaire survey

OBJECTIVES

To determine the psychological and social effects of kidney donation on kidney donors by using the short-form 36-item health survey (SF-36) as the quality-of-life questionnaire.

METHODS

A total of 104 living donor nephrectomies have been performed at Kobe University Hospital and Nishinomiya Prefectural Hospital. We mailed the questionnaires to donors or handed them out directly at the outpatient clinic. The first part of the questionnaire consisted of the SF-36 (limitations on physical functioning because of health problems) and the second part consisted of 15 questions about donation-related stress, expenses incurred, physical changes, and pre-existing factors such as relationship to the recipients.

RESULTS

The SF-36 and the questionnaire about donor satisfaction were completed by 69 donors (48 women and 21 men; mean age 52.1 +/- 8.2 years), only 6 of whom (9%) reported minor complications with the donor operation. The SF-36 scores of our donors were not significantly different from that of the general U.S. population and U.S. donors. In some categories (physical functioning, role-physical, bodily pain, general health, vitality, and mental health), our donors scored slightly higher than the U.S. general population. Although 97% of the donors would make the same choice again, 3% believed that donating had had a negative impact on their health, and 16% reported negative financial consequences.

CONCLUSIONS

The quality of life for kidney donors was not affected by donor nephrectomy. Living kidney transplantation seems to be suitable for the rescue of patients with end-stage renal disease. Better psychological and technical preparation for surgery and more consistent follow-up may reduce the negative outcomes even further.

Introduction of the certificate in transplant coordination in the United Kingdom

Training for transplant coordinators is not mandatory in the United Kingdom, although the United Kingdom Transplant Coordinators Association has provided informal courses since 1988. The authors of this article were responsible for the development of an accredited training program for transplant coordinators in the United Kingdom. Accredited by the University of Central England, the course modules have been run and managed by the Association since 1996. The course consists of 3 modules: Introduction to Transplant Coordination; Interpersonal and Professional Skills for Transplant Coordinators, and Introduction to Research Methods for Transplant Coordinators. Between 1996 and 1999, 64 transplant coordinators (60% of transplant coordinators currently in post) in the United Kingdom have undertaken at least 1 module. The Association feels that the accredited training program means one step further on the road to professional recognition of transplant coordinators in the United Kingdom.