1
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Levea SL, Prasadh JG, Wang BK, Salcedo-Betancourt JD, Matevish L, Sanchez Vivaldi J, Lieber SR, Shah JA, Hwang CS, Wojciechowski D, Vagefi PA, Patel MS. A Contemporary Analysis of Mental Well-being Among Living Donor Kidney Applicants. Transplant Direct 2024; 10:e1631. [PMID: 38757049 PMCID: PMC11098232 DOI: 10.1097/txd.0000000000001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background Living donation is paramount for expanding the donor pool. The aim of this study was to assess changes over time in self-reported mental health of living donor kidney applicants in efforts to inform patient-centered discussions with potential donors. Methods Kidney donor applications from 2017 through 2021 were compiled. Data included age, gender, race, ethnicity, applicant-recipient relationship, medical history, and medications. Trends over time were analyzed and post hoc analyses were performed. Results During the study period, 2479 applicants to the living donor kidney program were evaluated; 73% of applicants were female individuals. More than half of applicants were not related to their intended recipient; this fraction increased from 46% in 2017 to 58% in 2021 (P < 0.01). A similar decline in family relations was not present among Black and Latino applicants. Of all applicants, 18% reported depression and 18% reported anxiety; 20% reported taking antidepressants or anxiolytics. Depression and anxiety increased 170% (P < 0.001) and 136% (P < 0.001) from 2018 to 2019, respectively; antidepressant and anxiolytic use rose 138% (P < 0.001) between 2018 and 2020. Conclusions The profile of living donor applicants has changed in recent years, with approximately 1 in 5 requiring antidepressants or anxiolytics. Predonation counseling and postdonation monitoring are imperative to decrease adverse psychological outcomes for living donors.
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Affiliation(s)
- Swee-Ling Levea
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jai G. Prasadh
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Benjamin K. Wang
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Lauren Matevish
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jorge Sanchez Vivaldi
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Sarah R. Lieber
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Jigesh A. Shah
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Christine S. Hwang
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
| | - David Wojciechowski
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX
| | - Parsia A. Vagefi
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Madhukar S. Patel
- Division of Surgical Transplantation, University of Texas Southwestern Medical Center, Dallas, TX
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2
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Cholin LK, Ramos EF, Yahr J, Schold JD, Poggio ED, Delvalle CL, Huml AM. Psychosocial characteristics of potential and actual living kidney donors. BMC Nephrol 2024; 25:31. [PMID: 38267875 PMCID: PMC10807153 DOI: 10.1186/s12882-023-03375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 10/19/2023] [Indexed: 01/26/2024] Open
Abstract
The psychosocial assessment is an essential component of the living kidney donor (LKD) evaluation. However, it remains uncertain how specific psychosocial factors impact LKD eligibility. We performed a retrospective chart review of LKD candidates who initiated the evaluation process and who had completed a required, in-person licensed social work (LSW) visit. LSW notes were reviewed for frequency of psychosocial factors that may impact the success of LKD candidate approval by the selection committee. 325 LKD candidates were included in the study: 104 not-approved and 221 approved. Not-approved LKD candidates were more likely to receive a negative family reaction to wanting to donate than approved LKD candidates (8.7% vs 1.4%, p < 0.01). On multivariate analysis, Black race, history of psychiatric illness, highest level of education being high school, and high psychosocial risk score assignment were all associated with a lower odds ratio of being approved. The majority of not-approved LKD candidates were disqualified for medical reasons (N = 76, 73.1%). In conclusion, psychosocial factors impact donation even after LKD candidates make it to an in-person evaluation.
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Affiliation(s)
- Liza K Cholin
- Department of Nephrology, The Ohio State University Wexner Medical Center, 300 W 10Th Ave, Columbus, OH, #1150, USA.
| | - Everly F Ramos
- Department of Internal Medicine, Cleveland Clinic, Cleveland, USA
| | - Jordana Yahr
- Department of Internal Medicine, Cleveland Clinic, Cleveland, USA
| | - Jesse D Schold
- Department of Surgery and Transplant, University of CO Anschutz Medical Campus, Aurora, CO,, USA
| | - Emilio D Poggio
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Transplantation, Cleveland Clinic, Cleveland, OH, USA
| | | | - Anne M Huml
- Department of Kidney Medicine, Cleveland Clinic, Cleveland, OH, USA
- Department of Transplantation, Cleveland Clinic, Cleveland, OH, USA
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3
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Psychosocial and Ethical Behaviors and Attitudes of Health Care Professionals in the Clinical Setting of Living Kidney Donors: A Qualitative Study. Transplant Proc 2022; 54:1750-1758. [PMID: 35985877 DOI: 10.1016/j.transproceed.2022.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 03/15/2022] [Accepted: 04/13/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND There are several psychosocial and ethical issues surrounding the decision making of living kidney transplant donors. This study aimed to determine what health care professionals (HPs) consider in their clinical practice and their attitudes toward donors' decision-making processes. METHODS Face-to-face semistructured interviews were conducted with 15 HPs. A thematic analysis was performed to categorize the thematic elements of the transcripts. All procedures were approved by the relevant review board and conducted in accordance with the Declaration of Helsinki. RESULTS Six main categories-maintaining family relationships, improving donor understanding, supporting voluntary decision making, setting the environment for the examination, having different attitudes toward the donor's intentions, and resisting confirmation of intent-were identified. The HPs provided diverse considerations to respect the donors' autonomy. CONCLUSION In clinical practice, there is a lack of practical methods to confirm living donors' levels of understanding and spontaneity, suggesting that these methods need to be established. Factors related to family functioning may reflect the unique culture of Japan, and this may be indicative of the need to consider treatment based on cultural values.
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Abstract
BACKGROUND Living kidney donors incur donation-related expenses, but how these expenses impact postdonation mental health is unknown. METHODS In this prospective cohort study, the association between mental health and donor-incurred expenses (both out-of-pocket costs and lost wages) was examined in 821 people who donated a kidney at one of the 12 transplant centers in Canada between 2009 and 2014. Mental health was measured by the RAND Short Form-36 Health Survey along with Beck Anxiety Inventory and Beck Depression Inventory. RESULTS A total of 209 donors (25%) reported expenses of >5500 Canadian dollars. Compared with donors who incurred lower expenses, those who incurred higher expenses demonstrated significantly worse mental health-related quality of life 3 months after donation, with a trend towards worse anxiety and depression, after controlling for predonation mental health-related quality of life and other risk factors for psychological distress. Between-group differences for donors with lower and higher expenses on these measures were no longer significant 12 months after donation. CONCLUSIONS Living kidney donor transplant programs should ensure that adequate psychosocial support is available to all donors who need it, based on known and unknown risk factors. Efforts to minimize donor-incurred expenses and to better support the mental well-being of donors need to continue. Further research is needed to investigate the effect of donor reimbursement programs, which mitigate donor expenses, on postdonation mental health.
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5
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Massey EK, Pronk MC, Zuidema WC, Weimar W, van de Wetering J, Ismail SY. Positive and negative aspects of mental health after unspecified living kidney donation: A cohort study. Br J Health Psychol 2021; 27:374-389. [PMID: 34296497 PMCID: PMC9291094 DOI: 10.1111/bjhp.12549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/16/2021] [Indexed: 11/28/2022]
Abstract
Objectives Unspecified donors give a kidney to a stranger with end‐stage kidney failure. There has been little research on the long‐term impact of unspecified donation on mental health outcomes. The aim of this study was to assess the positive and negative aspects of mental health among unspecified donors. Design We invited all unspecified donors who donated a kidney between 2000 and 2016 at our centre to participate in an interview and to complete validated questionnaires. Methods We measured positive mental health using the Dutch Mental Health Continuum‐Short Form (MHC‐SF), psychological complaints using the Symptoms Checklist‐90 (SCL‐90) and psychiatric diagnoses using the Mini‐International Neuropsychiatric Interview (M.I.N.I.) Screen for all donors and the M.I.N.I. Plus on indication. Results Of the 134 eligible donors, 114 participated (54% female; median age 66 years), a median of 6 years post‐donation. Scores on emotional and social well‐being subscales of the MHC‐SF were significantly higher than in the general population. Psychological symptoms were comparable to the general population. Thirty‐two per cent of donors had a current or lifetime psychiatric diagnosis. Psychological symptoms did not significantly change between the pre‐donation screening and the post‐donation study. Conclusions We concluded that, with the appropriate screening, unspecified donation is a safe procedure from a psychological perspective.
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Affiliation(s)
- Emma K Massey
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Mathilde C Pronk
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Willij C Zuidema
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Willem Weimar
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Medical Psychology and Psychotherapy, Erasmus Medical Center, Rotterdam, The Netherlands
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6
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Schick-Makaroff K, Hays RE, Hunt J, Taylor LA, Rudow DL. Education Priorities and What Matters to Those Considering Living Kidney Donation. Prog Transplant 2020; 31:32-39. [PMID: 33297879 DOI: 10.1177/1526924820978599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Although informed consent content elements are prescribed in detailed regulatory guidance, many live kidney donors describe feeling underprepared and under informed. The goal of this pilot study was to explore the educational components needed to support an informed decision-making process for living kidney donors. METHODS/APPROACH A qualitative description design was conducted with thematic analysis of 5 focus groups with 2 cohorts: living kidney donor candidates (n = 11) and living kidney donors (n = 8). FINDINGS The educational components needed to engage in an informed decision-making process were: 1) contingent upon, and motivated by, personal circumstances; 2) supported through explanation of risks and benefits; 3) enhanced by understanding the overall donation experience; and 4) personalized by talking to another donor. DISCUSSION Tailoring education to meet the needs for fully informed decision-making is essential. Current education requirements, as defined by regulatory bodies, remain challenging to transplant teams attempting to ensure fully informed consent of living kidney donor candidates. Information on the emotional, financial, and overall life impact is needed, along with acknowledgement of relational ties driving donor motivations and the hoped-for recipient outcomes. Discussion of care practices, and access to peer mentoring may further strengthen the informed decision-making process.
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Affiliation(s)
| | - Rebecca E Hays
- 5229University of Wisconsin Hospital and Clinics, Madison, WI, USA
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, 5944Mount Sinai Hospital, New York, NY, USA
| | - Laura A Taylor
- 1865Uniformed Services University of the Health Science/Daniel K. Inouye Graduate School of Nursing, Bethesda, MD, USA
| | - Dianne LaPointe Rudow
- Recanati/Miller Transplantation Institute, 5944Mount Sinai Hospital, New York, NY, USA
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7
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Altruistic Renal Donation in a Patient With Dissociative Identity Disorder: A Case Report. PSYCHOSOMATICS 2020; 61:825-829. [DOI: 10.1016/j.psym.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/25/2022]
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8
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Kook YWA, Shenoy A, Hunt J, Desrosiers F, Gordon-Elliott JS, Jowsey-Gregoire S, Trompeta JA, Vandrovec M, Weinberg S, Fan W, LaPointe Rudow D. Multicenter investigation of the reliability and validity of the live donor assessment tool as an enhancement to the psychosocial evaluation of living donors. Am J Transplant 2019; 19:1119-1128. [PMID: 30414243 DOI: 10.1111/ajt.15170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/15/2018] [Accepted: 10/21/2018] [Indexed: 01/25/2023]
Abstract
The live donor assessment tool (LDAT) is the first psychosocial assessment tool developed to standardize live donor psychosocial evaluations. A multicenter study was conducted to explore reliability and validity of the LDAT and determine its ability to enhance the psychosocial evaluation beyond its center of origin. Four transplant programs participated, each with their own team of evaluators and unique demographics. Liver and kidney living donors (LDs) undergoing both standard psychosocial evaluation and LDAT from June 2015 to September 2016 were studied. LDAT interrater reliability, associations between LDAT scores and psychosocial evaluation outcome, and psychosocial outcomes postdonation were tested. 386 LD evaluations were compared and had a mean LDAT score of 67.34 ± 7.57. In 140 LDs with two LDATs by different observers, the interrater scores correlated (r = 0.63). LDAT scores at each center and overall stratified to the conventional grouping of psychosocial risk level. LDAT scores of 131 subjects who proceeded with donation were expectedly lower in LDs requiring postdonation counseling (t = -2.78, P = .01). The LDAT had good reliability between raters and predicted outcome of the psychosocial evaluation across centers. It can be used to standardize language among clinicians to communicate psychosocial risk of LD candidates and assist teams when anticipating postdonation psychosocial needs.
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Affiliation(s)
- Yoon Won Amy Kook
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Akhil Shenoy
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Farrah Desrosiers
- New York-Presbyterian/Weill Cornell Medical College, New York, New York
| | | | - Sheila Jowsey-Gregoire
- William J. Von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, Minnesota
| | - Joyce A Trompeta
- University of California (UCSF), San Francisco, San Francisco, California
| | - Margo Vandrovec
- William J. Von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, Minnesota
| | - Sandra Weinberg
- University of California (UCSF), San Francisco, San Francisco, California
| | - Weijia Fan
- Columbia University Mailman School of Public Health, New York, New York
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9
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Informative for Decision Making? The Spectrum and Consistency of Outcomes After Living Kidney Donation Reported in Trials and Observational Studies. Transplantation 2019; 103:284-290. [DOI: 10.1097/tp.0000000000002489] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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10
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Agerskov H, Thiesson H, Specht K, D Pedersen B. Parents' experiences of donation to their child before kidney transplantation: A qualitative study. J Clin Nurs 2019; 28:1482-1490. [PMID: 30552722 DOI: 10.1111/jocn.14734] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/27/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
AIM AND OBJECTIVES To explore parents' experiences of donation to their child before kidney transplantation. BACKGROUND Transplantation is the treatment of choice for paediatric patients with end-stage renal disease. Living donor kidney transplantation has shown a higher long-term transplant survival compared to deceased donor transplantation and entails a more controllable process, with shorter waiting time. Besides complex care and treatment of their child, parents must reflect on the prospects of being a donor for their child. However, little is known about the parent donor and parent caregiver perspective. DESIGN A qualitative exploratory study taking a phenomenological-hermeneutic approach. METHOD The study was conducted in a Danish university hospital. Interviews were conducted with the parents of seven children, aged between 5-15 years, with end-stage renal disease in the period before kidney transplantation. Data were analysed with inspiration from Ricoeur's theory of interpretation on three levels: naïve reading, structural analysis and critical interpretation and discussion. RESULTS The decision about donation was experienced as a matter of course and commitment. There were preferences for a kidney from a living donor, including the hope of being accepted as a donor. Being refused as a donor revealed feelings of powerlessness. However, transformation was performed into having a new role providing care and comfort to the child during the transplant process. Asking family and friends about donation could feel like crossing a line. CONCLUSION The prospect of donating to one's child had an impact on the well-being of the entire family. Parents were in a vulnerable situation and in need of support, regarding both living and deceased donation. Waiting time included hopeful thoughts and reflections on a new caregiver role for the child during transplantation. RELEVANCE TO CLINICAL PRACTICE Health professionals' attention, engagement and dialogue are essential in order to gain extensive and varied knowledge about the individual parent's experiences and the well-being of the entire family to provide care and support before, during and after the donation and transplantation process.
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Affiliation(s)
- Hanne Agerskov
- Department of Nephrology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Institute, University of Southern Denmark, Odense C, Denmark
| | - Helle Thiesson
- Department of Nephrology, Odense University Hospital, Odense C, Denmark.,Department of Clinical Institute, University of Southern Denmark, Odense C, Denmark
| | - Kirsten Specht
- Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.,Faculty of Health Science, Department of Regional Health Research, University of Southern Denmark, Odense C, Denmark
| | - Birthe D Pedersen
- Department of Clinical Institute, University of Southern Denmark, Odense C, Denmark
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11
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Barnieh L, Kanellis J, McDonald S, Arnold J, Sontrop JM, Cuerden M, Klarenbach S, Garg AX, Boudville N. Direct and indirect costs incurred by Australian living kidney donors. Nephrology (Carlton) 2018; 23:1145-1151. [DOI: 10.1111/nep.13205] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2017] [Indexed: 12/22/2022]
Affiliation(s)
- Lianne Barnieh
- Division of Nephrology; Western University; London Ontario Canada
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Department of Medicine; Monash University; Melbourne Victoria Australia
| | - Stephen McDonald
- Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital; Adelaide South Australia Australia
| | - Jennifer Arnold
- Division of Nephrology; Western University; London Ontario Canada
| | - Jessica M. Sontrop
- Department of Epidemiology and Biostatistics; Western University; London Ontario Canada
| | - Meaghan Cuerden
- Division of Nephrology; Western University; London Ontario Canada
| | | | - Amit X. Garg
- Division of Nephrology; Western University; London Ontario Canada
- Department of Epidemiology and Biostatistics; Western University; London Ontario Canada
| | - Neil Boudville
- Medical School, Faculty of Medicine, Dentistry and Health Sciences; University of Western; Crawley Western Australia Australia
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12
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Frech A, Natale G, Hayes D, Tumin D. Marital Status and Return to Work After Living Kidney Donation. Prog Transplant 2018; 28:226-230. [PMID: 29879858 DOI: 10.1177/1526924818781560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE Living kidney donation is safe and effective, but patients in need of a transplant continue to outnumber donors. Disincentives to living donation include lost income, risk of job loss, perioperative complications, and unreimbursed medical expenses. METHODS This study uses US registry and follow-up data on living kidney donors from 2013 to 2015 to identify social predictors of return to work across gender following living kidney donation. RESULTS Using logistic regression, we find that predictors of return to work following living kidney donation differ for women and men. Among women, age, education, smoking status, and procedure type are associated with return to work. Among men, education, procedure type, and hospital readmission within 6 weeks postdonation are associated with return to work. Notably, single and divorced men are less likely to return to work compared to married men (odds ratio [OR] for single men 0.51, 95% confidence interval [CI], 0.37-0.69, P < .001; OR for divorced men 0.51, 95% CI, 0.34-0.75, P = .006). Marital status is not associated with return to work for women. Single and divorced men's greater odds of not returning to work are robust to controls for relevant pre- and postdonation characteristics. CONCLUSIONS Single and divorced men's lack of social support may present an obstacle to work resumption following living kidney donation.
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Affiliation(s)
- Adrianne Frech
- 1 Department of Health Sciences, University of Missouri, Kent State University, Ginny Natale, MA, USA
| | | | - Don Hayes
- 3 Nationwide Children's Hospital, Columbus, OH USA
| | - Dmitry Tumin
- 4 Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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13
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Hanson CS, Chapman JR, Gill JS, Kanellis J, Wong G, Craig JC, Teixeira-Pinto A, Chadban SJ, Garg AX, Ralph AF, Pinter J, Lewis JR, Tong A. Identifying Outcomes that Are Important to Living Kidney Donors: A Nominal Group Technique Study. Clin J Am Soc Nephrol 2018; 13:916-926. [PMID: 29853616 PMCID: PMC5989678 DOI: 10.2215/cjn.13441217] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/14/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Living kidney donor candidates accept a range of risks and benefits when they decide to proceed with nephrectomy. Informed consent around this decision assumes they receive reliable data about outcomes they regard as critical to their decision making. We identified the outcomes most important to living kidney donors and described the reasons for their choices. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Previous donors were purposively sampled from three transplant units in Australia (Sydney and Melbourne) and Canada (Vancouver). In focus groups using the nominal group technique, participants identified outcomes of donation, ranked them in order of importance, and discussed the reasons for their preferences. An importance score was calculated for each outcome. Qualitative data were analyzed thematically. RESULTS Across 14 groups, 123 donors aged 27-78 years identified 35 outcomes. Across all participants, the ten highest ranked outcomes were kidney function (importance=0.40, scale 0-1), time to recovery (0.27), surgical complications (0.24), effect on family (0.22), donor-recipient relationship (0.21), life satisfaction (0.18), lifestyle restrictions (0.18), kidney failure (0.14), mortality (0.13), and acute pain/discomfort (0.12). Kidney function and kidney failure were more important to Canadian participants, compared with Australian donors. The themes identified included worthwhile sacrifice, insignificance of risks and harms, confidence and empowerment, unfulfilled expectations, and heightened susceptibility. CONCLUSIONS Living kidney donors prioritized a range of outcomes, with the most important being kidney health and the surgical, lifestyle, functional, and psychosocial effects of donation. Donors also valued improvements to their family life and donor-recipient relationship. There were clear regional differences in the rankings.
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Affiliation(s)
- Camilla S. Hanson
- Sydney School of Public Health and
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jeremy R. Chapman
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - John S. Gill
- Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Kanellis
- Department of Nephrology, Monash Health and Centre for Inflammatory Diseases, Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Germaine Wong
- Sydney School of Public Health and
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, New South Wales, Australia
| | - Jonathan C. Craig
- Sydney School of Public Health and
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Armando Teixeira-Pinto
- Sydney School of Public Health and
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Steve J. Chadban
- Kidney Node, Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
- Renal Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Amit X. Garg
- Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada; and
| | - Angelique F. Ralph
- Sydney School of Public Health and
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Jule Pinter
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
- Division of Nephrology, Department of Medicine, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Joshua R. Lewis
- Sydney School of Public Health and
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health and
- Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
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14
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Rodrigue JR, Schold JD, Morrissey P, Whiting J, Vella J, Kayler LK, Katz D, Jones J, Kaplan B, Fleishman A, Pavlakis M, Mandelbrot DA. Mood, body image, fear of kidney failure, life satisfaction, and decisional stability following living kidney donation: Findings from the KDOC study. Am J Transplant 2018; 18:1397-1407. [PMID: 29206349 PMCID: PMC5988866 DOI: 10.1111/ajt.14618] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/02/2017] [Accepted: 11/29/2017] [Indexed: 01/25/2023]
Abstract
Prior studies demonstrate that most living kidney donors (LKDs) report no adverse psychosocial outcomes; however, changes in psychosocial functioning at the individual donor level have not been routinely captured. We studied psychosocial outcomes predonation and at 1, 6, 12, and 24 months postdonation in 193 LKDs and 20 healthy controls (HCs). There was minimal to no mood disturbance, body image concerns, fear of kidney failure, or life dissatisfaction, indicating no incremental changes in these outcomes over time and no significant differences between LKDs and HCs. The incidence of any new-onset adverse outcomes postdonation was as follows: mood disturbance (16%), fear of kidney failure (21%), body image concerns (13%), and life dissatisfaction (10%). Multivariable analyses demonstrated that LKDs with more mood disturbance symptoms, higher anxiety about future kidney health, low body image, and low life satisfaction prior to surgery were at highest risk of these same outcomes postdonation. It is important to note that some LKDs showed improvement in psychosocial functioning from pre- to postdonation. Findings support the balanced presentation of psychosocial risks to potential donors as well as the development of a donor registry to capture psychosocial outcomes beyond the mandatory 2-year follow-up period in the United States.
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Affiliation(s)
- JR Rodrigue
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - JD Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - P Morrissey
- Transplant Center, Rhode Island Hospital, Providence, RI
| | - J Whiting
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - J Vella
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - LK Kayler
- Montefiore Einstein Center for Transplantation, Bronx, NY,Regional Center of Excellence for Transplantation & Kidney Care, Erie County Medical Center, University of Buffalo, Buffalo, NY
| | - D Katz
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - J Jones
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - B Kaplan
- Department of Medicine, University of Arizona, Tucson, AZ,School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ
| | - A Fleishman
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - M Pavlakis
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - DA Mandelbrot
- Department of Medicine, University of Wisconsin, Madison, WI
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15
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Massey EK, Timmerman L, Ismail SY, Duerinckx N, Lopes A, Maple H, Mega I, Papachristou C, Dobbels F. The ELPAT living organ donor Psychosocial Assessment Tool (EPAT): from 'what' to 'how' of psychosocial screening - a pilot study. Transpl Int 2017; 31:56-70. [PMID: 28850737 DOI: 10.1111/tri.13041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/20/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
Thorough psychosocial screening of donor candidates is required in order to minimize potential negative consequences and to strive for optimal safety within living donation programmes. We aimed to develop an evidence-based tool to standardize the psychosocial screening process. Key concepts of psychosocial screening were used to structure our tool: motivation and decision-making, personal resources, psychopathology, social resources, ethical and legal factors and information and risk processing. We (i) discussed how each item per concept could be measured, (ii) reviewed and rated available validated tools, (iii) where necessary developed new items, (iv) assessed content validity and (v) pilot-tested the new items. The resulting ELPAT living organ donor Psychosocial Assessment Tool (EPAT) consists of a selection of validated questionnaires (28 items in total), a semi-structured interview (43 questions) and a Red Flag Checklist. We outline optimal procedures and conditions for implementing this tool. The EPAT and user manual are available from the authors. Use of this tool will standardize the psychosocial screening procedure ensuring that no psychosocial issues are overlooked and ensure that comparable selection criteria are used and facilitate generation of comparable psychosocial data on living donor candidates.
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Affiliation(s)
- Emma K Massey
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Lotte Timmerman
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Nathalie Duerinckx
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium.,Heart Transplant Program, Department of Cardiovascular Sciences, University Hospitals of Leuven, Leuven, Belgium
| | - Alice Lopes
- Psychiatry and Health Psychology Unit, Centro Hospitalar do Porto, Porto, Portugal
| | - Hannah Maple
- Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Inês Mega
- Hepato-Biliar-Pancreatic and Transplantation Center, Hospital Curry Cabral, Lisbon, Portugal
| | - Christina Papachristou
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
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16
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Abstract
There is a trend of recruiting faith leaders at mosques to overcome religious barriers to organ donation, and to increase donor registration among Muslims. Commentators have suggested that Muslims are not given enough information about organ donation in religious sermons or lectures delivered at mosques. Corrective actions have been recommended, such as funding campaigns to promote organ donation, and increasing the availability of organ donation information at mosques. These actions are recommended despite published literature expressing safety concerns (i.e., do no harm) in living and end-of-life organ donation. Living donors require life-long medical follow-up and treatment for complications that can appear years later. Scientific and medical controversies persist regarding the international guidelines for death determination in end-of-life donation. The medical criteria of death lack validation and can harm donors if surgical procurement is performed without general anesthesia and before biological death. In the moral code of Islam, the prevention of harm holds precedence over beneficence. Moral precepts described in the Quran encourage Muslims to be beneficent, but also to seek knowledge prior to making practical decisions. However, the Quran also contains passages that demand honesty and truthfulness when providing information to those who are seeking knowledge. Currently, information is limited to that which encourages donor registration. Campaigning for organ donation to congregations in mosques should adhere to the moral code of complete, rather than selective, disclosure of information. We recommend as a minimal standard the disclosure of risks, uncertainties, and controversies associated with the organ donation process.
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Affiliation(s)
- Mohamed Y. Rady
- Department of Critical Care Medicine, Mayo Clinic Hospital, 5777 East Mayo Blvd, Phoenix, AZ 85054 USA
| | - Joseph L. Verheijde
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85259 USA
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17
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DiMartini A, Dew MA, Liu Q, Simpson MA, Ladner DP, Smith AR, Zee J, Abbey S, Gillespie BW, Weinrieb R, Mandell MS, Fisher RA, Emond JC, Freise CE, Sherker AH, Butt Z. 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). Am J Transplant 2017; 17:1081-1096. [PMID: 27647626 PMCID: PMC5359081 DOI: 10.1111/ajt.14055] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/04/2016] [Accepted: 09/07/2016] [Indexed: 01/25/2023]
Abstract
Because 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 Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2) consortium. Among other initiatives, A2ALL-2 examined the nature of these outcomes following donation. Using validated measures, donors were prospectively surveyed before donation and at 3, 6, 12, and 24 mo after donation. Repeated-measures regression models were used to examine social relationship and financial outcomes over time and to identify relevant predictors. Of 297 eligible donors, 271 (91%) consented and were interviewed at least once. Relationship changes were positive overall across postdonation time points, with nearly one-third reporting improved donor family and spousal or partner relationships and >50% reporting improved recipient relationships. The majority of donors, however, reported cumulative out-of-pocket medical and nonmedical expenses, which were judged burdensome by 44% of donors. Lower income predicted burdensome donation costs. Those who anticipated financial concerns and who held nonprofessional positions before donation were more likely to experience adverse financial outcomes. These data support the need for initiatives to reduce financial burden.
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Affiliation(s)
- A DiMartini
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, USA,Department of Surgery, University of Pittsburgh, Pittsburgh PA, USA
| | - MA Dew
- Department of Psychiatry, University of Pittsburgh, Pittsburgh PA, USA,Department of Psychology, University of Pittsburgh, Pittsburgh PA, USA,Department of Epidemiology, University of Pittsburgh, Pittsburgh PA, USA,Department of Biostatistics, University of Pittsburgh, Pittsburgh PA, USA
| | - Q Liu
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - MA Simpson
- Lahey Hospital and Medical Center Clinical Research and Education, Burlington, MA, USA,Department of Transplantation, Burlington, MA, USA
| | - DP Ladner
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Chicago, IL, USA,Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA
| | - AR Smith
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA,Departments of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - J Zee
- Arbor Research Collaborative for Health, Ann Arbor, MI, USA
| | - S Abbey
- Department of Psychiatry, University of Toronto and University Health Network, Toronto ON, CA
| | - BW Gillespie
- Departments of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - R Weinrieb
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - MS Mandell
- Department of Anesthesiology, University of Colorado, Denver CO, USA
| | - RA Fisher
- Department of Transplant Surgery, Virginia Commonwealth University, Richmond, VA, USA (current affiliation, Beth Israel Deaconess Department of Surgery, Harvard University)
| | - JC Emond
- Department of Surgery, Columbia University Medical Center, New York, New York, USA
| | - CE Freise
- Department of Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - AH Sherker
- Liver Diseases Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Z Butt
- Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Chicago, IL, USA,Comprehensive Transplant Center, Northwestern University, Chicago, IL, USA,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago IL, USA,Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago IL, USA
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18
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Traino HM, Nonterah CW, Gupta G, Mincemoyer J. Living Kidney Donors' Information Needs and Preferences. Prog Transplant 2016; 26:47-54. [PMID: 27136249 DOI: 10.1177/1526924816633943] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Past research suggests the information exchanged from transplant centers to potential living kidney donors is, in many cases, suboptimal. The purpose of this study was to assess donors' perceptions of the information provided while considering living donation. METHODS Semistructured telephone interviews conducted with 81 past living donors seen at 1 mid-Atlantic transplant center assessed the extent to which living kidney donors deemed Centers for Medicare and Medicaid Services (CMS)-mandated information useful to making a decision about donation and to which more information was or would have been desired before donating. Understanding of and satisfaction with the information was also assessed. RESULTS Participants were primarily white (67.9%), females (67.9%), with an average age of 57.8 years. Perceived usefulness ranged from a mean of 3.1 for the confidentiality of the transplant center's communication to 4.1 for postoperative care and short-term medical risks of donation. Donors of minority descent as well as those with more education and less income found the information provided most useful. Few donors desired additional information about the right to opt out of (8.6%) or decline (13.6%) donation; however, most wanted more information regarding the risk of being refused health, disability and/or life insurance after donating (77.8%), and insurance coverage for future health problems (66.7%). DISCUSSION This study revealed limited usefulness of certain CMS-mandated topics and a desire for additional information about donation. Efforts to standardize the informed consent process should incorporate donors' perspectives as to the specific topics, quantity of information, and the mode of communication found most useful when considering living donation.
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Affiliation(s)
- Heather M Traino
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Camilla W Nonterah
- Department of Psychology, Virginia Commonwealth University (VCU), Richmond, VA, USA
| | - Gaurav Gupta
- Department of Internal Medicine, VCU Health System, Richmond, VA, USA
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19
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Hays R, Rodrigue JR, Cohen D, Danovitch G, Matas A, Schold J, LaPointe Rudow D. Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies. Am J Transplant 2016; 16:1973-81. [PMID: 27037542 DOI: 10.1111/ajt.13813] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/13/2016] [Accepted: 03/19/2016] [Indexed: 01/25/2023]
Abstract
In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation-related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out-of-pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD "financial neutrality," offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation.
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Affiliation(s)
- R Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - J R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - D Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - G Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - A Matas
- Department of Surgery, University of Minnesota Medical Center-Fairview, Minneapolis, MN
| | - J Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - D LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
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20
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Timmerman L, Laging M, Timman R, Zuidema WC, Beck DK, IJzermans JN, Betjes MG, Busschbach JJ, Weimar W, Massey EK. The impact of the donors' and recipients' medical complications on living kidney donors' mental health. Transpl Int 2016; 29:589-602. [DOI: 10.1111/tri.12760] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/28/2015] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Lotte Timmerman
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Mirjam Laging
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Reinier Timman
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Willij C. Zuidema
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Denise K. Beck
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan N.M. IJzermans
- Department of General Surgery; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Michiel G.H. Betjes
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan J.V. Busschbach
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
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21
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Rodrigue JR, Schold JD, Morrissey P, Whiting J, Vella J, Kayler LK, Katz D, Jones J, Kaplan B, Fleishman A, Pavlakis M, Mandelbrot DA. Direct and Indirect Costs Following Living Kidney Donation: Findings From the KDOC Study. Am J Transplant 2016; 16:869-76. [PMID: 26845630 DOI: 10.1111/ajt.13591] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 09/11/2015] [Accepted: 09/23/2015] [Indexed: 01/25/2023]
Abstract
Some living kidney donors (LKDs) incur costs associated with donation, although these costs are not well characterized in the United States. We collected cost data in the 12 mo following donation from 182 LKDs participating in the multicenter prospective Kidney Donor Outcomes Cohort (KDOC) Study. Most LKDs (n = 167, 92%) had one direct cost or more following donation, including ground transportation (86%), health care (41%), meals (53%), medications (36%), lodging (23%), and air transportation (12%). LKDs missed 33 072 total work hours, 40% of which were unpaid and led to $302 175 in lost wages (mean $1660). Caregivers lost $68 655 in wages (mean $377). Although some donors received financial assistance, 89% had a net financial loss in the 12-mo period, with one-third (33%) reporting a loss exceeding $2500. Financial burden was higher for those with greater travel distance to the transplant center (Spearman's ρ = 0.26, p < 0.001), lower household income (Spearman's ρ = -0.25, p < 0.001), and more unpaid work hours missed (Spearman's ρ = 0.52, p < 0.001). Achieving financial neutrality for LKDs must be an immediate priority for the transplant community, governmental agencies, insurance companies, nonprofit organizations, and society at large.
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Affiliation(s)
- J R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - J D Schold
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - P Morrissey
- Transplant Center, Rhode Island Hospital, Providence, RI
| | - J Whiting
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - J Vella
- Maine Transplant Center, Maine Medical Center, Portland, ME
| | - L K Kayler
- Montefiore Einstein Center for Transplantation, Bronx, NY.,Regional Center of Excellence for Transplantation and Kidney Care, Erie County Medical Center, University of Buffalo, Buffalo, NY
| | - D Katz
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - J Jones
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - B Kaplan
- Department of Medicine, University of Arizona, Tucson, AZ.,School for the Science of Health Care Delivery, Arizona State University, Phoenix, AZ
| | - A Fleishman
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
| | - M Pavlakis
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Harvard Medical School, Boston, MA
| | - D A Mandelbrot
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA.,Department of Medicine, University of Wisconsin, Madison, WI
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22
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Timmerman L, Timman R, Laging M, Zuidema WC, Beck DK, IJzermans JNM, Busschbach JJV, Weimar W, Massey EK. Predicting mental health after living kidney donation: The importance of psychological factors. Br J Health Psychol 2016; 21:533-54. [DOI: 10.1111/bjhp.12184] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 12/22/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Lotte Timmerman
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Reinier Timman
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center; Rotterdam The Netherlands
| | - Mirjam Laging
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Willij C. Zuidema
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Denise K. Beck
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Jan N. M. IJzermans
- Department of General Surgery; Erasmus Medical Center; Rotterdam The Netherlands
| | - Jan J. V. Busschbach
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center; Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine; Section Nephrology & Transplantation; Erasmus Medical Center; Rotterdam The Netherlands
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23
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Matas AJ, Hays RE. Little effect of state policies on organ donation in the USA. Nat Rev Nephrol 2015; 11:570-2. [DOI: 10.1038/nrneph.2015.113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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24
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Tushla L, Rudow DL, Milton J, Rodrigue JR, Schold JD, Hays R. Living-Donor Kidney Transplantation: Reducing Financial Barriers to Live Kidney Donation--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1696-702. [PMID: 26002904 DOI: 10.2215/cjn.01000115] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.
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Affiliation(s)
- Lara Tushla
- University Transplant Program, Rush University Medical Center, Chicago, Illinois;
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York
| | - Jennifer Milton
- University of Texas Health Science Center of San Antonio, San Antonio, Texas
| | - James R Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; and
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
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25
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Tan JC, Gordon EJ, Dew MA, LaPointe Rudow D, Steiner RW, Woodle ES, Hays R, Rodrigue JR, Segev DL. Living Donor Kidney Transplantation: Facilitating Education about Live Kidney Donation--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1670-7. [PMID: 25908792 DOI: 10.2215/cjn.01030115] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Best Practice in Live Kidney Donation Consensus Conference held in June of 2014 included the Best Practices in Living Donor Education Workgroup, whose charge was to identify best practice strategies in education of living donors, community outreach initiatives, commercial media, solicitation, and state registries. The workgroup's goal was to identify critical content to include in living kidney donor education and best methods to deliver educational content. A detailed summary of considerations regarding educational content issues for potential living kidney donors is presented, including the consensus that was reached. Educational topics that may require updating on the basis of emerging studies on living kidney donor health outcomes are also presented. Enhancing the educational process is important for increasing living donor comprehension to optimize informed decision-making.
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Affiliation(s)
- Jane C Tan
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California;
| | - Elisa J Gordon
- Center for Healthcare Studies and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York
| | - Robert W Steiner
- Department of Medicine, University of California at San Diego, San Diego, California
| | - E Steve Woodle
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital, Madison, Wisconsin
| | - James R Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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26
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Rudow DL, Hays R, Baliga P, Cohen DJ, Cooper M, Danovitch GM, Dew MA, Gordon EJ, Mandelbrot DA, McGuire S, Milton J, Moore DR, Morgieivich M, Schold JD, Segev DL, Serur D, Steiner RW, Tan JC, Waterman AD, Zavala EY, Rodrigue JR. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant 2015; 15:914-22. [PMID: 25648884 PMCID: PMC4516059 DOI: 10.1111/ajt.13173] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 12/07/2014] [Accepted: 12/21/2014] [Indexed: 01/25/2023]
Abstract
Live donor kidney transplantation is the best treatment option for most patients with late-stage chronic kidney disease; however, the rate of living kidney donation has declined in the United States. A consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Transplant professionals, patients, and other key stakeholders discussed processes for educating transplant candidates and potential living donors about living kidney donation; efficiencies in the living donor evaluation process; disparities in living donation; and financial and systemic barriers to living donation. We summarize the consensus recommendations for best practices in these educational and clinical domains, future research priorities, and possible public policy initiatives to remove barriers to living kidney donation.
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Affiliation(s)
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - Prabhakar Baliga
- Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - David J. Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | | | - Gabriel M. Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Elisa J. Gordon
- Comprehensive Transplant Center and Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Suzanne McGuire
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Jennifer Milton
- Transplant Center, University of Texas at San Antonio, San Antonio, TX
| | - Deonna R. Moore
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Marie Morgieivich
- The Living Donor Institute, Barnabas Health Transplant Division, Livingston, NJ
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Serur
- Department of Medicine, Cornell University, New York, NY
| | - Robert W. Steiner
- Department of Medicine, University of California at San Diego, San Diego, CA
| | - Jane C. Tan
- Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Amy D. Waterman
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - Edward Y. Zavala
- Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - James R. Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Timmerman L, Laging M, Westerhof GJ, Timman R, Zuidema WC, Beck DK, IJzermans JNM, Betjes MGH, Busschbach JJV, Weimar W, Massey EK. Mental health among living kidney donors: a prospective comparison with matched controls from the general population. Am J Transplant 2015; 15:508-17. [PMID: 25582231 DOI: 10.1111/ajt.13046] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Revised: 10/07/2014] [Accepted: 10/08/2014] [Indexed: 01/25/2023]
Abstract
The impact of living kidney donation on donors' mental health has not been sufficiently nor comprehensively studied. Earlier studies demonstrated that mental health did not change in the majority of donors, however they often lacked a suitable control group and/or had other methodological limitations. Consequently, it remains unclear whether changes in mental health found among a minority of donors reflect normal fluctuations. In this study we matched 135 donors with individuals from the general Dutch population on gender and baseline mental health and compared changes in mental health over time. Mental health was measured using the Brief Symptom Inventory and Mental Health Continuum Short Form. Primary analyses compared baseline and 6 months follow-up. Secondary analyses compared baseline and 9 (controls) or 15 months (donors) follow-up. Primary multilevel regression analyses showed that there was no change in psychological complaints (p = 0.20) and wellbeing (p = 0.10) over time and donors and controls did not differ from one another in changes in psychological complaints (p = 0.48) and wellbeing (p = 0.85). Secondary analyses also revealed no difference in changes between the groups. We concluded that changes in mental health in the short term after donation do not significantly differ from normal fluctuations found in the Dutch general population.
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Affiliation(s)
- L Timmerman
- Department of Internal Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
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