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Living Donor Research Living Kidney Donor Psychosocial Risks

Female Living Kidney Donors Show Impairment

ETA 10-3-2015: more info and links.

Researchers at the Transplant Center at Heidelberg provided inventories to 400+ of their living donors, an average of 77 months post-donation. From the abstract:

  • 27% were receiving hypertensive medication.
  • SF-36 mental component summary score was lower for female donors, caused by a reduced role functioning.
  • Prevalence of fatigue was increased in female donors between the ages of 40 and 59 years.

 

This is how this particular transplant center selects and treats their living kidney donors:

“According to the Center’s practice, a medically low-risk population is eligible for donation. Body mass index should
be <35 kg/m2 and blood pressure has to be well controlled with at least two antihypertensives (systolic/diastolic blood pressure <140/90 mmHg). Donors with diabetes or impaired fasting glucose concentrations as well as donors
with obvious psychiatric diseases are not accepted as living renal donors.”

“In addition,medical history, clinical data, laboratory, and extensive body examination results were collected during the regular visits at the Transplant Center prior to living donation and yearly thereafter.”

US transplant centers are supposed to provide follow-up at six weeks, six-months, one-year and two-years post-donation. However, as of 2013, 35% were reported lost by one year with no indication contact was attempted. LKDs are on their own after two years, and mental health care is never required.

 

About the assessment tools used:

“The SF-36 is a self-assessment of day-to-day function and well-being over the previous 4 weeks. The SF-36 contains eight multi-item subscales: general health perceptions, physical functioning, physical role (role limitations due to physical problems), bodily pain, general mental health, vitality (vitality, energy, fatigue), emotional role (role limitations due to emotional problems), and social functioning.”

“The MFI-20 [Multidimensional Fatigue Inventory] is a 20-item self-administered questionnaire developed to assess fatigue and to reflect feelings over the previous few days [17]. The MFI-20 consists of five subscales: general fatigue, physical fatigue, mental fatigue, reduced activity, and reduced motivation.”

“Depression was measured with the depression part of the Psychosomatic Health Questionnaire PHQ-9 [19]. The
PHQ-9 is the summary of nine items on a three-point scale with higher scores indicating more depressive symptoms
within the previous 4 weeks. Somatization was measured using the PHQ-15 somatic symptom module [20], which
consists of 15 items on somatic symptoms and answered on a three-point scale.”

 

Composition of the study participants:

“In total, 430 of 519 living renal donors were eligible to participate. Eleven previous living kidney donors (median time after donation 245 (43–555) months) had already died (two from cancer, three from cardiac disease, two from liver cirrhosis, and four unknown).”

“…completed questionnaires were returned by 295 living donors [106 (35.9%) male]. Non-responding donors were younger than the responding donors at the time of donation (43  vs. 49) and at the time of questionnaire distribution (55  vs. 57). In the responding donor cohort, the mean age at donation was 49  11 years, with 19 donors over the age of 65 years. The median time after donation was 77 (24–484) months, with 85 (28.8%) donors being ?10 years post-donation”

“68.6% of all donors at the Transplant Center provided informed consent and answered the questionnaires.”

(emphasis below mine)

Most of the donors were first-degree relatives [mother n = 78 (26.4% of total); father n = 58 (19.7%); (brother n = 15 (5.1%); sister n = 32 (10.8%)] and second-degree relative spouses [wife n = 69 (23.4%); husband n = 24 (8.1%)].

Health risks can have a biological component. Also, some transplant professionals seem to hold the belief that relatives have an obligation or duty to donate. Complicated familial relationships can make the decision not to donate nearly impossible.

“93% donors would again donate the kidney to the specific recipient.”

Which is exactly why researchers need to stop asking living donors if they don’t donate again or if they regret donating. Because the question is really asking: Would you try to help your loved one again? Which is an incredibly biased and unfair question.

 

  • Kidney function (GFR) decreased 30% or more in 36.95 of LKDs; 2 donors lost more than 50% of their pre-donation GFR.
  • Significant protein excretion (?150 mg/l) was noted in 2.4% donors before donation and in 5.8% donors post-donation (So that doubled).
  • Antihypertensive medication was administered to 19.0% donors before and to 27.1% donors post-donation. New onset or worsening of hypertension,defined as de novo antihypertensives or >30% increase of
    MAP, was documented in 12.9% donors.

 

Living donors are *supposed to be* healthier and more well-adjusted than the general population. At least this is what the transplant industry keeps telling the public. So, when analysis results say “LDs fare better than the general population”, that’s a reason to yawn. We *should* be, according to the transplant industry’s insistence. But when we are “equal to” or “less than” the general population. we’ve most assuredly been harmed and diminished in some way.

 

  • The role function of female donors was rated lower by living kidney donors compared with the German population.
  • Physical fatigue or mental fatigue above the average results of the general population was detected in 15% and 17% of all the donors.
  • Detailed analysis revealed female donors ranging in age from 40 to 59 years were a more vulnerable population for general and physical fatigue,
  • Depressive disorders, including minor symptoms, were noted in 82.8% of donors with signs of fatigue.
  • Fatigue scores correlated inversely with quality of life assessed by the SF-36 physical
    and mental component score. [This means that as fatigue scores increased, quality of life scores decreased]

 

I’m including the information below not just for the sciency types, but so living donors can understand what symptoms to look for and know they’re not alone:

  • The Mental Component Score measured: disturbances in concentration and memory, brooding, reduced motivation
    (fatigue scale), depression sum score, and partnership problems.
  • The Physical Component Score measured: health concerns, muscle weakness, arthralgia, and deterioration of athleticism.
  • (emphasis mine) Recipient health did not independently predict either of the above two scores.
  • General fatigue was determined by depression symptoms (PHQ-9 sum scale), exhaustion, muscle weakness, the burden of caring for a family member, and having nobody to talk to.
  • The depression sum scale was predicted by Mental Component Scale, Physical Component Scale, sleeplessness, exhaustion, having nobody to talk to, stress at work or school, emotional distress, scar numbness or prickling, and financial difficulties.

 

This is the third recent study demonstrating fatigue, loss of vitality or a decreased quality of life for living kidney donors.The first that revealed a more significant issue in women.

“…guidelines on psychosocial donor evaluation are inconsistent among various transplant centers and countries. There is a need for prospective psychosocial outcome studies on living donors and the use of uniform terminology to label psychosocial screening criteria”

No kidding.

“Detailed analysis shows that fatigue was present in female donors aged between 40 and 59 years. This cohort represents an emotionally and physically highly engaged population. These results have important implications, because this cohort includes a considerable number of donors”

Yes. Exactly.

 

 

Post-script: This little nugget was buried in the middle of the “discussion” portion of the paper (emphasis mine again) –

In the present evaluation, approximately 8.5% of the donors were re-hospitalized after kidney donation; approximately 50% of these were possibly caused by donation (mostly wound problems). Schold et al. reported a cumulative 3-year incidence of re-hospitalization of 9% following donation; readmission resulting from surgical complications in the early post-transplant period might be common.

Common, huh? Wow. Tell that to all the transplant industry folks who keep claiming that complications are non-existent to rare.

 

 

Sommerer, C., Feuerstein, D., Dikow, R., Rauch, G., Hartmann, M., Schaier, M., Morath, C., Schwenger, V., Schemmer, P., & Zeier, M. (2015). Psychosocial and physical outcome following kidney donation-a retrospective analysis Transplant International, 28 (4), 416-428 DOI: 10.1111/tri.12509

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