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Liver Donor Living Donor Research Psychosocial Risks

Psychiatric Complications in Living Liver Donors

The authors studied 142 donors who underwent live-donor liver transplantation at Nagoya University Hospital between April 2004 and July 2014. None of the living donors had pre-existing psychological complaints prior to donation.

 

4.2% developed psychiatric complaints after donation, including major depressive disorder, panic disorder, conversion disorder, and substance use disorder.

(my emphasis)

“all donors received anti-anxiety drugs, half took anti-depressants, and supportive psychiatric therapy was concomitantly provided to all subjects. The average treatment period was 53.3 months. Regarding subject outcomes, 50% donors achieved remission, and the other half continued treatment.”

 

The average treatment period was 4.5 years. Think of that whenever someone says that liver donation has no long-term consequences.

 
Kimura, H., Onishi, Y., Sunada, S., Kishi, S., Suzuki, N., Tsuboi, C., Yamaguchi, N., Imai, H., Kamei, H., Fujisiro, H., Okada, T., Ishigami, M., Ogura, Y., Kiuchi, T., & Ozaki, N. (2015). Postoperative Psychiatric Complications in Living Liver Donors Transplantation Proceedings, 47 (6), 1860-1865 DOI: 10.1016/j.transproceed.2015.06.021

Categories
Living Donor Protections Living Donor Research Living Kidney Donor Psychosocial Risks

Resilience and Quality of Life in Living Kidney Donors

Resilience, according to various sources on the net, is described as an ability to recover quickly from misfortune, change or difficulty; moderating the negative effects of stress, and promoting adaptation.

 

In this study, 161 potential living kidney donors took the RS-13 (Short version of the Resilience Scale), which “measures the competence to moderate the negative effects of stress, and acceptance of life and self”. The prospective kidney donors had higher resilience scores than the norm. The 12 excluded potential living donors had resilience scores comparable to the norm.

 

For quality of life, the researchers “used the German version of WHOQOL-Bref, which includes four domains such as physical health, psychological health, social relationships and environmental conditions.”

“In all domains of quality of life, eligible donors had significantly higher values than the normative sample”

 

(emphasis mine)

Three months after donation health-related quality of life was significantly impaired in all domains compared to pre-donation values

“Out of the whole group of potential kidney donors (n=?161) 111 have undergone a nephrectomy. 41 (46.7 %) donors responded to follow-up questionnaires by mail*. Three months after donation, all domains of health related quality of life were correlated significantly with pre-donation resilience score”

“Our results indicate donors may have higher distress levels in the early period after nephrectomy. Psychosocial support may be most necessary at this point in time.”

 

One more note (emphasis mine):

“The authors reported emotional summary score for quality of life was lower in female donors, caused by a reduced role functioning. The world-wide higher incidence of depressive disorders in women may explain the differences. Women may be burdened by multiple familial role requirements in the context of donation, e.g. as donors and simultaneously as care giving marital partners. Nevertheless this finding requires further investigation and women should be regarded as a risk group.”

This echoes another recent study, which found that female living donors experienced greater fatigue, role function reduction and depression post-donation.

 

*Gotta wonder about that other half.
Erim, Y., Kahraman, Y., Vitinius, F., Beckmann, M., Kröncke, S., & Witzke, O. (2015). Resilience and quality of life in 161 living kidney donors before nephrectomy and in the aftermath of donation: a naturalistic single center study BMC Nephrology, 16 (1) DOI: 10.1186/s12882-015-0160-z

Categories
Ethical Considerations Liver Donor Living Donor Research Living Donor Risks Psychosocial Risks

Liver Donors Suffer Emotionally Post-Transplant

Even I was pretty shocked by the breadth and depth of this one.

South Korea, Japan and other Asian countries perform a lot more living liver donations than the U.S. because deceased donor livers are unavailable (or in very short supply). I’ve been well aware of the possible detrimental psychological and emotional consequences of living donation (kidney and/or liver) for quite some time, but this surprised even me.

Of the 30 categories derived from the liver donors’ interviews, 27 were unambiguously negative. While it would be easy to dismiss these results with “They only talked to 10 liver donors” and “It’s only one study” or even “it’s a cultural thing”, the authors admit the results confirm what other previous researchers have found. And I’ve heard variations of these same sentiments from American living donors many times over the past six years.

In other words, this is not an aberration.

 

Here are some examples:

“I felt more emptiness than a sense of fulfillment of donating my liver.”

“If I had known about the physical side effects, it wouldn’t be so tough mentally. I resent that I wasn’t given information about this.”

“The donor also underwent a huge operation but all the guardians go to the recipient…” [Note: I don’t know what “guardians” refers to here, but the category was “focus on the recipient”, a sentiment I’ve heard a lot]

“I don’t believe TV anymore. It tricked us by showing a donor saying that nothing was wrong after the donation.”

“We can’t tell the recipient where we are hurting. Even if we are hurting. We have to be careful. ”

“I get really depressed. The loss of energy makes me feel really depressed.”

“Even after two years since donating my organ, I can’t sleep well and even when I do sleep, it feels like I didn’t sleep properly.”

 

 

Please click the link above and read the entire chart.

 
Jeong, & Yoo (2014). The psychological and mental experiences of living liver donors in South Korea Contemporary Engineering Sciences DOI: 10.12988/ces.2014.49149

Categories
Ethical Considerations Informed Consent Psychosocial Risks

Unintended Consequences

Excerpt:

…former Chicago Bear Dave Duerson that, after deciding to kill himself last Thursday, he shot himself in the chest, apparently so that his brain could remain intact for similar examination.

This intent, strongly implied by text messages Duerson sent to family members soon before his death, has injected a new degree of fear in the minds of many football players and their families, according to interviews with them Sunday. To this point, the roughly 20 N.F.L. veterans found to have chronic traumatic encephalopathy — several of whom committed suicide — died unaware of the disease clawing at their brains, how the protein deposits and damaged neurons contributed to their condition.

Duerson, 50, was the first player to die after implying that brain trauma experienced on the football field would be partly responsible for his death.

Because of the trauma I experienced after my kidney donation, including the transplant industry’s complete abandonment, I took it upon myself to look beyond the headlines and marketing material and began digging into published research articles. This lead to a closer examination of the history of the US transplant industry, including the activities of DHHS, HRSA, ACOT and OPTN/UNOS.

With each revelation, I was struck anew with horror and betrayal at what had been done to me without my consent. The adrenal dysfunction, pancreatits, higher risk of end stage renal disease, chylous ascites, cardiac issues, lack of long-term data, etc. By the time of my six month follow-up appointment, I was so terrified of how my body had been compromised that I couldn’t even look at my lab results.

I imagine this is, to some extent, how Duerson felt when he realized his football career may have permanently and crucially damaged his brain. He was prepared for the broken bones, strained ligaments and separated shoulders, but memory loss and unfixable depression? That simply wasn’t part of the contract.

Some players have, so far, been able to deny this phenomenon (just like some living donors I encounter, but that’s a post for a different day), but Duerson had to listen to the stories of the ‘old-timers’, how they ended up broke and homeless, and he saw first-hand how this brain damage could ruin a person’s life. His feelings of helplessness and futility must’ve been unbearable.

So far I’ve been lucky; my health and remaining kidney are holding steady. But I’m not naive enough to think I’m home free, and that’s why I have nothing but compassion for Duerson and his loved ones. I understand.