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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
Liver Donor Living Donor Research

Deceased & Living Liver Transplant Comparable For Hepatorenal Syndrome

30 patients with HRS receiving a live donor liver transplantation (LDLT) and 90 HRS patients (Hepatorenal Syndrome) receiving a full graft deceased donor liver transplantation (DDLT) were compared.

No difference was detected between LDLT and DDLT patients regarding graft survival at 1 (80% vs. 82%), at 3 (69% vs. 76%) and 5 years (65% vs. 76%) (p = 0.63), as well as patient survival at 1 (83% vs. 82%), 3 (72% vs. 77%) and 5 years (72% vs. 77%) (p = 0.93). The incidence of chronic kidney disease post-LT (10% vs. 6%; p = 0.4) was similar between both groups. Living donor living transplant results in identical long-term outcome when compared with deceased donor liver transplant in patients with HRS.

 

*Hepatorenal Sydrome = progressive kidney disease and failure due to cirrhosis of the liver.

 

 

Goldaracena, N., Marquez, M., Selzner, N., Spetzler, V., Cattral, M., Greig, P., Lilly, L., McGilvray, I., Levy, G., Ghanekar, A., Renner, E., Grant, D., & Selzner, M. (2014). Living vs. Deceased Donor Liver Transplantation Provides Comparable Recovery of Renal Function in Patients With Hepatorenal Syndrome: A Matched Case-Control Study American Journal of Transplantation DOI: 10.1111/ajt.12975

Categories
Liver Donor Living Donor Research Living Donor Risks

Chronic Pain in Live Liver Donors

Emphasis mine:

 

A substantial proportion of donors reported a moderate-to-severe level of pain intensity (> 4 on a 0-10 scale) at rest and at movement on day one (42%, 74%) and day two (33%, 32%). Persistent post-surgical pain was reported by 31% of donors at the six-month follow-up and by 27% of donors at the twelve-month follow-up.

 

Holtzman S, Clarke HA, McCluskey SA, Turcotte K, Grant D, & Katz J (2014). Acute and chronic post-surgical pain after live liver donation: Incidence and predictors. Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society PMID: 25045167

Categories
Informed Consent Liver Donor Living Donor Research Psychosocial Risks

Complications and Quality of Life for Pediatric Live Liver Donors

Pediatric liver donors have the smaller lobe removed, as opposed to adult-to-adult living liver donation, which requires 60-75% of the donor’s liver. Pediatric liver donation has a lower surgical, or short-term, complication rate than adult-to-adult.

 

 A total of 13% of the donors developed postoperative complications of Clavien grades I (7%), II (3%), and IIIA (3%). There was no grade IV morbidity or mortality. 

 

…donors had difficulty in the decision-making process, and suggested that it may be necessary to administer multistep informed consent. We identified unique predictive risk factors for lower SF-36 scores in the donors, which were the time to donation (more than 4 weeks) and the predonation self-oriented perception. The donors who have risk factors require enhanced pre- and post-donation psychological care.

 

Unfortunately, like with most recently published articles, I am unable to access the full study without payment.

I’m curious to know what the researchers mean by “predonation self-oriented perception”. Are we talking about high expectations for transplant success? Or expectations regarding the relationship with the recipient? Or are the authors trying to say NARCISSIST nicely?

It’s also important to remember this are Japanese liver donors, so there may be some cultural differences.

 

http://www.sciencedirect.com/science/article/pii/S0041134514001419

Fukuda A, Sakamoto S, Shigeta T, Uchida H, Hamano I, Sasaki K, Kanazawa H, Loh DL, Kakee N, Nakazawa A, & Kasahara M (2014). Clinical Outcomes and Evaluation of the Quality of Life of Living Donors for Pediatric Liver Transplantation: A Single-Center Analysis of 100 Donors. Transplantation proceedings PMID: 24836837

Categories
Liver Donor Living Donor Research

HLA mismatch matters in live liver donation too

See yesterday’s explanation

From the authors:

Poor results after ABO-incompatible living donor liver transplantation (LDLT) are closely associated with severe hyperacute rejection due to the presence of anti-donor ABO antibodies during the early postoperative period.