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Living Donor Psychosocial Evaluations Are Inadequate

Seven European researchers, on behalf of the ELPAT Paychological Care for Living Donors and Recipients Working Group “performed a systematic literature review of guidelines, consensus statements, and protocols on the content and process of psychosocial screening of living kidney and liver donor candidatesThirty-four publications were identified, including seven guidelines, six consensus statements, and 21 protocols or programs.”

“Across 34 publications, 197 different psychosocial factors were identified that can be clustered into 42 psychosocial domains”. According to the researchers, this “broad spectrum” suggests that the transplant industry has no clear definition of what factors need to be identified and/or addressed.There was also a lot of discrepancy in terminology (e.g., psychological well-being, psychosocial stability, psychopathology) “and in the level of detail provided in defining each criterion: some authors only addressed broad “umbrella” terms, like psychiatric disorders, whereas others specified these (e.g., mood disorders (depression, anxiety), personality disorder (schizophrenia, borderline)). Moreover, some authors just listed factors without any clarification, whereas others provided detailed descriptions, together with examples from clinical practice. For example, Leo et al. explained why employment status is important, as employers are a principal source of economic support by providing sick leave or vacation time during postsurgical recovery.”

Here are some of the factors covered, from most common to least (From Table 4 in the paper):

  • Motivation-related factors: 73.5%
  • Coercion or Pressure to donate: 67.6%
  • Support before and after donation; 64.7%
  • Donor-recipient relationship: 58.8%
  • Current of Past psychiatric disorders: 50%
  • Competence: 47.1%
  • Financial Issues: 47.1%
  • Coping-related issues: 44.1%
  • Employment-related issues: 44.1%
  • Family-related issues: 41.2%
  • Ambivalence: 38.2%
  • Unrealistic Expectations: 32.4%
  • Cognitive Status: 29.4%
  • Health Behavior (eg. obesity, smoking, exercise): 23.5%
  • Potential Medical Risks and urgency of donation:: 8.8%
  • Health concerns during and after donation: 5.9%

“Most factors were not supported by evidence or were at least not referenced, making it unclear if they indeed predict poor outcomes in donor candidates.”

In layperson’s terms, this means no proof exists that any of the factors the evaluation examines (eg. drug abuse, history of depression] is linked to poor living donor outcomes. What this really means is that the transplant industry hasn’t taken the time to study living donors and quantify exactly how they fare post-donation and which attributes contribute to their well-being.

“Contraindications for donation [aka red flags, or reasons folks shouldn’t donate] were specifically stipulated in 18 papers (52.9%),of which only three indicated whether these were absolute or relative contraindications [‘relative’ meaning: well, maybe they shouldn’t donate, whereas ‘absolute’ means: no, absolutely not], and only one paper indicated that these were evidence-based”


Their final conclusion:

“At present, there is no consensus, nor strong evidence or concrete guidance on what to screen for, how to handle identified psychosocial problems, and how to perform the screening, leading to huge variability in screening practices,the risk that important psychosocial factors might be overlooked or that unnecessarily time-consuming and costly procedures are being undertaken.”

Read the whole thing at the link


Duerinckx, N., Timmerman, L., Van Gogh, J., van Busschbach, J., Ismail, S., Massey, E., Dobbels, F., & , . (2014). Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review Transplant International, 27 (1), 2-18 DOI: 10.1111/tri.12154

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