Abstract
Although single-center and cross-sectional studies have suggested a modest impact of liver donation on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. We conducted one of the largest, prospective, multicenter studies of psychological outcomes in living liver donors within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2) consortium. In total, 271 (91%) of 297 eligible donors were interviewed at least once before donation and at 3, 6, 12, and 24 mo after donation using validated measures. We found that living liver donors reported low rates of major depressive (0–3%), alcohol abuse (2–5%), and anxiety syndromes (2–3%) at any given assessment in their first 2 years after donation. Between 4.7% and 9.6% of donors reported impaired mental well-being at various time points. We identified significant predictors for donors’ perceptions of being better people and experiencing psychological growth following donation, including age, sex, relationship to recipient, ambivalence and motivation regarding donation, and feeling that donation would make life more worthwhile. Our results highlight the need for close psychosocial monitoring for those donors whose recipients died (n=27); some of those donors experienced guilt and concerns about responsibility. Careful screening and targeted, data-driven follow-up hold promise for optimizing psychological outcomes following this procedure for potentially vulnerable donors.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1267-1277 |
| Number of pages | 11 |
| Journal | American Journal of Transplantation |
| Volume | 17 |
| Issue number | 5 |
| DOIs | |
| State | Published - May 2017 |
Funding
This is publication number #39 of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study. This study was supported by the National Institute of Diabetes & Digestive & Kidney Diseases through cooperative agreements (grants U01-DK62444, U01-DK62467, U01-DK62483, U01-DK62484, U01-DK62494, U01-DK62496, U01-DK62498, U01-DK62505, U01-DK62531, U01-DK62536, U01-DK85515, U01-DK85563, and U01-DK85587). Additional support was provided by Health Resources and Services Administration (HRSA), and the American Society of Transplant Surgeons (ASTS). The following individuals were instrumental in the planning and conduct of this study at each of the participating institutions: Columbia University Medical Center, New York, NY (DK62483): PI: Jean C. Emond, MD; Co-Is: Robert S. Brown, Jr., MD, MPH, James Guarrera, MD, FACS, Martin R. Prince, MD, PhD, Benjamin Samstein, MD, Elizabeth Verna, MD, MS; Study Coordinators: Taruna Chawla, MD, Scott Heese, MPH, Connie Kim, BS, Theresa Lukose, PharmD, Tarek Mansour, MB BCH, Joseph Pisa, BA, Rudina Odeh-Ramadan, PharmD, Jonah Zaretsky, BS. Lahey Hospital & Medical Center, Burlington, MA (DK85515): PI: Elizabeth A. Pomfret, MD, PhD, FACS; Co-Is: Christiane Ferran, MD, PhD, Fredric Gordon, MD, James J. Pomposelli, MD, PhD, FACS, Mary Ann Simpson, PhD; Study Coordinators: Erick Marangos, Agnes Trabucco, BS, MTASCP. Northwestern University, Chicago, IL (DK62467): PI: Michael M.I. Abecassis, MD, MBA; Co-Is: Talia B. Baker, MD, Zeeshan Butt, PhD, Laura M. Kulik, MD, Daniela P. Ladner, MD, Donna M. Woods, PhD; Study Coordinator: Patrice Al-Saden, RN, CCRC, Tija Berzins, Amna Daud, MD, MPH, Elizabeth Rauch, BS, Teri Strenski, PhD, Jessica Thurk, BA, MA, Erin Wymore, BA, MS, CHES. University of California Los Angeles, Los Angeles, CA (DK62496): PI: Johnny C. Hong, MD; Co-I: Ronald W. Busuttil, MD, PhD; Study Coordinator: Janet Mooney, RN, BSN. University of California San Francisco, San Francisco, CA (DK62444): PI: Chris E. Freise, MD, FACS; Co-I: Norah A. Terrault, MD, MPH; Study Coordinators: Alexandra Birch, BS, Dulce MacLeod, RN. University of Colorado, Aurora, CO (DK62536): PI: James R. Burton, Jr., MD; Co-Is: Gregory T. Everson, MD, FACP, Igal Kam, MD, James Trotter, MD, Michael A. Zimmerman, MD; Study Coordinators: Jessica Fontenot, BS, Carlos Garcia, RN, BS, Anastasia Krajec, RN. University of Michigan Health System, Ann Arbor, MI (DK62498): PI: Robert M. Merion, MD, FACS; DCC Staff: Yevgeniya Abramovich, BA, Mary Akagi, MS, CCRP, Douglas R. Armstrong, BSN, MS, Charlotte A. Beil, MPH, Carl L. Berg, MD, Abby Brithinee, BA, Tania C. Ghani, MS, MSI, Brenda W. Gillespie, PhD, Beth Golden, BScN, Margaret Hill-Callahan, BS, LSW, Lisa Holloway, BS, CCRC, Terese A. Howell, BS, CCRC, Anna S.F. Lok, MD, Monique Lowe, MSI, Anna Nattie, BA, Akinlolu O. Ojo, MD, PhD, Samia Shaw, AAIT, Abigail Smith, MS, Robert A. Wolfe, PhD, Gary Xia, BA. University of North Carolina, Chapel Hill, NC (DK62505): PI: Paul H. Hayashi, MD, MPH; Study Coordinator: Tracy Russell, MA. University of Pennsylvania, Philadelphia, PA (DK62494): PI: Abraham Shaked, MD, PhD, Kim Olthoff MD; Co-Is: David S. Goldberg, MD, Karen L. Krok, MD, K. Rajender Reddy, MD, Mark A. Rosen, MD, PhD, Robert M. Weinrieb, MD; Study Coordinators: Brian Conboy, PA, MBA, Mary Kaminski, PA-C, Debra McCorriston, RN, Mary Shaw, RN, BBA. University of Pittsburgh Medical Center, Pittsburgh, PA (DK85587): PI: Abhinav Humar, MD; Co-Is: Andrea F. DiMartini, MD, Mary Amanda Dew, PhD, Mark Sturdevent, MD; Study Coordinators: Megan Basch, RN, Sheila Fedorek, RN, CCRC, Leslie Mitrik, BS, Mary L. McNulty, MLS. University of Toronto, Toronto, ON, CA (DK85563): PI: David Grant, MD, FRCSC; Co-Is: Oyedele Adeyi, MD, FCAP, FRCPC, Susan Abbey, MD, FRCPC, Hance Clarke, MSc, MD, FRCPC, Susan Holtzman, PhD, Joel Katz, CRC, PhD, Gary Levy, BSc, FRCPC, MD, Nazia Selzner, MD, PhD; Study Coordinators: Kimberly Castellano, BSc, Andrea Morillo, BM, BCh, Erin Winter, BSc. University of Virginia, Charlottesville, VA (DK62484): PI: Carl L. Berg, MD; Co-I: Timothy L. Pruett, MD; Study Coordinator: Jaye Davis, RN. Virginia Commonwealth University - Medical College of Virginia Campus, Richmond, VA (DK62531): PIs: Adrian H. Cotterell, MD, FACS, Robert A. Fisher, MD, FACS; Co-Is: Martha K. Behnke, PhD, Adrian H. Cotterell, MD, FACS, Ann S. Fulcher, MD, Pamela M. Kimball, PhD, HCLD, Mary E. Olbrisch, PhD, ABPP, Marc P. Posner, MD, FACS, Mark A. Reimers, PhD, Amit Sharma, MD, R. Todd Stravitz, MD, FACP; Study Coordinators: April Ashworth, RN, BSN, Joanne Davis, RN, Sarah Hubbard, Andrea Lassiter, BS, Luke Wolfe, MS. National Institute of Diabetes and Digestive and Kidney Diseases, Division of Digestive Diseases and Nutrition, Bethesda, MD: Edward Doo, MD, James E. Everhart, MD, MPH, Jay H. Hoofnagle, MD, Stephen James, MD, Patricia R. Robuck, PhD, Leonard B. Seeff, MD, Averell H. Sherker, MD, FRCPC, Rebecca J. Torrance, RN, MS.
Keywords
- clinical research/practice
- depression
- donors and donation
- donors and donation: donor evaluation
- donors and donation: donor follow-up
- donors and donation: living
- liver transplantation/hepatology
ASJC Scopus subject areas
- Immunology and Allergy
- Transplantation
- Pharmacology (medical)
