Quality of life of living kidney donors in Brazil: an evaluation by the short form-36 and the WHOQOL-bref questionnaires

Abstract: Introduction: There are few studies that evaluate donors’ quality of life (QOL) following renal transplant in developing countries. This study was conducted to evaluate post‐donation QOL of Brazilian living kidney donors using SF‐36 and WHOQOL‐bref questionnaires. Subjects and methods: Demographic, socioeconomic and the QOL data were analyzed utilizing SF‐36 and WHOQOL‐bref questionnaires of 69 living kidney donors and compared with 68 non‐donor subjects from the same community. Results: The donors and controls were similar as for gender and ethnicity, predominating the female. There was no difference in the educational level or socioeconomic class between the groups, the lower income being more prevalent. The evaluation of the donors’ QOL was not significantly different from that of the control group. In some domains of the SF‐36 and of the WHOQOL‐bref questionnaires, donors scored higher than controls. Even the evaluation of the QOL of donors whose recipients had suffered loss of the graft or death following renal transplantation, showed in a general manner a similar QOL to the controls. Conclusions: Living kidney donors in a mainly low‐income segment of the Brazilian population present a post‐donation quality of life equal or superior to that of the non‐donor population with the same socioeconomic profile. The two generic instruments used to evaluate the quality of life presented similar results.     

Impact assessment in living kidney donation: psychosocial aspects in the donor

BACKGROUND: Living donor kidney transplantation has a positive influence on graft survival and recipient quality of life (QoL). We assessed the psychosocial impact of donation to the donor. METHODS: Before and after the procedure 32 living kidney donors (mean age 41 years) completed the Zung Self-Rating Anxiety and Depression Scales; a Sociodemographic, Short-Form 36 Health Survey (SF-36), and a Donation Perceptions Questionnaire. RESULTS: Living kidney donors were siblings (62.5%), parents (34.4%), or a daughter (3.1%). Transplantation was not successful in two cases: one recipient death and one graft failure. No significant changes were observed in donor QoL except for the SF-36 social functioning subscale that showed significant improvement after donation (P = .038). A reduction in depression symptom frequency was verified after donation (from 65.6% to 46.9%). There was an almost significant decrease in depression scores (P = .077), which was in fact was significant when one considered only successful transplants (P = .021). There was no significant variation in anxiety scores among donors. Time since transplantation was inversely correlated with overall anxiety (r = .443, P = .011), and with somatic anxiety subscales (r = .357, P = .045). For most donors, the decision to donate was easy and spontaneous. Nearly all donors would donate again and strongly encourage others to donate. CONCLUSIONS: Except for the social functioning scale that improved, no significant changes were observed in QoL of living kidney donors after the procedure. Depression scores significantly decreased after donation, but anxiety scores remained stable. Donors, who were mostly siblings, showed positive perceptions about donation, did not regret their decision, and strongly recommend it to others.     

亲属活体供肾者术后心理状态调查和分析

目的 分析与研究亲属活体供肾者术前一般情况和术后心理状态.方法 应用自编个人资料问卷、社会支持评定量表、SF-36量表、Beck抑郁自评量表和Zung焦虑自评量表(SAS)对56名活体供肾者术后6个月至4年时的心理状态进行调查分析.结果 供者以女性、农村中低收入、低学历者居多,所有供者自愿捐肾.供者术后客观和主观支持良好,支持利用度稍差.供者术后躯体健康质量稍差,精神健康较好,无抑郁和焦虑状态.结论 亲属活体供.肾者术后的心理状态较好,但临床工作者仍应适时采取心理干预,加强健康教育,同时社会应加强宣教,术后应给予供者良好的社会支持.     

Long-term outcomes of living kidney donors: a single centre experience of 29 years

Aim: Living kidney donation provides the best source of kidney graft. The mortality and morbidity rates are small but the long‐term effects have not been studied. This is a report on our 29‐year experience of living kidney donation. Methods: All living donors were arranged to have follow‐ups. Defaulters were traced via a territory‐wide computer system. Results: A total of 149 living kidney donor operations were performed. 136/149 records were available. 41 defaulted follow‐up. One donor died of multiple myeloma. The male to female ratio was 1.00 to 1.52. Mean age at donation was 33.94 ± 9.66 years. Mean follow‐up duration was 160.39 ± 87.96 months. Hypertension was diagnosed in 27 donors (19.9%). 22 donors (17.3%) had stage 3 chronic kidney disease (CKD). Glomerular filtration rate (GFR) dropped from 90.95 ± 15.62 mL/min per 1.73 m² at time 0 to 66.29 ± 12.06 mL/min per 1.73 m² at 2 years. GFR improved subsequently and remained stable for 25 years. Age at donation was associated with hypertension (HT) in univariate and multivariate analyses. HT was not associated with sex or GFRs over time. Using binary logistic regression, age at donation was associated with the development of stage 3 CKD and GFR before donation was associated with lower CKD risk. In multivariate analysis, only age at donation was associated with CKD. Other co‐morbidities included: hyperlipidaemia 16/136, diabetes mellitus 6/136, cardiovascular event 1/136, stroke 1/136 and cancer 5/136. Conclusions: Living kidney donors had reductions in GFR post uninephrectomy with subsequent improvement. A significant proportion developed HT and stage 3 CKD. Age at donation was a strong determinant of development of HT and stage 3 CKD.     

Devenir des donneurs vivants de rein pour la transplantation

Nowadays, several treatments exist to treat terminal chronic renal failure. Best results for the recipients are obtained with kidney transplantation concerning mortality and quality of life. Transplantation is also the cheaper option for society. Living kidney donation raises the issue of the becoming of the donor, an absolutely healthy subject who gets to a surgical procedure. The becoming of living kidney donors has been compared with the one of controls subjects in several studies. The evaluations focused on the complications of nephrectomy in the short and long-term: kidney failure, hypertension, proteinuria, possibility of pregnancy, quality of life, and mortality. The first results did not show any risk linked to kidney donation, compared to general population. However, since 2013, kidney donors were found at higher risk for kidney failure and even for mortality, compared with controls selected like donor candidates. The risk of kidney donation is nevertheless acceptable and minimal, on the condition of rigorous selection of candidates and regular follow-up.     

Living kidney donors – a prospective study of quality of life before and after kidney donation

Although the safety of living kidney donation has been well established, prospective studies examining the physical and psychosocial aspects of the donor's quality of life are still scarce. Thus, the purpose of this prospective work was to assess the quality of life of 50 consecutive donors before and after kidney transplantation. All donors were asked to respond to both a donor questionnaire and the short‐form 36‐item health survey (SF‐36). Interviews were individually conducted before, three months after, and over one yr after transplantation. Donation was considered a positive experience by all patients and had no impact on any physical or psychosocial aspect of the donor's life. Improved self‐esteem and better quality of life after donation were reported in 52% of the cases. All donors would donate again and encouraged donation. SF‐36 data indicated improvement in post‐donation mental and physical scores among living donors closely related to recipient. Overall, most donors had a positive experience, felt no changes in quality of life, experienced enhanced self‐esteem, would donate again, and recommended donation.     

Donor-recipient relationships in African American vs. Caucasian live kidney donors

Reeves‐Daniel A, Bailey A, Assimos D, Westcott C, Adams PL, Hartmann EL, Rogers J, Farney AC, Stratta RJ, Daniel K, Freedman BI. Donor–recipient relationships in African American vs. Caucasian live kidney donors.
Clin Transplant 2011: 25: E487–E490. © 2011 John Wiley & Sons A/S. Abstract: Purpose: The purpose of the study was to characterize differences in donor and recipient relationships between African American (AA) and Caucasian living kidney donors. Methods: Data from all successful living kidney donors at a single institution between 1991 and 2009 were reviewed. Relationships between donor and recipient were categorized and between‐group comparisons performed. Results: The study sample consisted of 73 (18%) AA and 324 Caucasian living kidney donors. The distribution of donor–recipient relationships differed significantly between AA and Caucasians. AA donors were more likely to be related to the recipient (88% vs. 74%, p = 0.007) than Caucasians. AA donors were more likely to participate in child to parent donation and were less likely to participate in parent to child donation or to donate to unrelated individuals. Sibling and spousal donations were similar in both groups. Caucasian donors were more likely to be unrelated to the recipient than AA donors. Conclusions: Differences exist in donor–recipient relationships between AA and Caucasian living kidney donors. Future studies exploring cultural differences and family dynamics may provide targeted recruitment strategies for AA and Caucasian living kidney donors. Living unrelated kidney transplantation appears to be a potential growth area for living kidney donation in AA.     

Psychosocial wellbeing after living kidney donation – a longitudinal,prospective study

Living kidney donation (LKD) has become routine practice across the world as the gold standard treatment of end‐stage renal failure. Whilst the physical risks and harms of LKD surgery are well documented, relatively little is known about psychosocial outcomes. The aim of this study was to determine whether it was possible to quantify the psychosocial impact of LKD. A prospective longitudinal study of 93 living kidney donors was performed. Data were collected preoperatively, and 3 and 12 months after donation. Questionnaires included 11 validated psychosocial outcome measures and questions specific to LKD. Over time, there was no significant change in wellbeing, life satisfaction, self‐esteem, social comparison, distress, depression, stress, anxiety or social support at 3 or 12 months. Despite this, questions specific to LKD indicated that donors felt positively about donation, with low levels of regret. This study provides a thorough assessment of psychosocial outcomes after LKD over the first year. Donors felt positive about LKD although there was no evidence of any significant change in psychosocial outcomes. Despite no measurable psychosocial benefit after living kidney donation, there was also no evidence of harm.     

Depression and quality of life in living related renal transplantation

BACKGROUND: More than other operations on the body, organ transplantation has a psychological resonance relating to the self and body image representation, both in donors and in recipients. In the medical literature there are many psychopathological patterns related to ESRD and to the changes in psychologic assessment and lifestyle after transplantation. Similar changes have been found in living donors. METHODS: Forty-eight donor-recipient couples were evaluated before and 4 months after transplantation, using clinical interview, according to the DSM IV TR criteria; The structured Interview for renal transplantation, both for recipients and for donors; psychodiagnostic tests: mini-mental state; Hamilton Rating Scale for Depression; Hamilton Anxiety Scale; Self-Rating Anxiety Scale; Short-Form 36 Health Survey Questionnaire. RESULTS: Comparisons by paired Students t tests showed a significant Hamilton depression variation among recipients, with improvement in the gained score and reduction of depressive symptom (Hamilton score >7) frequency from 45.8% to 32%, and a decreased proportion of patients with a score >18 from 16.4% to 0%. There was no significant Hamilton Depression variation among donors, but there was somehow a reduction in depressive symptom frequency (Hamilton score >7) from 37.5% to 33.3% and a decrease among >18 scores from 12.6% to 0% patients. CONCLUSIONS: Living donor kidney transplantation did not adversely affect the lives of donors and significantly improved many aspects of the lives of recipients. However, physical and psychological aspects may be impaired by living donation. Careful donor selection, with appropriate pretransplantation psychiatric consulting, allows those with a normal life quality to donate without consequence to their physical or psychological status.     

Evaluation of living related kidney donors in China: policies and practices in a transplant center

Zhao W‐Y, Zhang L, Han S, Zhu Y‐H, Wang L‐M, Zhou M‐S, Zeng L. Evaluation of living related kidney donors in China: policies and practices in a transplant center.
Clin Transplant 2010 DOI: 10.1111/j.1399‐0012.2010.01229.x.
© 2010 John Wiley & Sons A/S. Abstract: Background: Rigorous donor evaluation is essential for living related donor kidney transplantation (LRDKT). However, guidelines for living kidney donor evaluation are absent in China. The aim of this study is to describe the initial experience in the living kidney donor evaluation process in a single transplant center in China. Methods: The evaluation process of our center is sequentially divided into five steps: outpatient consultation and information, preliminary evaluation, comprehensive evaluation, final informed consent, and ethics committee oversight. Results: Between June 2007 and March 2009, 124 potential living donors were evaluated in our center, of whom 82 (66.1%) became effective donors and the remaining 42 (33.9%) were excluded. The exclusion reasons were related to clinical problems in 27 cases, psychosocial problems in seven cases, and suspected organ trading in eight cases. Conclusion: Although strongly forbidden by Chinese laws, organ trading remains a threat to the healthy development of LRDKT in China. To prohibit organ trading, the kinship between the donor and recipient should be carefully identified. Guidelines for living donor evaluation appropriate to the actual situation in China should be set up for the sake of safety and to protect the rights and interests of both donors and recipients.     

Psychological effects of living related kidney transplantation - risks and chances

BACKGROUND: Recipients of living donor kidney transplantation hope for an improved physical well-being after transplant. Furthermore the patients and their relatives frequently expect an improvement in their psychological findings in consequence of the living related transplantation. The present study examines the psychosocial effects of living donor kidney transplantation for donors and recipients under successful as well as complicated circumstances. MATERIAL AND METHODS: Based on 31 catamnestic interviews of recipient-donor couples and a content analysis of these interviews, hypotheses regarding the psychological requirements for a successful progression of a living kidney donation are deduced and put forward. RESULTS: The aspiration for an improvement of psychological problems, particularly anxiety and depression, as an effect of transplantation can on the basis of the present results not be supported. Living donor kidney transplantation between close recipient and donors must not be regarded as a means to solve psychological problems and familial conflicts. An attitude characterized by realistic and modest expectations as well as relationships, which have been cleared of extreme conflicts prior to the transplantation could facilitate a favourable psychological progression.     

Psychosocial impact of pediatric living‐donor kidney and liver transplantation on recipients,donors, and the family: a systematic review

Living‐donor kidney and liver transplantation intend to improve pediatric recipients’ psychosocial well‐being, but psychosocial impact in recipients strongly depends upon the impact on the donor and the quality of family relations. We systematically reviewed quantitative and qualitative studies addressing the psychosocial impact of pediatric living‐donor kidney and liver transplantation in recipients, donors, and the family. In accordance with the PRISMA guidelines, we systematically searched the databases Medline, Web of Knowledge, Cinahl, Embase, ERIC, and Google Scholar. We identified 23 studies that satisfied our inclusion criteria. Recipients had improved coping skills and satisfactory peer relationships, but also reported anxiety and depressive symptoms, worried about the future, and had a negative body image. Similarly, donors experienced increased self‐esteem, empowerment, and community awareness, but also complained of postoperative pain and a lack of emotional support. With respect to family impact, transplantation generated a special bond between the donor and the recipient, characterized by gratitude and admiration, but also raised new expectations concerning the recipient's lifestyle. As psychological problems in recipients were sometimes induced by feelings of guilt and indebtedness toward the donor, we recommend more research on how gift exchange dynamics function within donor–recipient relationships, enrolling donors and recipients within the same study.     

Higher quality of life in living donor kidney transplantation: prospective cohort study

This prospective, longitudinal cohort study investigated the effect of donating or receiving a kidney on quality of life and relationship dynamics. Forty donors and 35 recipients from two UK transplantation centres completed the World Health Organisation quality of life questionnaire (WHOQOL) with additional questionnaires before, 6 weeks and one year after operation. Before donation the donor mean quality of life score in the physical domain was 18.8. This was significantly higher than the UK value for a healthy person of 16.4 (P < 0.001). Six weeks after operation, donor score reduced to UK normative levels however improved again at one year (17.7). Recipient mean physical domain score before was 11.4, significantly lower than the UK norm (P < 0.01), increasing to 16.0 one year after. Both donor (P < 0.009) and recipient (P < 0.05) experienced a significant improvement in their mutual relationship. Recipients expressed anxiety about the donor before operation. Donors were not concerned about living with one kidney. We concluded that living kidney donation has no detrimental effect on the physical or psychological well being of donors one year after donation. Transplantation results in a major improvement in quality of life for the recipient. Most donors would donate again, if this were possible.     

A prospective study on living related kidney donors' quality of life in the first year: choosing appropriate reference data

Prospective studies on living kidney donors’ quality of life (QoL) are still rare. Most existing studies compare healthy donors with the general population, including subjects with diseases. This is the first prospective study comparing living donors’ QoL with reference data of both the general population and healthy individuals. We investigated QoL, anxiety, and depression in living kidney donors (n = 79) before donation and at two post‐operative data points (three months and one yr). Subsequently, data from the donors were compared with the reference data. Our results show an impaired physical QoL three months post‐donation. One yr after surgery, physical QoL had returned to the pre‐operative level. Neither mental QoL nor anxiety or depression showed major changes across time. Pre‐operative QoL was comparable to that of healthy individuals and higher than that in the general population. Donors’ perception of the recipient's health showed moderate correlations with donors’ mental outcome three months after donation. In conclusion, the impact on physical QoL seems to persist for at least three months after kidney donation. It could be demonstrated that in the context of living donation, healthy individuals provide more adequate reference data. Future research needs to determine the length and the nature of the post‐operative QoL impairment and further explore possible influencing factors.     

Living donor evaluation and exclusion: the Stanford experience

Lapasia JB, Kong S‐Y, Busque S, Scandling JD, Chertow GM, Tan JC. Living donor evaluation and exclusion: the Stanford experience.
Clin Transplant 2011: 25: 697–704. © 2010 John Wiley & Sons A/S. Abstract: Background: The proportion of prospective living donors disqualified for medical reasons is unknown. The objective of this study is to delineate and quantify specific reasons for exclusion of prospective living donors from kidney donation. Methods: All adult prospective kidney donors who contacted our transplant program between October 1, 2007 and April 1, 2009 were included in our analysis (n = 484). Data were collected by review of an electronic transplant database. Results: Of the 484 prospective donors, 39 (8%) successfully donated, 229 (47%) were excluded, 104 (22%) were actively undergoing evaluation, and 112 (23%) were withdrawn before evaluation was complete. Criteria for exclusion were medical (n = 150), psychosocial (n = 22), or histocompatibility (n = 57) reasons. Of the 150 prospective donors excluded for medical reasons, 79% were excluded because of obesity, hypertension, nephrolithiasis, and/or abnormal glucose tolerance. One hundred and forty‐seven (61%) intended recipients had only one prospective living donor, of whom 63 (42%) were excluded. Conclusions: A significant proportion of prospective living kidney donors were excluded for medical reasons such as obesity (body mass index >30), hypertension, nephrolithiasis, and abnormal glucose tolerance. Longer‐term studies are needed to characterize the risks to medically complex kidney donors and the potential risks and benefits afforded to recipients.     

Information au patient: Traitement chirurgical du cancer du gros intestine

Living donation kidney transplantation has been popular worldwide to try to increase the donor pool. In Belgium, the rate of living donation kidney transplantation has been traditionally relatively low compared to other countries. This is - in part - due to the relatively higher cadaveric organ offer that is available in Belgium (around 25 donors per million inhabitants), compared to other countries. However, the increasing waiting times on cadaveric waiting list and the superiority of the results of live donation versus cadaveric kidney transplantation have led to a reappraisal of this strategy. In our center a living donation kidney transplant programme was started in 1997. Since then 40 cases of live donation kidney transplantation have been performed and are reported herein.     

An economic assessment of contemporary kidney transplant practice

Kidney transplantation is the optimal therapy for end‐stage renal disease, prolonging survival and reducing spending. Prior economic analyses of kidney transplantation, using Markov models, have generally assumed compatible, low‐risk donors. The economic implications of transplantation with high Kidney Donor Profile Index (KDPI) deceased donors, ABO incompatible living donors, and HLA incompatible living donors have not been assessed. The costs of transplantation and dialysis were compared with the use of discrete event simulation over a 10‐year period, with data from the United States Renal Data System, University HealthSystem Consortium, and literature review. Graft failure rates and expenditures were adjusted for donor characteristics. All transplantation options were associated with improved survival compared with dialysis (transplantation: 5.20‐6.34 quality‐adjusted life‐years [QALYs] vs dialysis: 4.03 QALYs). Living donor and low‐KDPI deceased donor transplantations were cost‐saving compared with dialysis, while transplantations using high‐KDPI deceased donor, ABO‐incompatible or HLA‐incompatible living donors were cost‐effective (<$100 000 per QALY). Predicted costs per QALY range from $39 939 for HLA‐compatible living donor transplantation to $80 486 for HLA‐incompatible donors compared with $72 476 for dialysis. In conclusion, kidney transplantation is cost‐effective across all donor types despite higher costs for marginal organs and innovative living donor practices.     

Living kidney donor transplantation - new dimensions

Abstract The ethical view points concerning living kidney donation are changing in Europe. Objections against emotionally related donation are fading away, whilst ethical arguments around brain death and "true death" are put first in some regions. Emotionally related donation is highly motivated and gives excellent results, despite rather bad HLA matches, but yet remains neglected as large source of kidneys in many centres and countries. Avoiding dialysis by pre-emptive transplantation with living donors is the best treatment of enD-stage renal disease in order to maintain quality of life and socioeconomic benefit. The technique of laparoscopic donor nephrectomy will probably spread quickly. The future of crossover transplantation is unclear as yet, but will probably not be stopped by law since it is ethically and biologically well justified. And, finally, all centres in regions where live donor kidney transplantation is rapidly expanding should prospectively follow up the health of their donors and interact as soon as necessary. An example of such an institution is the Swiss living kidney donor registry which has been following up 181 donors since April 1993.     

Quality of life of living kidney donors in Germany: a survey with the Validated Short Form-36 and Giessen Subjective Complaints List-24 questionnaires

BACKGROUND: Most studies evaluating the impact of kidney donation on donors' quality of life (QOL) have limitations such as small cohort size, unmatched references, use of nonstandardized and nonvalidated questionnaires, or low response rates. METHODS: We performed a study on donors' QOL that was designed to avoid these limitations. All available living renal donors in our department in the last 18 years were included in the study. QOL was assessed with two validated, standardized questionnaires (Short Form-36, Giessen Subjective Complaints List [Giessener Beschwerdebogen]-24) and compared with gender- and age-matched references. In addition, specific questions relating to kidney donation were asked. RESULTS: The response rate (89.8%) is one of the highest reported for studies on QOL of living kidney donors. Most donors had an equal or better QOL than the healthy population. Donors' willingness to donate again (93.4%) or recommend living-donor kidney transplantation (92.4%) was high, irrespective of complications. A small number of donors experienced financial drawbacks or occupational disadvantages. Donors aged 31 to 40 years were found to be at risk of QOL deterioration after organ donation. Donor and recipient complications had a significant impact on donors' QOL. One third of the donors found that the psychologic care preceding and after kidney donation was insufficient. CONCLUSIONS: Our findings support the practice of living-donor kidney transplantation as a good means to meet the persisting organ shortage. Further effort must be put into minimizing donor and recipient complications. The specific demands of younger donors should be further elucidated. In addition to medical follow-up, living kidney donors should also be offered lifelong psychologic counseling.     

Incentive Models to Increase Living Kidney Donation: Encouraging Without Coercing

Kidney transplantation is a superior treatment strategy than chronic dialysis for end-stage renal disease patients. However, there is a severe shortage of cadaveric kidneys that are available for transplantation. Therefore many patients are turning to living donors. We describe four models of incentives to improve rates of living kidney donation: the market compensation model, the fixed compensation model, no-compensation model and the expense reimbursement model. We discuss the advantages and disadvantages of each of these models. Any incentive to improve rates of living kidney donation must be accompanied by safeguards. These safeguards will prevent living donors from being viewed primarily as a resource for transplants. These safeguards will also prevent vulnerable individuals from being coerced into donation and will monitor long-term outcomes of donors using a donor registry. We recommend the use of the expense reimbursement model along with these safeguards, in order to increase rates of living kidney donation.