The study of living kidney donor decision-making and psychosocial outcomes

R Medicine (General);BF Psychology

McNeill, Yvonne L. ; Millar, Keith

University:University of Glasgow

关键词: living kidney donor, psychosocial outcomes, donor decision making;   

Others  :  http://theses.gla.ac.uk/3498/1/2011McNeillDClinPsych_Redacted.pdf

来源: University of Glasgow

【 摘 要 】

Background: Individuals with end-stage kidney disease need dialysis or a kidney transplant. Kidneytransplantation from a living donor is the preferred treatment. Live kidney donortransplantation, however, is an invasive surgery performed on a healthy individual for thebenefit of another person. Therefore, donors should be fully informed of the risks involved indonation. The medical outcomes for kidney donors are well known, however, the researchinvestigating the psychosocial impact of donation is limited. Understanding the psychosocialoutcome of living kidney donation would promote informed consent, allow donors to plantheir postoperative recovery period, and guide the development of services that maintain thelong-term health of donors.Aims: This study aimed to investigate the postoperative quality of life of live kidney donors, toinvestigate which variables predict postoperative psychosocial outcome, with particularinterest in the variable of coping style and to gather information regarding how individualsdecide to become living kidney donors and how satisfied they are with their pre- and postoperativecare.Methods: Living kidney donors at Glasgow Western Infirmary, Manchester Royal Infirmary and St.James’ Hospital, Leeds were asked to complete a preoperative assessment consisting of theSF-36, HADS, COPE and The Donor Decision Control Scale. Four weeks postoperative,donors were asked to again complete these questionnaires, and in addition The Living DonorSurvey.Results:-­‐48-­‐Complete data was available for thirteen donors. The results indicate that live kidneydonation had a significant adverse affect on the physical wellbeing of the donors; thepostoperative scores on the PCS and all of the corresponding domains were significantlylower and with a large effect size. Five (38%) of the donors experienced postoperativecomplications, three of whom were readmitted to hospital. With respect to psychologicalwellbeing, donors’ scores on the MCS did not differ significantly from their preoperativescores. With respect to anxiety, for the group as a whole, postoperative HADS anxiety scoreswere lower and the severity and prevalence of anxiety symptoms reduced. For depressionthere was only a marginal increase in HADS depression scores. Analysis of each individual’soutcomes indicated that there was a marked difference in the impact of donation. The resultssuggest that poor psychosocial outcome following donation was marginally associated withrelying on mental disengagement as a coping strategy. Improved outcome in thepostoperative period was associated with seeking social supportConclusions: The physical health of donors is adversely affected by live kidney donation. Four weekspostoperatively live kidney donors report their physical health as being worse than those withlong-standing illness. The psychological wellbeing of the majority of donors appears to belargely unaffected by live kidney donation. However, a minority of donors report a poorerpsychological wellbeing following donation. Individuals who use active coping strategieshave higher postoperative MCS scores, reflecting better psychological wellbeing. However,this conclusion should be interpreted with caution due the small sample size and therefore thepossibility of a type I error.