In the context of living donation, the safety and health of the organ donor have the highest priority and strict requirements apply to ensure this.1 For a long time, the focus was primarily on physical well-being, but in recent years the psychosocial consequences of organ donation for donors have increasingly been scientifically examined.1
In addition to financial losses and insurance law effects, psychological aspects such as depression, chronic fatigue, feelings of guilt and fear of illness also play a role.1,2 These are probably favored by certain risk factors, including manifest or not yet obvious psychological problems before the donation.1,3 For example, a meta-analysis with living kidney donors revealed a correlation between poorer mental performance before transplantation and the occurrence of fatigue after donation.3
Collection period too short
Questionnaires for quantitative and qualitative self-assessment, which have proven themselves in scientific practice, are usually used to record the physical and mental health of the donors.1 They are used to validate the so-called “Health-Related Quality of Life” (HRQoL), both before and after the transplantation.1 This should ensure early detection of risk factors that can lead to the development of psychological limitations and offer the opportunity to intervene in good time.1
So far, however, there has been no uniform approach. In addition, this data is usually only collected up to a year after the organ donation.1 However, a meta-analysis on living kidney donation showed that the physical and psychological limitations after a long observation period were slightly greater than before the donation.3 A longer observation period could therefore be appropriate here in order to realistically depict the consequences.1
Standards through new guideline
Uniform standards for diagnostics and the implementation of psychosocial treatment in organ transplantations are to be introduced in Germany as part of the new S3 guideline “Psychosocial diagnostics and treatment of patients before and after organ transplantation”, which is expected this year.4 So emphasized Coordinator of the guideline, Martina de Zwaan, at the German Congress for Psychosomatic Medicine and Psychotherapy in 2019, that living donation for healthy donors is not a medical intervention and that protecting the donors from possible negative consequences is of particular importance. Although psychosocial problems occur much less frequently than with organ recipients, psychosocial aftercare is also recommended for donors.5
Credentials:
- Weidemann A. Psychosocial effects of living kidney donation. Transplant Campus (2019); available at: https://www.transplant-campus.de/nierentransplantation-lebertransplantation-herztransplantation-highlights/nierentransplantation-und-nierenlebendspende/wissen-kompakt-zur-nierentransplantation-und-nierenlebendspende/psychosoziale-auswirkungen-der-nierenlebendspende/
- Duerinckx N et al. Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review. Transplant International (2013); Volume 27, Issue 1 p. 2-18.
- Wirken, L. et al. The Course and Predictors of Health-Related Quality of Life in Living Kidney Donors: A Systematic Review and Meta-Analysis. Am J Transplant 15, 3041-3054, doi:10.1111/ajt.13453 (2015).
- AWMF. S3 guideline “Psychosocial diagnostics and treatment of patients before and after organ transplantation”; https://www.awmf.org/leitlinien/detail/anmeldung/1/ll/051-031.html
- German Society for Psychosomatic Medicine and Medical Psychotherapy (DGPM) e. V. Press conference at the DGPM/DKPM Congress on March 20, 2019; Available at: https://www.dgpm.de/en/presse/presse-informationen/presse-information/pressekonferenz-der-deutschen-gesellschaft-fuer-ultraschall-in-der-medizin-degum/
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