Living Donor Assessment

The number of patients deemed eligible for transplant following a comprehensive medical and psychosocial pretransplant evaluation has been steadily increasing, which is exacerbating the shortage of organs. Living donation first occurred with kidney transplantation (Merrill et al. 1956) and is now frequently used for renal and liver transplants (by donating a liver section) and less frequently for lung and other organ transplants. An advantage to having a living donor is that the transplant can be planned. However, living donation places an otherwise healthy individual at risk of bleeding, infection, development of other health problems, psychological distress, and even death during and after surgery.

Given these potential risks, psychosocial screening before and after live donation is recommended, and a careful evaluation of living donors from both medical and psychological standpoints is essential (Sajjad et al. 2007). In fact, the Live Organ Donor Consensus Group (2000) stressed the importance of psychological evaluation of donors. Several authors have outlined important issues to assess in potential living donors (Rodrigue and Sobel 2003; Sterner et al. 2006). Obviously, the donor's ability to provide informed consent and lack of coercion in the decision to donate are vital first steps. Donor safety is an important basic issue that includes both medical risks and possible psychological risks (Russell and

Jacob 1993). Medically, the donor must be free of health problems (e.g., obesity) that could negatively impact surgery. Psychological symptoms or disorders, such as depression, anxiety, and substance abuse, should be treated prior to donation (Rodrigue and Sobel 2003). The financial burden should also be considered, especially in light of possible postsur-gical pain and complications that may delay return to work and normal daily functioning (Sterner et al. 2006). In summary, the evaluation of the prospective donor should include the donor's ability to provide informed consent based on comprehensive information regarding transplant and potential risks, motivation to donate, relationship with the recipient, mental health, substance use, and support system and financial resources. Other important areas to explore include the donor's expectations for child health and behavior as well as family functioning posttransplant (Streisand and Tercyak 2001). For example, the donor's potential reaction to recipient nonadherence may be a particularly relevant issue, especially when a parent donates to an adolescent. Additional information about a protocol for donor evaluation that was developed at the Children's Hospital of Philadelphia is presented in an editorial commentary by Sterner et al. (2006).

Donation from living unrelated donors often raises concerns among medical professionals regarding donor psychological status, motivation, and understanding of donation. As a result, Dew et al. (2007) have outlined guidelines for psychosocial screening of unrelated donors. Whether a living donor is related or unrelated, postdonation follow-up is important and recommended, although this is not always routine care (Rodrigue et al. 2001). A couple of common issues include pain and distress after donation. Additionally, if recipients have poor outcome posttransplantation, the donors may experience significant psychological distress, such as depression or trauma-related symptoms (Russell and Jacob 1993).

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