Christina Papachristou

Willingness to donate: an interview study before liver transplantation

Objectives: The introduction of the living donation in organ transplantation introduces important new psychological conflicts and ethical questions in the transplantation process. Operation related risks, as well as dependencies in the family structure, generate considerable pressure on potential donors. The aim of the study was to reconstruct the determinants of willingness to donate before transplantation. Methods: Evaluation of 20 taped and transcribed interviews oriented to current approaches in qualitative interview research. The approach used is based on grounded theory, qualitative content analysis, and the concept of the ideal type. Results: Before surgery, “openly motivated” donors push for an operation, leaving no room for ambivalence in the evaluation process. They idealise the relationship with the recipient, and link their donation with the individual—partly in subconscious expectations and wishes. In contrast, “openly ambivalent” donors formulate their anxieties and express arguments against donation. Conclusions: Statements that claim ambivalence towards donation or utterance of arguments against donation indicate earlier coercion. Before transplantation, potential donors should have the opportunity to discuss their emotional situation to help their decision making process.

Psychosocial stress of living donors after living donor liver transplantation.

LIVING DONOR liver transplantation (LDLT) has emerged as an established treatment modality in the therapy of terminal liver disease in adults. Surgery-related complications and reports of fatalities among donors result in an ethical dilemma in the process of donor-recipient evaluation. Because the mortality rate among LDLT recipients is low, the surgery-related potential hazard primarily exists for donors. Initial results have shown an overall good psychosocial outcome for donors: all donors reported a willingness to donate on another occasion and no limitations of physical or social activities as of psychologic status. Little is known, however, about the factors that impinge on the psychosocial outcome following organ donation. For this reason, we evaluated the relationship between complications following LDLT surgery and stress perception among donors, and sought potential pre-surgery predictors of enhanced stress perception.

Impaired psychosocial outcome of donors after living donor liver transplantation: a qualitative case study

Abstract:  Adult‐to‐adult living donor liver transplantation (LDLT) of the right hepatic lobe has been developing into an established therapy for treating pre‐terminal liver diseases. There is little experience available on the psychosocial outcome of living donors. The aim of this first qualitative case study was to investigate the patterns for impaired psychosocial outcome in donors after LDLT. Donor hepatectomies were performed in 30 donors at the Charité Berlin. Six months after surgery, the six of the 30 donors with negative moods and physical complaints in psychometric monitoring were examined. The post‐operative interviews were transcribed and analysed using current qualitative research methods. These six donors (20%) reported various unspecific complaints and psychological conflicts. Sadness was expressed about organ rejection and death of the recipient. Anxieties about the recipient and their own health were verbalized. Disappointment and anger refer to the experience that they were not as fully appreciated by the medical system and their social environment as expected. The negative emotions of donors with impaired psychosocial outcome could be related to a decrease in self‐esteem in the post‐operative course. Adequate medical and psychological treatment opportunities for these donors should be provided.

Decision-Making and Risk-Assessment in Living Liver Donation: How Informed Is the Informed Consent of Donors? A Qualitative Study

Background The practice of living donor liver transplantation (LDLT) has been increasing over the past 20 years. In LDLT, a healthy individual offers a substantial part of his or her liver (up to 60%) for the benefit of a terminally-ill recipient. Objective The aim of the study was to identify decisionmaking and risk-assessment patterns of living liver donors and assess whether the principles of informed consent and decision autonomy are being met. Method The authors conducted semistructured clinical interviews with 28 donors before transplantation. Results The authors found that a decision was being reached before a decision-making process could take place. Surgery risks were perceived and processed in different ways, including the factors of risk-awareness, denial, limited acceptance, and fatalism. Discussion The authors assess concepts of informed consent and decision autonomy in LDLT, and offer suggestions for donor selection.

Living donor liver transplantation and its effect on the donor―recipient relationship ― a qualitative interview study with donors

Abstract:  An important aspect in the preoperative evaluation and a legal precondition for an living donor liver transplantation (LDLT) is a family or emotionally close relationship between donor and recipient. We investigated the development of the donor–recipient relationship after LDLT. We conducted semi‐structured clinical interviews with 18 donors as part of a regular postoperative follow‐up and analyzed them using the method of Grounded Theory. The donation does not lead to any major changes in the donor‐recipient relationship, probably due to careful pre‐selection. It does however enhance the existing positive or conflicting character of the relationship. Donors sometimes downplay negative aspects in the relationship and emphasize the improvement as a way of dealing with a major life event. A donation cannot fulfill expectations linked to it and it is unfavorable to be used to improve the relationship. Potential misuse or instrumentalization of the donation by the donor are possible. Postoperative feelings of gratitude are an issue after surgery. A good relationship enhances a better management of the postoperative course. The preoperative donor–recipient relationship should be as free of conflict as possible. A thorough preoperative evaluation of the donor–recipient relationship is particularly important to assess the donors’ suitability and clarify conflicts and unrealistic expectations.

Gender-specific differences associated with living donor liver transplantation: a review study.

Living donor liver transplantation (LDLT) has developed into an important therapeutic option for liver diseases. For living donor kidney transplantation (LDKT), gender‐specific differences have been observed among both donors (two‐thirds being women and one‐third being men) and recipients (two‐thirds being men and one‐third being women). The aim of this study was to determine whether there is a gender disparity for LDLT. We contacted 89 national and international transplantation registries, single transplant centers, and coordinators. In addition, a sample of 274 articles dealing with LDLT and its outcomes was reviewed and compared with the registry data. The data included the gender of the donors and recipients, the country of transplantation, and the donor‐recipient relationship. The investigation showed that overall there were slightly more men among the donors (53% male and 47% female). As for the recipients, 59% of the organs were distributed to males, and 41% were distributed to females. Differences in the gender distribution were observed with respect to individual countries. Worldwide, 80% of the donors were blood‐related, 11% were not blood‐related, and 9% were spouses. The data acquired from the publications were similar to the registry data. Our research has shown that there are hardly any registry data published, a lot of countries do not have national registries, or the access to these data is difficult. Even widely ranging published studies often do not give information on the gender distribution or the donor‐recipient relationship. Further investigations are needed to understand the possible medical, psychosocial, or cultural reasons for gender distribution in LDLT and the differences in comparison with LDKT. Liver Transpl 16:375–386, 2010.

The ELPAT living organ donor Psychosocial Assessment Tool (EPAT): from ‘what’ to ‘how’ of psychosocial screening – a pilot study

Thorough psychosocial screening of donor candidates is required in order to minimize potential negative consequences and to strive for optimal safety within living donation programmes. We aimed to develop an evidence‐based tool to standardize the psychosocial screening process. Key concepts of psychosocial screening were used to structure our tool: motivation and decision‐making, personal resources, psychopathology, social resources, ethical and legal factors and information and risk processing. We (i) discussed how each item per concept could be measured, (ii) reviewed and rated available validated tools, (iii) where necessary developed new items, (iv) assessed content validity and (v) pilot‐tested the new items. The resulting ELPAT living organ donor Psychosocial Assessment Tool (EPAT) consists of a selection of validated questionnaires (28 items in total), a semi‐structured interview (43 questions) and a Red Flag Checklist. We outline optimal procedures and conditions for implementing this tool. The EPAT and user manual are available from the authors. Use of this tool will standardize the psychosocial screening procedure ensuring that no psychosocial issues are overlooked and ensure that comparable selection criteria are used and facilitate generation of comparable psychosocial data on living donor candidates.

Body Experience After Liver Transplantation: A Body Grid Examination

Living with a donated organ raises not only clinical aspects, such as surgery risks and possible graft rejection, but also questions regarding the psychological integration of the donor organ and the recipients body experience. Organ recipients need to cope with the transplantation and its impact on their bodies and lives. This study presents findings concerning the psychological outcome of liver recipients and their body experience after transplantation. The focus lies on the psychological integration of the liver by the recipients and on differences in the body experience between recipients of a living liver donation (LDLT) and a deceased donor donation (LTx). To study the subjective body experience and the donor-organ integration, we used the body grid, a modification of the repertory grid technique pioneered by Kelly (1955). This technique allows both a quantitative and a qualitative research approach. We examined 22 liver recipients (12 LDLT; 10 LTx), matched for age, gender, years since transplantation, and type of liver disease. Additionally, quality of life data were collected using the Short Form-8 health survey (SF-8), along with sociodemographic data, including the current living situation, changes after transplantation, living donor data, and the donor-recipient relationship for the LDLT cases. Correlations between the SF-8 scores and the element distances were calculated. The results depict the recipients’ body experiences after liver transplantation, the psychological integration of the transplanted organ, and correlations between quality of life and organ integration. Differences between the LDLT and LTx group are discussed, as well as implications for improving the treatment and psychological support of the recipients.

Psychosoziale Evaluation von Transplantationspatienten – Empfehlungen für die Richtlinien zur Organtransplantation

For the last few years, the German Medical Associations guidelines for transplant medicine have been subject to an extensive revision process. The present contribution presents recommendations regarding the psychosocial evaluation of patients prior to organ transplantation, which were developed by experts from the Psychology/Psychosomatics committee of the German Transplant Society with the aim to incorporate the recommendations into the guidelines. The main objective is to establish a mandatory psychosocial evaluation for all patients prior to their admission to the transplant waiting list. Contents, potential contraindications, and the procedure of the evaluation are described. Furthermore, the qualification deemed necessary for the examiners is addressed in detail. Finally, the future need for action is determined.