M Walter

Psychosocial data of potential living donors before living donor liver transplantation

In view of the scarcity of organ resources for transplantation, donation by living donors is assuming greater significance now that the technical‐surgical problems involved have been solved. In the period between December 1999 and December 2000, 47 potential living liver donors were evaluated and a total of 27 hepatic lobes were transplanted at the Virchow‐Klinikum of the Charité Hospital in Berlin. The close personal relationships between recipients and donors gives reason to anticipate high levels of psychosocial pressure during the pre‐operative evaluation process; this process consists in part in looking into donor motivation, ambivalence and anxiety.

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.

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.

On the theory of individual health

On top of elaborate methods and approaches in research, diagnostics, and therapy, medicine is in need of a theory of its own thought and action; without theoretical reflection and referentiality, action becomes blind (and thus costly) and thought takes on a monotonous and circular character. Take the concept of health. The field of medicine, more and more taking its cues from evidence-based medicine (EBM), is onesidedly oriented to concepts of health which are based on notions of standard values for large populations or—in the shadow of the genome project—see health as the outcome of an intact genome, often turning a blind eye to the individual aspects of health. With an eye in particular to Friedrich Nietzsches philosophy, the present paper looks into some continental European theories of individual health, seeking to determine to what extent they can contribute to reducing medicines theory deficit and what consequences this may have for research, diagnostics, and therapy.