Wilij Zuidema

Living kidney donors: Impact of age on long-term safety

The safety of older live kidney donors, especially the decline in glomerular filtration rate (GFR) after donation, has been debated. In this study we evaluated long‐term renal outcome in older live kidney donors. From 1994 to 2006 follow‐up data of 539 consecutive live kidney donations were prospectively collected, during yearly visits to the outpatient clinic. Donors were categorized into two groups, based on age: <60 (n = 422) and ≥60 (n = 117). Elderly had lower GFR predonation (80 vs. 96 mL/min respectively, p < 0.001). During median follow‐up of 5.5 years, maximum decline in eGFR was 38%± 9% and the percentage maximum decline was not different in both groups. On long‐term follow‐up, significantly more elderly had an eGFR <60 mL/min (131 (80%) vs. 94 (31%), p < 0.001). However, renal function was stable and no eGFR of less than 30 mL/min was seen. In multivariate analysis higher body mass index (HR 1.09, 95%CI 1.03–1.14) and more HLA mismatches (HR 1.17, 95%CI 1.03–1.34) were significantly correlated with worse graft survival. Donor age did not influence graft survival. After kidney donation decline in eGFR is similar in younger and older donors. As kidney function does not progressively decline, live kidney donation by elderly is considered safe.

Encouraging Psychological Outcomes After Altruistic Donation to a Stranger

In a growing number of transplant centers worldwide, altruistic donors are accepted to anonymously donate a kidney to a stranger. An important hesitation to expand these transplantation programs is the fear of evoking psychological distress in the altruistic donor after donation. To what extent this fear is justified has not yet been systematically investigated. In this study, 24 altruistic donors were interviewed on average 2 years after donation. Lifetime mental health history, current psychological complaints, satisfaction with and impact of the donation on well‐being, motives for donation, communication with recipient and donation experience were assessed. Altruistic donors report a considerable positive impact of donation on psychological well‐being, whereas negative impact was limited. Satisfaction with donation was very high. Although a history of a psychiatric diagnosis was ascertained in almost half of the donors, psychological complaints before and after donation were comparable to national average norm scores. Motives for donation were genuine and the experience of donation generally conformed to their expectations. In conclusion, living kidney donation to a stranger does not appear to exacerbate psychological complaints. Moreover, altruistic donors report considerable satisfaction and personal benefit. The exceptional gift of altruistic donors can contribute toward solving the current organ shortage issue.

Long‐Term Follow‐up of a Randomized Trial Comparing Laparoscopic and Mini‐Incision Open Live Donor Nephrectomy

Long‐term physical and psychosocial effects of laparoscopic and open kidney donation are ill defined. We performed long‐term follow‐up of 100 live kidney donors, who had been randomly assigned to mini‐incision open donor nephrectomy (MIDN) or laparoscopic donor nephrectomy (LDN). Data included blood pressure, glomerular filtration rate, quality of life (SF‐36), fatigue (MFI‐20) and graft survival. After median follow‐up of 6 years clinical and laboratory data were available for 47 donors (94%) in both groups; quality of life data for 35 donors (70%) in the MIDN group, and 37 donors (74%) in the LDN group. After 6 years, mean estimated glomerular filtration rates did not significantly differ between MIDN (75 mL/min) and LDN (76 mL/min, p = 0.39). Most dimensions of the SF‐36 and MFI‐20 did not significantly differ between groups at long‐term follow‐up, and most scores had returned to baseline. Twelve percent of the donors reported persistent complaints, but no major complications requiring surgical intervention. Five‐year death‐censored graft survival was 90% for LDN, and 85% for MIDN (p = 0.50). Long‐term outcome of live kidney donation is excellent from the perspective of both the donor and the recipient.

Home‐Based Family Intervention Increases Knowledge, Communication and Living Donation Rates: A Randomized Controlled Trial

Our aim was to develop and test an educational program to support well‐informed decision making among patients and their social network regarding living donor kidney transplantation (LDKT). One hundred sixty‐three patients who were unable to find a living donor were randomized to standard care or standard care plus home‐based education. In the education condition, patients and members of their social network participated in home‐based educational meetings and discussed renal replacement therapy options. Patients and invitees completed pre–post self‐report questionnaires measuring knowledge, risk perception, communication, self‐efficacy and subjective norm. LDKT activities were observed for 6 months postintervention. Patients in the experimental group showed significantly more improvements in knowledge (pu2009<u20090.001) and communication (pu2009=u20090.012) compared with the control group. The invitees showed pre–post increases in knowledge (pu2009<u20090.001), attitude toward discussing renal replacement therapies (pu2009=u20090.020), attitude toward donating a kidney (pu2009=u20090.023) and willingness to donate a kidney (pu2009=u20090.039) and a decrease in risk perception (pu2009=u20090.003). Finally, there were significantly more inquiries (29/39 vs. 13/41, pu2009<u20090.001), evaluations (25/39 vs. 7/41, pu2009<u20090.001) and actual LDKTs (17/39 vs. 4/41, pu2009=u20090.003) in the experimental group compared with the control group. Home‐based family education supports well‐informed decision making and promotes access to LDKT.

The psychological evaluation of Samaritan kidney donors: a systematic review

BACKGROUNDnLiving kidney donation to a loved one has become common practice. Another type of living donation that is becoming more acceptable to the transplant community is Samaritan donation. Samaritan kidney donors are willing to donate to patients they do not know. Until recently there has been great reluctance to accept the offers of Samaritan donors because it was feared that these donors might be mentally unstable.nnnMETHODnThe purpose of this article is to review the literature about the psychological evaluation of potential Samaritan kidney donors for donor suitability. We have performed a systematic literature search in Pubmed, ISI Web of Science and PsycINFO. We compare and discuss how each study approaches the question about Samaritan donor selection. In addition, we have also screened the studies for reports of rejections of Samaritan donors on psychological grounds.nnnRESULTSnWe have found five articles that at least in some detail describe the evaluation of potential Samaritan donors. For all five articles found, a consultation with either a psychiatrist or a psychologist formed a standard part of the donor evaluation procedure. This evaluation consisted of an interview, and in most instances, additional psychometric testing. According to the articles found, the two major criteria for donor rejection were psychopathology/psychological instability and motivational issues. Three studies reported on the rejection of potential donors on psychological grounds.nnnCONCLUSIONSnThe evaluation of Samaritan kidney donors is a developing field in clinical medicine. Given the relatively low incidence of these types of donations, we recommend the exchange of experience between centres that run a Samaritan donor programme, in order to improve donor evaluation criteria.

Mental health among living kidney donors: A prospective comparison with matched controls from the general population

The impact of living kidney donation on donors mental health has not been sufficiently nor comprehensively studied. Earlier studies demonstrated that mental health did not change in the majority of donors, however they often lacked a suitable control group and/or had other methodological limitations. Consequently, it remains unclear whether changes in mental health found among a minority of donors reflect normal fluctuations. In this study we matched 135 donors with individuals from the general Dutch population on gender and baseline mental health and compared changes in mental health over time. Mental health was measured using the Brief Symptom Inventory and Mental Health Continuum Short Form. Primary analyses compared baseline and 6 months follow‐up. Secondary analyses compared baseline and 9 (controls) or 15 months (donors) follow‐up. Primary multilevel regression analyses showed that there was no change in psychological complaints (pu2009=u20090.20) and wellbeing (pu2009=u20090.10) over time and donors and controls did not differ from one another in changes in psychological complaints (pu2009=u20090.48) and wellbeing (pu2009=u20090.85). Secondary analyses also revealed no difference in changes between the groups. We concluded that changes in mental health in the short term after donation do not significantly differ from normal fluctuations found in the Dutch general population.

Postmortal or living related donor: preferences of kidney patients. Authors’ reply

We studied the willingness and motives for accepting a living kidney donation in 61 kidney patients on the waiting list by a semistructured interview and a questionnaire on two occasions. Between both moments of measurement patients received general information on transplantation options. We tested whether demographic data, medical status data or quality of life correlated with treatment choice. Our results showed that 61% of the patients preferred living kidney donation to postmortal donation. Their main motivation for this choice was the better quality of the living kidney. The most often named reasons to choose postmortal donation were unwillingness to burden a loved one and fear of psychological problems in relation to the donor after transplantation. There was no statistical significant change of preference between both moments of measurement; however there seemed to be a tendency in favor of living kidney donation. Fewer years spent on renal replacement therapy correlated statistically significant with the choice for living kidney donation. These findings encourage the development of new strategies to facilitate the living kidney donation program, and confirm the need for the standard option of psychosocial support for patients.

Changes in mental health among living kidney donors after donation: a a matched control study

Background It is unclear whether living kidney donors experience psychological burden as a result of their donation. Research is hampered by the lack of a suitable control group: changes in mental health could reflect normal fluctuations. We used a control group from the general population to compare changes in mental health over time. Methods Controls were matched with 125 living kidney donors on gender and baseline mental health. Donors and controls completed the Brief Symptom Inventory (BSI) and Mental Health Continuum twice, 6 months apart. Donors donated their kidney median 3 months after baseline. Multilevel linear models were used as well as the reliable change index (RCI) of the BSI. Findings Multilevel modelling showed that donors and controls did not differ in changes of mental health over time. Based on the RCI, 2 donors versus 4 controls showed a decrease in psychological complaints and 10 donors versus 5 controls showed an increase. RCI changes were not significantly different between donors and controls. Discussion We conclude that changes in donors’ mental health 3 months after donation do not significantly differ from natural fluctuations found in the general population.