Prevention of poor psychosocial outcomes in living organ donors: from description to theory-driven intervention development and initial feasibility testing
ABSTRACT Although some living donors experience psychological, somatic, and interpersonal difficulties after donation, interventions to prevent such outcomes have not been developed or evaluated.
To (1) summarize empirical evidence on psychosocial outcomes after donation, (2) describe a theoretical framework to guide development of an intervention to prevent poor outcomes, and (3) describe development and initial evaluation of feasibility and acceptability of the intervention.
Based on a narrative literature review suggesting that individuals ambivalent about donation are at risk for poor psychosocial outcomes after donation, the intervention targeted this risk factor. Intervention structure and content drew on motivational interviewing principles in order to assist prospective donors to resolve ambivalence. Data were collected on donors' characteristics at our institution to determine whether they constituted a representative population in which to evaluate the intervention. Study participants were then recruited to assess the feasibility and acceptability of the intervention. They were required to have scores greater than 0 on the Simmons Ambivalence Scale (indicating at least some ambivalence about donation).
Our population was similar to the national living donor population on most demographic and donation-related characteristics. Eight individuals who had been approved to donate either a kidney or liver segment were enrolled for pilot testing of the intervention. All successfully completed the 2-session telephone-based intervention before scheduled donation surgery. Participants' ratings of acceptability and satisfaction were high. Open-ended comments indicated that the intervention addressed participants' thoughts and concerns about the decision to donate.
The intervention is feasible, acceptable, and appears relevant to donor concerns. A clinical trial to evaluate the efficacy of the intervention is warranted.
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ABSTRACT: There has been dramatic growth in the last decade in the literature on psychosocial and financial impacts of living organ donation. With this growth has come recognition that these impacts must be considered when educating prospective donors about the donation process and when planning donor follow-up care after donation. Our review highlights recent studies that provide new information on the nature of psychosocial and financial outcomes in living donors, with special attention to studies examining unrelated donors (i.e., those with no biologic or longstanding emotional connection to the transplant patient), given that these individuals represent a growing segment of the living donor population. Limitations and gaps in available evidence are noted. We also discuss recent recommendations for post-donation monitoring of donors’ psychosocial and financial outcomes, and we consider advances in evidence regarding interventions and prevention strategies to minimize any adverse psychosocial and financial impacts of living donation.03/2014; DOI:10.1007/s40472-013-0003-4
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ABSTRACT: There are no evidence-based interventions to prevent adverse psychosocial consequences after living donation. We conducted a single-site randomized controlled trial to examine the postdonation impact of a preventive intervention utilizing motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence (i.e. lingering hesitation and uncertainty) about donating. Of 184 prospective kidney or liver donors, 131 screened positive for ambivalence; 113 were randomized to (a) the MI intervention, (b) an active comparison condition (health education) or (c) standard care only before donation. Ambivalence was reassessed postintervention (before donation). Primary trial outcomes-psychosocial variables in somatic, psychological and family interpersonal relationship domains-were assessed at 6 weeks and 3 months postdonation. MI subjects showed the greatest decline in ambivalence (p = 0.050). On somatic outcomes, by 3 months postdonation MI subjects reported fewer physical symptoms (p = 0.038), lower rates of fatigue (p = 0.021) and pain (p = 0.016), shorter recovery times (p = 0.041) and fewer unexpected medical problems (p = 0.023). Among psychological and interpersonal outcomes, they had a lower rate of anxiety symptoms (p = 0.046) and fewer unexpected family-related problems (p = 0.045). They did not differ on depression, feelings about donation or family relationship quality. The findings suggest that the intervention merits testing in a larger, multisite trial.American Journal of Transplantation 08/2013; 13(10). DOI:10.1111/ajt.12393 · 6.19 Impact Factor
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ABSTRACT: Donor safety in living liver donation is of paramount importance, however, information on long-term outcomes is limited by incomplete follow-up. We sought to ascertain factors that predict post-donation follow-up in 456 living liver donors in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Completed donor follow-up was defined as physical, phone, or laboratory contact at a given time point. Univariate and multivariable mixed effects logistic regression models were developed to predict completed follow-up using donor and recipient demographic and clinical data and donor quality of life data. 90% of donors completed follow-up in the first three months, 83% at year 1; completed follow-up ranged from 57% to 72% in years 2-7 and from 41% to 56% in years 8-10. The probability of completed follow-up in the first year was higher for white donors (odds ratio (OR)=3.27, 95% confidence interval (CI)=1.25-8.58), but lower for donors whose recipients had hepatitis C virus or hepatocellular carcinoma (OR=0.34, 95% CI=0.17-0.69). After the first year, older age at donation predicted more complete follow-up. There were significant center differences at all time points (OR range 0.29-10.11), with center variability in both return for in-center visits and in the use of phone/long distance visits. Donor follow-up in the first year post-donation was excellent but decreased with time. Predictors of follow-up varied based on the time since donation. Adapting center best practices, enhanced by using telephone and social media to maintain contact with donors, represents a significant opportunity to gain valuable information about long-term donor outcomes. Liver Transpl , 2014. © 2014 AASLD.Liver Transplantation 05/2014; 20(8). DOI:10.1002/lt.23912 · 3.79 Impact Factor