Altruistic Renal Donation in a Patient With Dissociative Identity Disorder: A Case Report

Abstract

Abstract Altruistic donation is currently a common source of organs for kidney transplantation in the United States. In clinical practice, prospective donors typically undergo psychosocial evaluations to determine their suitability for donation. However, the current guidelines for such assessments contain limited recommendations in regard to specific psychiatric disorders. Here we discuss the case of a patient with dissociative identity disorder (DID) who presented for altruistic kidney donation, the challenges involved in her evaluation, and available evidence pertaining to risk assessment in this patient population. Stable baseline functioning, fewer suicidal behaviors, higher integration of personality states and engagement in long term specialized treatment may predict a better general psychiatric prognosis for DID patients, and thus may be useful parameters to consider when assessing risk for live organ donation. We recommend a multi-pronged approach to the psychosocial evaluation for DID patients for altruistic kidney donation. Such an approach should include taking an extensive history of psychiatric illness including suicidal and self-injurious behavior, any prior experiences or adverse responses to medical and surgical procedures, and assessment of baseline functioning and level of integration of personality states. Performing a careful capacity assessment for informed consent should include a focus on the patient’s personalities’ opinions about donation while evaluating for any discrepancies between them. Collateral history is also crucial for determining risk as both the patient’s psychiatric narrative and consistency amongst personality states must be corroborated. Finally, we recommend consulting DID experts and including their recommendations in the final risk assessment.