THE PSYCHOSOCIAL IMPACT OF LIVING KIDNEY DONATION AMONG ASIAN KIDNEY DONORS IN SINGAPORE

Abstract

Introduction: Living kidney donation in Singapore has proven to show excellent clinical outcomes. Despite outstanding results, the psychosocial outcomes of being a Living Kidney Donor (LKD) remain unknown. Thus, this study was performed to examine the longitudinal changes in psychosocial conditions of LKDs before and after living kidney donation. This study hypothesises that the psychosocial conditions before and after living kidney donation is not significantly different. Methodology: This study examined a cohort of 20 LKDs at Singapore General Hospital (SGH), who completed self-reported questionnaires at several time points of the study – before donation, six weeks, six months and 12 months after donation. Comprehensive survey instruments such as the Beck Anxiety Inventory (BAI), Body Image State Scale (BISS), Rosenberg Self-Esteem Scale (RSES), Short-Form Health Survey (SF-36) and a custom questionnaire were used to assess the LKD’s motivation to donation, perceptions on the quality of personal relationships with others and pain levels of LKDs. Results: At six weeks-post-donation, SF-36 scores for role-physical domain were lower as compared to pre-donation (47.5±42.84 vs. 83.75± 32.72;p=0.0058), but scores for emotional (78.4±8.84 vs. 71.6±11.08;p=0.0059) and pain (74.12±17.06 vs. 86.88±74.12±17.06;p=0.0100) domains were higher as compared to pre-donation. Scores on the BAI, BISS and RSES showed no significant differences at six weeks-post donation. When surveyed at six months-post-donation, all scores on SF-36 domains were comparable to baseline scores, except the social domain where LKDs scored higher (96.05±9.37 vs. 88.12±19.23;p=0.0439). BAI scores were also significantly lower at six months-post-donation compared to baseline (1.05±1.08 vs. 3.11±3.58;p=0.0132). At 12 months-post-donation, scores from all survey instruments were similar to those obtained at baseline. In the custom questionnaire, majority of LKDs had positive attitudes towards living kidney donation, which remained constant throughout the study. Moreover, at 12 months-post-donation, at least 80% of LKDs did not express any decline in their mental or physical health, or reduction in recreational or social activities, but instead had 35% increase in concerns over their physical health. Conclusion: Despite experiencing a decline in perceived physical functioning, LKDs faced improved emotional and pain regulation by six months-post-donation and increased levels of social functioning. By 12 months-post-donation, there were no significant differences in psychosocial condition from the time before donation. LKDs remain positive about living kidney donation and did not perceive any negative mental, physical or social impact. This study concludes that the psychosocial well-being of LKDs in SGH is preserved, but further studies are required to examine issues such as post-donation anxiety.