Health-related Quality Of Life Of Donors Research Articles

Donor quality of life after living donor liver transplantation: a review of the literature.

Living donor liver transplantation (LDLT) provides a source for transplant in the setting of the deceased donor organ shortage. Seeing as living donors do not derive any medical benefit from the procedure, fully understanding the impact of donation on donor health-related quality of life (HRQOL) is essential. A systematic search of the MEDLINE database was performed from 2008–2020, using relevant Medical Subject Headings. Articles were evaluated for study design, cohort size and follow-up time and excluded if they contained significant methodological flaws. A total of 43 articles were included: 20 (47%) were cross-sectional and 23 (53%) were longitudinal. The mean number of donors per study was 142 (range:8–578) with follow-up ranging from 12–132 months. Forty-two unique HRQOL metrics were implemented across the 43 studies, the majority of which were questionnaires. Of the 31 studies that used the Medical Outcomes Study Short Form 36 questionnaire, 9.1% of donors reported physical QOL did not return to pre-LDLT levels for at least 2 years after donation. Mental QOL remained stable or improved after LDLT, with mean mental composite scores increasing from 50 to 52 at 3 months post-LDLT in one study. The predicted probability of poor sexual desire decreased at 1-year post-LDLT (male: 0.08, female: 0.26) relative to pre-LDLT (male: 0.44, female: 0.76; P<0.001) and three months post-LDLT (male: 0.35, female 0.69; P=0.001). Forty percent of donors found LDLT to be financially burdensome at 3 months and 19% at 2 years post-LDLT. Female gender and obesity were consistent predictors of worse HRQOL. Laparoscopy-assisted donor hepatectomy was associated with shorter hospitalizations than open donor hepatectomy (10.3 vs. 18.3 days, P=0.02). No studies used the National Institutes of Health Patient Reported Outcomes Measurement Information System (PROMIS) measures of HRQOL. Our review demonstrates that LDLT can have a long-lasting negative impact on physical QOL in 9.1% of donors and can cause both sexual dysfunction and significant financial strain. Future studies should consider using standardized and extensively validated patient reported outcomes measures, such as PROMIS, in order to directly compare outcomes across studies and gain further insight into the impact of LDLT on D-HRQOL.

Impact of Perioperative Complications on Living Kidney Donor Health-Related Quality of Life and Mental Health: Results From a Prospective Cohort Study.

Background:Although living kidney donation is safe, some donors experience perioperative complications.Objective:This study explored how perioperative complications affected donor-reported health-related quality of life, depression, and anxiety.Design:This research was a conducted as a prospective cohort study.Setting:Twelve transplant centers across Canada.Patients:A total of 912 living kidney donors were included in this study.Measurements:Short Form 36 health survey, Beck Depression Inventory and Beck Anxiety Inventory.Methods:Living kidney donors were prospectively enrolled predonation between 2009 to 2014. Donor perioperative complications were graded using the Clavien-Dindo classification system. Mental and physical health-related quality of life was assessed with the 3 measurements; measurements were taken predonation and at 3- and 12-months postdonation.Results:Seventy-four donors (8%) experienced a perioperative complication; most were minor (n = 67 [91%]), and all minor complications resolved before hospital discharge. The presence (versus absence) of a perioperative complication was associated with lower mental health-related quality of life and higher depression symptoms 3-month postdonation; neither of these differences persisted at 12-month. Perioperative complications were not associated with any changes in physical health-related quality of life or anxiety 3-month postdonation.Limitations:Minor complications may have been missed and information on complications postdischarge were not collected. No minimal clinically significant change has been defined for kidney donors across the 3 measurements.Conclusions:These findings highlight a potential opportunity to better support the psychosocial needs of donors who experience perioperative complications in the months following donation.Trial registration:NCT00319579 and NCT00936078.

Living-Donor Liver Transplantation: Impact on Donor's Health-Related Quality of Life

Objective The aim of this study was to evaluate the health-related quality of life of living liver donors after living-donor liver transplantation (LDLT). Methods Health-related quality of life (HRQOL) in 55 living liver donors operated on at our center between 2002 and 2009 was assessed using the German Version of the 36-Item Health Survey (SF-36). Results Donors after full right-lobe hepatectomy (n = 18) scored similarly to and without statistically significant difference from the German reference population, whereas donors after left lateral segmentectomy (n = 37) revealed statistically significant higher average score values ( P < .005) in the categories of physical functioning, bodily pain, and general health compared with the German reference population. In the analysis between donors after full right-lobe hepatectomy and donors after left lateral segmentectomy no statistically significant difference was observed in any of the SF-36 categories. Postoperative complications of the donors and postoperative recipient mortality were particularly revealing regarding HRQOL. Donors who developed postoperative complications presented a lower HRQOL, especially in the categories of role physical, bodily pain, and social functioning, where statistically significant differences ( P < .005) were observed. Similarly, postoperative recipient mortality correlated with lower mean score values in all SF-36 categories, but a statistically significant difference ( P < .005) was reached only in the categories of role emotional and mental health. Conclusions Donors did not regret their decision to donate, because HRQOL was not negatively affected by the donation procedure. Living liver donors scored as well as or even better than the German reference population, but it was clearly shown that the development of postoperative donor complications and the postoperative recipient mortality had a negative effect on the HRQOL of donors.

Laparoscopic versus Open Donor Nephrectomy in Germany: Impact on Donor Health-Related Quality of Life and Willingness to Donate

Introduction Laparoscopic living donor nephrectomy (LDN) offers multiple advantages to the donor. Since 1999 LDN has become the only surgical approach for living kidney donation in our department. To our knowledge a donor health-related quality of life (QoL) has not yet been performed with standardized and validated questionnaires to compare laparoscopic with open nephrectomy. We therefore performed a study with two questionnaires (SF-36/GBB-24) and one set of open questions for all donors in our department. Methods Questionnaires were sent out to all donors between 1983 and 2001 with at least a 1-year follow-up. To exclude a bias a maximum response rate was sought; donors who did not answer were recontacted as well as their recipients or their physicians to motivate them for participation. Results The response rate was (89.8%). Except for less limb pain in the laparoscopy group, no difference could be detected for donors QoL with respect to the surgical method. Willingness to donate again was not affected by the surgical method. Nevertheless if asked again today, most donors want laparoscopic kidney retrieval. Conclusions Donors health-related QoL is not affected by the surgical method when queried retrospectively. Nevertheless, most donors today would favor laparoscopy, if they could chose again. How laparoscopy affects a reluctant donor to step forward must be determined in a prospective study.

Future of adult living donor liver transplantation.

Key points 1. Future application of adult living donor liver transplantation (ALDLT) will be determined by accurate assessment of hazards imposed on the donor and documentation of potential benefits for the recipient. 2. Definition of the risks imposed on living donors can be elucidated only by the adoption of a standardized uniform method for adverse-event reporting that defines the severity of complications and assessment of living donor health-related quality of life after donation. 3. Recipient survival outcomes after ALDLT should be risk adjusted to allow valid comparison to outcomes achieved by whole-organ transplantation. 4. Short-and long-term transplant recipient complications must be compared with those of whole-organ recipients by using standardized approaches. 5. The use of living donor grafts in patients with hepatitis C virus (HCV) infection and hepatocellular carcinoma (HCC) must be investigated because advantages of early transplantation in HCV-infected transplant recipients may be offset by risks for graft loss caused by rapid recurrence, whereas early transplantation of patients for HCC may not provide additional survival benefits because shorter waiting times may negate evaluation of tumor biological characteristics, as is possible by longer waiting times for cadaveric transplant recipients.