Quality Of Life In Donors Research Articles

Change in Donor Quality of Life After Living Donor Liver Transplantation Surgery: A Single-Institution Experience

AimChanges in quality of life (QOL) of donors after living donor liver transplantation surgery were studied using Short Form 36 (SF-36) to evaluate physical health and the Profile of Mood States (POMS) to evaluate mood. MethodsAmong the 28 donors who had undergone surgery at our hospital, 21 donors replied to our questionnaire (recovery rate: 75%). Changes in the QOL of donors were examined based on the results of pre- and postoperative SF-36 and POMS and a questionnaire survey. ResultsThe donors included 12 men and nine women with a mean age of 43 years. One donor operation was complicated by biliary stenosis. The SF-36 results showed significant postoperative decline in physical function and increase in pain, but no other significant changes. The POMS results showed no significant differences, with the mean values for anxiety, depression, anger, vitality, and confusion all recovering postoperatively. The questionnaire results indicated that all subjects had recovered physical function, but 24% of subjects felt wound-related physical symptoms and 19% felt anxiety concerning their future health. ConclusionsSome donors had symptoms that persisted for comparatively long periods postoperatively and considered that long-term outpatient observation was required. No significant psychological changes were found, but donors felt anxiety about their future health and considered that patient meetings would be useful and that adequate outpatient health guidance should be provided.

Donor quality of life in living-donor lobar lung transplantation

Living-donor lobar lung transplantation has been established as a life-saving option for end-stage pulmonary diseases. However, factors associated with quality of life (QOL) of living lung donors have not been fully investigated. A cross-sectional study was performed at Okayama University using the version 2 questionnaire of the 36-item Short Form (SF-36) Health Survey. Linear regression analysis was used to estimate the relationship of donor factors and recipient outcomes using the SF-36 component summary scores. Of 65 donors, 42 (65%) agreed to participate in this study; the mean age was 42 ± 1 (range 25 to 59) years. Mean time from the operation to questionnaire was 39 ± 4 (range 1 to 78) months. Donor-recipient relationships were as follows: sibling (18 cases); spouse (9 cases); parent (11 cases); and child (4 cases). Thirty-four of 42 donors were paired with those who donated their organ to the same recipient. Both physical and mental health scores in donors were higher than those in the general Japanese population. Lower mental health scores were seen in those who donated to their child or parent. There was a significant correlation in mental health scores between the paired donors. In the univariate analysis, donor age (r = -0.35, p = 0.02), donor-recipient relationship (r = 0.38, p = 0.01) and recipient death (r = -0.42, p = 0.006) were factors significantly associated with donor mental health scores. The average QOL in the living lung donors was better than that of the general population. However, a fatal outcome in the recipient significantly impacted donor mental health QOL. Ensuring that donor candidates consider both the risks/benefits of donation, and the potential recipient outcomes may be critical in the informed consent process.

Quality of Life for Donors After Living Donor Liver Transplantation: A Review of the Literature

Quality of Life for Donors After Living Donor Liver Transplantation: A Review of the Literature

Live related donors in India: Their quality of life using world health organization quality of life brief questionnaire

Context:Organ selling is now legally banned in India. Numerous studies have documented that organ vendors have a poor quality of life (QOL) following kidney donation. Aims: This study was designed to assess the QOL of living related donors in India. Settings and Design: This study was a single-center prospective study.Materials and Methods:The QOL of 106 consecutive related kidney donors was compared before and 6 months after the donation using the World Health Organisation Quality of Life Brief Questionnaire.Statistical Analysis Used:STATA 9.0 (College Station, Texas) was used and a p value less than 0.05 was considered significant.Results:The response rate was 94.3% and the mean age was 43.2±11.95 years. Females constituted 73% of the population. Our study showed a significant improvement in the QOL among three of the four domains. The surgical technique (86- mini open donor nephrectomy, and 14 laparoscopic donor nephrectomy), education status, and marital status did not make any difference in the change in the QOL.Conclusions:Despite a number of our donors being unemployed and not being well educated, live related kidney donation improves the QOL of donors.

Quality of life for donors after living donor liver transplantation: A review of the literature

Living donor liver transplantation (LDLT) decreases the shortage of liver grafts for patients in need of a liver transplant, but it involves 2 patients: a recipient and a living donor. Despite the magnitude of the procedure for LDLT donors, only a few studies have investigated the effect of LDLT on the quality of life (QOL) of donors. We performed a systematic search of the MEDLINE database to identify peer-reviewed articles assessing QOL in adults after LDLT donation. Nineteen studies describing 768 unique donors met our inclusion criteria for this review. The median number of donors enrolled in each study was 30 (range = 10-143), and the median follow-up period was 10.4 months (range = 3-51.3 months). Before donation, donor QOL was significantly better than that in control adult populations across all measured QOL domains. Within the first 3 months after donation, the physical domains of QOL were significantly worse than the predonation levels, but they returned to baseline levels within 6 months for the majority of patients (80%-93%). Mental domains of QOL remained unchanged throughout the donation process. Common donor concerns after LDLT included bloating, loss of muscle tone, poor body image, and fatigue. In conclusion, according to our review of the existing literature, most LDLT donors return to their baseline QOL within 6 months. However, there is a lack of long-term data on donor QOL after LDLT, and few standardized assessments include measures of common patient concerns. Additional studies are necessary to develop a comprehensive risk profile for LDLT that includes a rigorous assessment of donor QOL.

Donor quality of life after living donor liver transplantation: a prospective study

It is important to determine the health-related quality of life of live donors in liver transplantation. We reviewed 35 live liver donors and prospectively and longitudinally evaluated their health-related quality for 1.5 years post-surgery based on the Short Form-36 version 2 questionnaire. Scores of the donors stratified by the clinical data were analyzed. The study was approved by the University of Tokyo Institutional Review Board (No. 1533). There was no donor mortality in the donor population studied. The percentage of major complications greater than Clavien's classification grade III was 8.6%. The physical component summary score decreased to 42.9 (p < 0.01) at 3 months, but recovered within 6 months after the operation. The mental component summary scores did not change during the observation period. The stratification study revealed that age and postoperative complications remained significant factors among the high physical component summary scores 3 months after the operation. The findings from this survey suggest that liver harvesting does not decrease the donor's quality of life during the 1.5 years following the surgery.

Quality of Life After Laparoscopic Donor Nephrectomy

ObjectivesDistinct from cadaveric donor renal transplantation, living donor renal transplantation has many benefits for the recipient, such as a shorter waiting time as well as longer patient and graft survivals. But, there is no potential physical benefit for the donors. Many studies have shown that laparoscopic donor nephrectomy (LDN) resulted in a lower complication rate and shorter hospital stay compared with an open donor nephrectomy. The present study was performed to analyze the quality of life (QoL) among patients who underwent LDN. Materials and MethodsFrom November 2005 to December 2008, 14 patients who underwent LDN were enrolled in this study. We assessed the QoL of these patients before versus 3 months after the operation using the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), which were expressed as a Physical Component Summary and a Mental Component Summary. We analyzed the association between QoL and donor age, gender, relationship to the recipient, and renal function. ResultsThe Physical Component Summaries showed a significant decrease from the values before kidney donation (92.9 ± 5.0) to 3 months thereafter (80.4 ± 16.6; P = .004). In addition, the Mental Component Summaries were also significantly decreased from 84.2 ± 10.2 to 76.8 ± 19.2 (P = .012). However, the changes of QoL were not significantly associated with donor age, gender, relationship to the recipient, or renal function after kidney donation. ConclusionThis study revealed that kidney donation had negative impacts on donor QoL after LDN although renal function was well preserved. The QoL of a potential living donor must be evaluated carefully before transplantation.

Quality of life of living kidney donors in Brazil: an evaluation by the short form‐36 and the WHOQOL‐bref questionnaires

There are few studies that evaluate donors' quality of life (QOL) following renal transplant in developing countries. This study was conducted to evaluate post-donation QOL of Brazilian living kidney donors using SF-36 and WHOQOL-bref questionnaires. Demographic, socioeconomic and the QOL data were analyzed utilizing SF-36 and WHOQOL-bref questionnaires of 69 living kidney donors and compared with 68 non-donor subjects from the same community. The donors and controls were similar as for gender and ethnicity, predominating the female. There was no difference in the educational level or socioeconomic class between the groups, the lower income being more prevalent. The evaluation of the donors' QOL was not significantly different from that of the control group. In some domains of the SF-36 and of the WHOQOL-bref questionnaires, donors scored higher than controls. Even the evaluation of the QOL of donors whose recipients had suffered loss of the graft or death following renal transplantation, showed in a general manner a similar QOL to the controls. Living kidney donors in a mainly low-income segment of the Brazilian population present a post-donation quality of life equal or superior to that of the non-donor population with the same socioeconomic profile. The two generic instruments used to evaluate the quality of life presented similar results.

Quality of Life, Coping, and Mental Health Status After Living Kidney Donation

The main aim of the study was to explore well-being after donation. This retrospective, cross-sectional study of 161 living kidney donors (104 women; response rate 81.4%) who were aged between 32 and 80 years ( x̄ = 56.3; standard deviation = 10.9) included responses to standardized questionnaires concerning quality of life (QOL), coping, and mental health status. Most donors recovered fully from donation within 6 months (90.8%). Donor willingness to donate again (96.1%) was high. Their relationship to the recipient did not change (67.9%) or even improved (27.5%) in most cases. Donor QOL (as assessed by the Short-Form [SF]-36) did not differ from healthy norms. In 25% of donors, screening with the Hospital Anxiety and Depression Scale revealed anxious and/or depressive symptoms above the clinical cutoff score. Donor predominant coping style with their recipient's renal disease was “active problem-focused coping.” The component scores of the SF-36 correlated positively with sociodemographic and self-reported medical parameters, coping, and mental health status. Although living kidney donation again proved to be a treatment without negative impact on donor QOL, the results underlined the importance of screening for donor mental health status and coping both in the evaluation process and after the procedure.

Psychosocial aspects of living-related donor renal transplantation: Quality of life and mood in recipients, donors and controls

Due to the high frequency of living-related donor renal transplantation (LRDRT) in our country, we were concerned both about the recipient and the donor quality of life and psychological well-being. We investigated HRQL and mood in LRDRT recipients, donors, and controls using the Beck Depression Inventory, Beck Anxiety Inventory, and 36-item Short Form Health Survey. The recipient group consisted of 69 individuals who underwent renal transplantation between August 2002 and June 2004. The donor group consisted of 35 and the control group 45 healthy individuals. Multivariate analysis of variance and the post hoc (Tukey) test were used to assess and to analyze differences among and between the three groups. The depression scores of the recipients were higher than donors (P < 0.05) but were similar to controls. The recipient scores indicated poorer physical functioning (P < 0.001), greater physical limitation on roles (P < 0.001), and lower levels of general health (P < 0.01) compared to controls. The donor scores indicated higher vitality (P < 0.01), better social functioning (P < 0.05) and greater mental health (P < 0.01) than controls. Poorer health and mood status among the recipient group might reflect the various negative impacts of chronic debilitating disease. It is therefore recommended to screen recipients regularly for clinically relevant HRQL impairments after transplantation.

Impact Assessment in Living Kidney Donation: Psychosocial Aspects in the Donor

Background Living donor kidney transplantation has a positive influence on graft survival and recipient quality of life (QoL). We assessed the psychosocial impact of donation to the donor. Methods Before and after the procedure 32 living kidney donors (mean age 41 years) completed the Zung Self-Rating Anxiety and Depression Scales; a Sociodemographic, Short-Form 36 Health Survey (SF-36), and a Donation Perceptions Questionnaire. Results Living kidney donors were siblings (62.5%), parents (34.4%), or a daughter (3.1%). Transplantation was not successful in two cases: one recipient death and one graft failure. No significant changes were observed in donor QoL except for the SF-36 social functioning subscale that showed significant improvement after donation ( P = .038). A reduction in depression symptom frequency was verified after donation (from 65.6% to 46.9%). There was an almost significant decrease in depression scores ( P = .077), which was in fact was significant when one considered only successful transplants ( P = .021). There was no significant variation in anxiety scores among donors. Time since transplantation was inversely correlated with overall anxiety ( r = .443, P = .011), and with somatic anxiety subscales ( r = .357, P = .045). For most donors, the decision to donate was easy and spontaneous. Nearly all donors would donate again and strongly encourage others to donate. Conclusions Except for the social functioning scale that improved, no significant changes were observed in QoL of living kidney donors after the procedure. Depression scores significantly decreased after donation, but anxiety scores remained stable. Donors, who were mostly siblings, showed positive perceptions about donation, did not regret their decision, and strongly recommend it to others.

Right Hepatic Lobe Donation: Impact on Donor Quality of Life

The aim of this study was to assess the impact of living-donor liver transplantation on the donor’s quality of life. Among the 48 performed at our hospital from October 2003 to June 2006, 46 (27 men, 19 women; mean age, 37.4 years) were followed for more than 4 months (mean, 16.5±8 months). In April 2006, these donors participated in a survey that included medical and psychosocial outcomes. Seven complications occurred in four of 46 donors (8.6%): two biliary leaks, two wound infections, one incisional hernia, one portal vein thrombosis, and one deep venous thrombosis. For the donor with portal vein thrombosis, the vein was recanalized, and she recovered without treatment; a bile leak from the cut liver surface and an incisional hernia also developed in the same donor. The biliary leak was treated with percutaneous drainage, and the incisional hernia was repaired surgically. Fifteen donors were housewives, 31 worked outside the home, and 94% returned to their work. A change in body image was reported in 4.3% of the donors. None reported impaired sexual function. Complete recovery occurred in 86% of donors, 94% of the donors said that they would donate again if necessary, and 97% believe that they had benefited from the donation experience. In conclusion, almost all donors were able to return to their prior jobs within a few months of surgery, and most donors were satisfied with the donation procedure.

Living Donor Kidney Transplants: Personal Reflections

Short- and long-term living kidney donor morbidity and mortality are discussed herein. The analysis includes over 3000 living donor kidney transplants from 1963 through 2002 at a single institution. The category of living donors includes living related donors, such as fathers, mothers, siblings, offspring, and other genetically related donors, as well as living unrelated donors, such as spouses, friends, or altruistic strangers. Graft and patient survival rates with living related and unrelated living donors are compared to rates with cadaveric donors. Donor risks are discussed, including short-term surgical risks as well as long-term risks of impaired renal function, possible hypertension, and psychological risks. Finally, early and late donor mortality statistics are presented. In addition, the benefits to potential donors are reviewed. Donors are carefully screened before donation. During this screening process, a significant number of donors have been found to have abnormal renal function—some had undisclosed hypertension and others had unknown cardiovascular disease. In addition, six malignancies were found, eventually resulting in curative resection. A secondary benefit to donors was reported in a study from Norway and Sweden, which showed that donors had improved long-term survival versus the general population. Our own long-term studies involving follow-up of 20 to 30 years after kidney donation have shown no significant difference in donor renal function, blood pressure, and incidence of proteinuria, as compared with their nondonor siblings. We also found donors to be perfectly normal in all other categories; several had even undergone normal pregnancies after donation. Most donors reported a high quality of life, with a boost in self-esteem and an increased sense of well-being: 96% felt it was a positive experience. In conclusion, living kidney donation has a very low mortality rate. Long-term follow-up shows minimal impact after donation. Donor quality of life is reported as excellent.

Donor quality of life after living donor liver transplantation

Living donor liver transplantation (LDLT) for children and adults has gained widespread acceptance due to the severe organ shortage. LDLT provides potential recipients with timely transplantation, but this procedure engenders a potentially significant risk to the donor. This study analyzed medical, functional, and psychological donor outcomes after LDLT. Nineteen donors (mean age 33.9 ± 12 years), who underwent hepatectomy for LDLT (13 right lobectomy for adult LDLT) from March 1998 to November 2002, were interviewed at a median of 13 months after donation (range, 2 to 58 months). According to the Clavien System classification, major complications occurred in three donors (16%), and minor in four (21%). The mean length of hospital stay was 5.7 ± 1.6 days. Five patients (27%) needed rehospitalization. Complete recovery was achieved at a mean time of 8.5 ± 3.5 weeks. All 19 donors were able to return to predonation activities. The donor's relationship to the recipient and to their families was improved after donation in all cases; 12 (63%) cited a positive psychological impact on their lives. About 90% would donate again and 84% would recommend donation to someone contemplating it. In conclusion, all donors are alive and well after donation and were able to return to their predonation occupation. Most of them felt that this experience changed their lives for the better and would donate again. Donor safety and quality of life should remain the priority in all donation processes.

Whither Living Donors?

Whither Living Donors?

Quality of life of living donors before and after living donor liver transplantation

Living donor liver transplantation (LDLT) is becoming an established method for treatment of terminal liver disease in adults. After resection of the right hepatic lobe, postoperative complications can arise in healthy donors, and even individual cases of death have been recorded. There remains, however, little research on the psychosocial aspects in living donors before and after LDLT. Using the WHOQOL questionnaire, this prospective study investigates the quality of life (QoL) in a sample of 28 living donors, including the relationship between postoperative complications and QoL before and 6 months after donation. Before LDLT, the donor QoL is high, above that of the general healthy population. After LDLT, a significant reduction in the QoL appears in the areas of “physical health” and “living conditions.” Nevertheless, the QoL remains above the level of the general population. Only two donors showed general QoL values below those of the general population. The postoperative complications had no significant influence on the QoL after transplantation. The high QoL of donors following LDLT indicates a positive psychosocial outcome for the majority of donors, irrespective of donation-related complications. Additional psychosocial studies will be necessary to disclose predictors for an unfavorable psychosocial outcome following LDLT.

Donor evaluation, donor risks, donor outcome, and donor quality of life in adult-to-adult living donor liver transplantation.

Right lobe living donor liver transplantation (LD-LTx) is currently performed at an increasing number of transplant centers. Donor selection, donor safety, donor recovery, and postdonation psychological impairment are essential criteria to determine whether and under which conditions LD-LTx is justifiable. Before commencing the LD-LTx program, approval was obtained from the local ethics committee. Potential donors underwent a comprehensive multistep evaluation protocol to exclude any conditions that could lead to an increased operative risk. Each donation was approved by the local Living Donation Commission. Follow-up investigations were performed after 6 and 12 months. Liver regeneration was assessed by computed tomography scan and magnetic resonance imaging scan derived volumetries. Quality of life (QOL) was investigated according to the Anamnestic Comparative Self-Assessment Scale (ACSA) before donation, and 6 and 12 months after donation. As of December 2001, 43 right lobe living donations have been performed at the Charité, Campus Virchow, Berlin. None of the donors died or has suffered life-threatening or persisting complications. All patients recovered completely. Complications occured in 8 donors (18%). The incidence of perioperative surgical complications was 9%, comprising temporary biliary leakages (n = 3; 6.8%) as well as postoperative bleeding (n = 1). Liver volume regeneration approximated 72% +/- 15% of predonation volume by 6 months and 85% +/- 18% (mean +/- SD) by 12 months. There was no evidence of significant psychological impairment after donation. QOL increased after donation compared with the preoperative state (P < .05). In our experience, LD-LTx has proven to be a practicable and safe procedure. However, there is a considerable risk of postoperative complications. The donor selection process plays a pivotal role in preventing complications. The discussion of potential risks, especially potential life-threatening risks, must be an integral part of informed consent.

Right hepatic lobe donation for living donor liver transplantation: impact on donor quality of life.

Adult right hepatic lobe living donor liver transplantation (LDLT) has rapidly gained widespread acceptance as an effective procedure for selected patients with end-stage liver disease. However, there are currently no published data on the effect of this procedure on the quality of life of donors. We report the results of a survey of our living liver transplant donors to determine the effect of right hepatic lobe donation on quality of life. We have performed 30 LDLTs since 1997; 24 of these have a follow-up of 4 months or longer. In August 2000, these patients were sent a questionnaire (including a Medical Outcomes Study 36-Item Short-Form Survey) regarding psychosocial outcomes and symptoms after surgery. Major complications occurred in 4 of 24 patients (16%), and minor complications, in 4 of 24 patients (16%). Complete recovery occurred in 75% of patients at a mean time of 3.4 months. Ninety-six percent of patients returned to the same predonation job after a mean time of 2.4 months, and 66% of patients required a period of light-duty work for a mean of 2.8 months before returning to full-duty work. A change in body image was reported in 42% of patients, and 71% reported mild ongoing symptoms (primarily abdominal discomfort) that they related to the donor surgery for which 29% sought evaluation by a physician. The donor's relationship with the recipient was the same or better in 96% of donors, and the relationship with the donor's significant other was the same or better in 88% of donors. Mean out-of-pocket expenses incurred by donors were $3,660. Sixty-three percent of donors reported experiencing more pain than anticipated. All patients would donate again if necessary, and 96% benefited from the donor experience. In conclusion, (1) all our donors are alive and well after donation; (2) almost all donors were able to return to predonation employment status within a few months; (3) most donors have mild persistent abdominal symptoms, and some donors had a change in body image that they attribute to the donor surgery; and (4) this information should be provided to potential donors so they may better understand the impact of donor surgery.