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1.
BMC Public Health ; 24(1): 1904, 2024 Jul 16.
Artículo en Inglés | MEDLINE | ID: mdl-39014341

RESUMEN

BACKGROUND: There is sustained interest in understanding the perspectives of liver transplant recipients and living donors, with several qualitative studies shedding light on this emotionally charged subject. However, these studies have relied primarily on traditional semi-structured interviews, which, while valuable, come with inherent limitations. Consequently, there remains a gap in our comprehension of the broader public discourse surrounding living liver donation. This study aims to bridge this gap by delving into public conversations related to living liver donation through a qualitative analysis of Twitter (now X) posts, offering a fresh perspective on this critical issue. METHODS: To compile a comprehensive dataset, we extracted original tweets containing the hashtags "#donateliver" OR "#liverdonor", all posted in English from January 1, 2012, to December 31, 2022. We then selected tweets from individual users whose Twitter (X) accounts featured authentic human names, ensuring the credibility of our data. Employing Braun and Clarke's reflexive thematic analysis approach, the study investigators read and analysed the included tweets, identifying two main themes and six subthemes. The Health Policy Triangle framework was applied to understand the roles of different stakeholders involved in the discourse and suggest areas for policy improvement. RESULTS: A total of 361 unique tweets from individual users were analysed. The major theme that emerged was the persistent shortage of liver donors, underscoring the desperation faced by individuals in need of life-saving liver transplants and the urgency of addressing the organ shortage problem. The second theme delved into the experiences of liver donors post-surgery, shedding light on a variety of aspects related to the transplantation process, including the visibility of surgical scars, and the significance of returning to physical activity and exercise post-surgery. CONCLUSION: The multifaceted experiences of individuals involved in the transplantation process, both recipients and donors, should be further studied in our efforts to improve the critical shortage of liver donors.


Asunto(s)
Trasplante de Hígado , Donadores Vivos , Investigación Cualitativa , Medios de Comunicación Sociales , Humanos , Medios de Comunicación Sociales/estadística & datos numéricos , Donadores Vivos/psicología , Donadores Vivos/estadística & datos numéricos , Trasplante de Hígado/psicología , Obtención de Tejidos y Órganos
2.
Clin Transplant ; 38(7): e15377, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38952192

RESUMEN

INTRODUCTION: The decision to become a living donor requires consideration of a complex, interactive array of factors that could be targeted for clinical, policy, and educational interventions. Our objective was to assess how financial barriers interact with motivators, other barriers, and facilitators during this process. METHODS: Data were obtained from a public survey assessing motivators, barriers, and facilitators of living donation. We used multivariable logistic regression and consensus k-means clustering to assess interactions between financial concerns and other considerations in the decision-making process. RESULTS: Among 1592 respondents, the average age was 43; 74% were female and 14% and 6% identified as Hispanic and Black, respectively. Among employed respondents (72%), 40% indicated that they would not be able to donate without lost wage reimbursement. Stronger agreement with worries about expenses and dependent care challenges was associated with not being able to donate without lost wage reimbursement (OR = 1.2, 95% CI = 1.0-1.3; OR = 1.2, 95% CI = 1.1-1.3, respectively). Four respondent clusters were identified. Cluster 1 had strong motivators and facilitators with minimal barriers. Cluster 2 had barriers related to health concerns, nervousness, and dependent care. Clusters 3 and 4 had financial barriers. Cluster 3 also had anxiety related to surgery and dependent care. CONCLUSIONS: Financial barriers interact primarily with health and dependent care concerns when considering living organ donation. Targeted interventions to reduce financial barriers and improve provider communication regarding donation-related risks are needed.


Asunto(s)
Toma de Decisiones , Donadores Vivos , Motivación , Obtención de Tejidos y Órganos , Humanos , Femenino , Masculino , Adulto , Donadores Vivos/psicología , Obtención de Tejidos y Órganos/economía , Persona de Mediana Edad , Encuestas y Cuestionarios , Pronóstico , Estudios de Seguimiento
3.
Ann Transplant ; 29: e944176, 2024 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-38915193

RESUMEN

BACKGROUND Post-donation regret in family living liver donors can impact their mental well-being. This study examined whether the relationship between post-donation regret and anxiety is mediated by family relationships and a sense of mastery. MATERIAL AND METHODS We conducted a secondary analysis of de-identified cross-sectional data from a prior study that included 124 living liver donors. These donors underwent partial hepatectomy between January 2011 and March 2021 at a tertiary hospital in Seoul, South Korea. The data included demographic and clinical characteristics, along with the results from administering the following measures: the Post-Donation Regret Scale, Family Relationships Index, Pearlin Mastery Scale, and the Generalized Anxiety Disorder-2 scale. RESULTS Among family living liver donors, 5.6% had anxiety after donation. The total effect of post-donation regret on anxiety was significant (B=0.41, p<0.05). However, the direct effect of regret on anxiety was not significant (B=-0.05, p=0.733). Post-donation regret had indirect effects on anxiety, solely through family relationships (B=0.329, 95% CI=0.130, 0.563) and sequentially through family relationships and mastery (B=0.088, 95% CI=0.008, 0.232), even after controlling for sex, age, postoperative complications, years since donation, and recipient's death. In addition, postoperative complication was a predictor of anxiety (B=0.64, p<0.05). CONCLUSIONS Providing family-centered and mastery-enhancing interventions may help alleviate the anxiety of family living liver donors.


Asunto(s)
Ansiedad , Emociones , Relaciones Familiares , Hepatectomía , Trasplante de Hígado , Donadores Vivos , Humanos , Masculino , Femenino , Donadores Vivos/psicología , Adulto , Trasplante de Hígado/psicología , Ansiedad/psicología , Ansiedad/etiología , Estudios Transversales , Persona de Mediana Edad , Relaciones Familiares/psicología , Hepatectomía/psicología , Hepatectomía/efectos adversos , República de Corea , Familia/psicología
4.
Transpl Infect Dis ; 26(3): e14300, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38809085

RESUMEN

BACKGROUND: HIV+-to-HIV+ organ transplantation has demonstrated promise and is now authorized for research purposes in certain countries. However, organ transplantation is dependent on the availability of organ donors. We assessed the awareness and willingness to donate organs among people with HIV (PWH) in Uganda. METHODS: We conducted a multicenter cross-sectional study between October 2023 and January 2024 in four large HIV clinics in Northern Uganda. The study population consisted of PWH. A structured questionnaire was used to collect data regarding awareness, willingness, and beliefs regarding organ donation. Organ donation was defined as the willingness to be a living donor of a solid organ. We conducted multivariable logistic regression to assess for an association between willingness to donate organs and selected exposures. Data were analyzed in Stata version 15.0. Results are expressed as adjusted odds ratio (AOR) with 95% confidence intervals (CI). RESULTS: A total of 232 participants were recruited. The mean age ± standard deviation of the participants was 42.2±11.8 years. All participants were on antiretroviral therapy. Sixty-two (26.7%) had a CD4 count less than or equal to 200 cells/mm3. The majority (80.6%, n = 187) had ever heard of organ donation. Slightly more than a third (34.9%, n = 81) were willing to donate organs. Factors associated with willingness to be a living organ donor included being female (AOR: 1.56; 95% CI: 1.15-2.11), having a tertiary education level (AOR: 1.79; 95% CI: 1.03-3.11), average monthly income >500 000 UGX (135.1USD) (AOR: 5.5; 95% CI: 1.97-15.40), ever heard about organ donation (AOR: 5.4; 95% CI: 1.67-17.8), and attending an organ donation campaign (AOR: 2.0; 95% CI: 1.07-3.74). CONCLUSIONS: Awareness about organ donation was high but the willingness to be a living organ donor was low among PWH in Uganda. There is a need to sensitize the community about the need and benefits of organ donation with the involvement of media and the healthcare workers.


Asunto(s)
Infecciones por VIH , Conocimientos, Actitudes y Práctica en Salud , Donadores Vivos , Obtención de Tejidos y Órganos , Humanos , Femenino , Uganda , Masculino , Estudios Transversales , Adulto , Infecciones por VIH/psicología , Persona de Mediana Edad , Donadores Vivos/psicología , Encuestas y Cuestionarios , Trasplante de Órganos
5.
J Gastrointest Surg ; 28(5): 731-737, 2024 May.
Artículo en Inglés | MEDLINE | ID: mdl-38704207

RESUMEN

BACKGROUND: Long-term medical and quality of life (QOL) outcomes in voluntary liver donors remain under investigated. The objective of the current study was to report long-term medical outcomes and re-evaluate QOL in living liver donors. METHODS: This was a single-center retrospective cohort study of donors who underwent donor hepatectomy between 2012 and 2018. We investigated long-term outcomes in 7 domains. These include medical problems, surgical procedures, work-related issues, pregnancy outcomes, psychiatric interventions, willingness to donate again, and long-term mortality. QOL was evaluated using short-form 36. RESULTS: The median follow-up time was 61.4 months (53.3-83.7). Among 698 donors, 80 (11.5%) experienced medical problems, 4 (0.6%) had work-related issues, and 20 (2.9%) needed psychiatric assistance. Surgery was performed in 49 donors (7%), and females were more likely to have undergone incisional hernia repair (5.8% vs 1.9%, P = .006). There were 79 postdonation pregnancies including 41 normal vaginal deliveries (51.9%), 35 cesarean sections (44.3%), and 3 miscarriages (3.8%). Willingness to donate again was reported by 658 donors (94.3%). Donors whose recipients were alive were more likely to donate again (95.5% vs 90.5%, P = .01). There were 3 deaths (0.4%) in the long-term. The mean physical composite score at initial and follow-up evaluation was 86.7 ± 13.9 and 76.5 ± 20.9 (P = .001), and the mean mental composite score at initial and follow-up evaluation was 92.1 ± 13.5 and 80.7 ± 16 (P = .001). CONCLUSION: The overall long-term outlook in living liver donors is promising. QOL parameters might deteriorate over time and frequent re-evaluation might be considered.


Asunto(s)
Hepatectomía , Trasplante de Hígado , Donadores Vivos , Calidad de Vida , Humanos , Femenino , Masculino , Estudios Retrospectivos , Adulto , Donadores Vivos/psicología , Hepatectomía/psicología , Trasplante de Hígado/psicología , Persona de Mediana Edad , Embarazo , Resultado del Embarazo , Estudios de Seguimiento , Factores de Tiempo , Adulto Joven , Herniorrafia
6.
Medicine (Baltimore) ; 103(19): e38068, 2024 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-38728517

RESUMEN

This study investigated the relationship between self-determination, physical health status, and Health related Quality of Life (=HRQoL) among living kidney donors. A descriptive survey was conducted between 2019 and 2020 and included 111 kidney donors. Data were collected using a self-report questionnaire on general and donation-related characteristics, self-determination, and HRQoL. The data also included medical records reflecting the physical health status at the time of the survey. Data were analyzed using a multiple regression model. Factors associated with HRQoL were perceived health recovery after donation (ß = 0.42, P < .001), up to 1 year since donation (ß = 0.33, P = .008), more than 1 up to 5 years since donation (ß = 0.52, P < .001), more than 5 up to 10 years since donation (ß = 0.53, P < .001), and competence of self-determination (ß = 0.23, P = .033). The explanatory power of these variables was 43.3%. HRQoL of living kidney donors can be affected by subjective and psychological factors. Therefore, health care providers should help living kidney donors have high self-determination during pre and post donation and concentrate on the subjective and psychological factors as well as objective health status.


Asunto(s)
Estado de Salud , Trasplante de Riñón , Donadores Vivos , Calidad de Vida , Humanos , Calidad de Vida/psicología , Donadores Vivos/psicología , Donadores Vivos/estadística & datos numéricos , Estudios Transversales , Masculino , Femenino , República de Corea , Adulto , Trasplante de Riñón/psicología , Persona de Mediana Edad , Autonomía Personal , Encuestas y Cuestionarios , Autoinforme
7.
J Pak Med Assoc ; 74(4): 706-710, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38751266

RESUMEN

Objective: To explore post-donation life satisfaction, quality of life and mood status among kidney donors. METHODS: The cross-sectional study was conducted from February 5 to July 10, 2021, at the Department of Kidney Transplant Surgery, Pakistan Kidney and Liver Institute and Research Centre, Lahore, Pakistan, and comprised living kidney donors who had donated a kidney at least 6 months before the interview date. Data was collected through telephonic interviews, and, in addition to demographics, the questionnaire comprised the World Health Organisation Quality of Life Brief Version scale, the Satisfaction with Life Scale, and the Patient Health Questionnaire and General Anxiety Disorder. Data was analysed using SPSS 20. RESULTS: Of the 41 subjects, 22(53.7%) were females and 19(46.3%) were males. The overall mean age was 41.10±9.648 years (range: 19-62 years). The most common donor-recipient relationship was brother-sister 10(34.1%) and wife-husband 10(24.4%). Among the donors, there was a significant positive correlation between quality of life and satisfaction with life (r=0.381, p=0.014). Quality of life had a negative correlation with anxiety (r=-0.429, p=0.005), and a negative but non-significant association with depression (r=-0.283, p=0.073). Anxiety and depression were highly positively correlated (r=0.681, p=0.000). Quality of life was significantly associated with donor age (p=0.029) with a negative effect (Beta=-0.588), while satisfaction with life had a positive relationship with age (Beta=0.147). Conclusion: Higher life satisfaction among living kidney donors was associated with an improved quality of life, while increased anxiety levels were linked to a lower quality of life. Age was a critical determinant, with older donors reporting a lower quality of life.


Asunto(s)
Trasplante de Riñón , Donadores Vivos , Satisfacción Personal , Calidad de Vida , Humanos , Calidad de Vida/psicología , Femenino , Masculino , Adulto , Pakistán , Donadores Vivos/psicología , Persona de Mediana Edad , Trasplante de Riñón/psicología , Estudios Transversales , Adulto Joven , Afecto , Ansiedad/epidemiología , Ansiedad/psicología
8.
Exp Clin Transplant ; 22(Suppl 4): 12-24, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38775692

RESUMEN

Solid-organ transplantation remains the optimal therapeutic option for end-stage organ disease. Altruistic donation represents the ultimate sign of generosity and the most important gift of life. Currently, <10% of the global needs for transplant are fulfilled. Organ shortages result from an inability to provide an adequate organ supply to match demands. The recently observed stagnation in living kidney donations in the United States is related to a drop in all types of organ donations from living related donors, which has been paralleled with a steady and continuous increase in all living unrelated donations. Some forms of living unrelated donation represent a financially driven survival system within which wealthy recipients exploit poor donors. Low rates of altruistic donation are related to cultural barriers, religious obstacles, fear, and consequent distrust in the system. The low rate indicates a state of lack of societal solidarity, a consequence of the state of subconsciousness at the individual and collective levels that humanity is living in. Human domestication, the conditioning process that humans go through since birth and the primary facilitator of this subconscious state, is guarded through familial, social, cultural, religious, political, and mass media organizations, which are all under the influence of the monetary establishment. Acquired beliefs, mainly during the domestication process, influence our perception of the environment, our values, and ultimately our way of life. Unfortunately, this conditioning process is negatively enforced, leading to a stressful state. The powerful subconscious mind places humans in a permanent survival mode, resulting in loss of intelligence, indispensable for well-being and happiness. Altruistic donation requires a close cooperation between all parties involved in the donation process and necessitates a positive reprograming of our subconscious based on sharing, generosity, satisfaction, gratitude, trust, inner peace, and ultimately happiness, well-known constituents of unconditional love, which represents the peak of consciousness.


Asunto(s)
Altruismo , Donadores Vivos , Obtención de Tejidos y Órganos , Humanos , Donadores Vivos/psicología , Donadores Vivos/provisión & distribución , Donaciones , Motivación , Conocimientos, Actitudes y Práctica en Salud , Trasplante de Órganos/psicología , Necesidades y Demandas de Servicios de Salud , Características Culturales , Donante no Emparentado/psicología
9.
Transplant Rev (Orlando) ; 38(3): 100855, 2024 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-38657495

RESUMEN

INTRODUCTION: Despite the lauded benefits of living kidney donation, there is growing evidence of the challenges that living kidney donors (LKD) encounter in their donation trajectory and gaps in healthcare service provision. However, most of the evidence is derived from research conducted by clinicians or academic investigators. Significantly less attention has been devoted to analyzing unsolicited accounts of LKDs' experiences. METHODS: We conducted a review and synthesis of published unsolicited first-person narratives of LKDs and aimed to synthesize their experiences and identify care needs. Four electronic databases were searched and 27 LKD narratives were included in our final analysis. Thematic synthesis was used to generate themes inductively. RESULTS: Although the majority of LKDs reported the act of donation to be a fulfilling experience, almost 48% reported encountering challenges in the care that they received. Also, 29% of LKDs reported experiencing an adverse clinical event. Five distinct themes emerged surrounding the donation experience and healthcare needs: 1) Educational needs due to perceived lack of transparency and compensating for knowledge gaps; 2) Respect for donor autonomy due to coercive influences from family or healthcare providers, lack of respect for donor preferences and loopholes in the consent process; 3) Unmet care needs related to poor communication with healthcare providers, coordination issues and inconsistent and inadequate long-term care; 4) Unanticipated outcomes due to economic costs and the emotional burden of donation; and 5) Contributing beyond the donation event by advocating for a balanced view of donation and generating support mechanisms. CONCLUSION: In this synthesis of LKDs narratives, important care gaps and the need to advocate for a balanced perspective on living kidney donation were highlighted. Our review underscores the value of patients' own stories as critical evidence that can inform improvement in healthcare service delivery.


Asunto(s)
Trasplante de Riñón , Donadores Vivos , Humanos , Donadores Vivos/psicología , Trasplante de Riñón/psicología , Narración , Masculino , Femenino , Nefrectomía
10.
Am Surg ; 90(6): 1772-1774, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38518210

RESUMEN

Surgical regret often experienced at times of a great loss may cause a surgeon to reflect on their practice and intraoperative decision-making. It is inevitable that in the surgical profession, both in training and practice, a surgeon's decisions will be questioned by themselves, peers, and possibly patients. Here, we explore a case of living donor kidney donation in which the surgeon chooses to discontinue the operation for an incidental finding. Ultimately, this is against the patient's wishes and a decision over which both the surgeon and patient experience moral hazard and regret. This article explores surgical regret from the lens of an altruistic donor case and a surgeon's inaction, discussing the ethics of the operative decision-making and surgeon's viewpoint intra- and post-operatively.


Asunto(s)
Toma de Decisiones , Emociones , Trasplante de Riñón , Donadores Vivos , Femenino , Humanos , Persona de Mediana Edad , Altruismo , Toma de Decisiones Clínicas/ética , Hallazgos Incidentales , Trasplante de Riñón/psicología , Trasplante de Riñón/ética , Donadores Vivos/psicología , Nefrectomía/psicología , Nefrectomía/métodos
11.
Exp Clin Transplant ; 22(Suppl 1): 28-36, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38385370

RESUMEN

Sex-disaggregated data reveal significant disparities in living kidney donation, with more female than male living kidney donors in most countries and proportions over 60% in some countries. We summarize the present state of knowledge with respect to the potential drivers of this disparity and argue that it is primarily driven by gender-related factors. First, we present the differences between sex and gender and then proceed to summarize the potential medical reasons that have been proposed to explain why males are less likely to be living kidney donors than females, such as the higher prevalence of kidney failure in males. We then present counterarguments as to why biological sex differences are not enough to explain lower living kidney donation among males, such as a higher prevalence of chronic kidney disease among females, which could affect donation rates. We argue that gender differences likely provide a better explanation as to why there are more women than men living kidney donors and explore the role of economic and social factors, as well as gender roles and expectations, in affecting living kidney donation among both men and women. We conclude with the need for a gender analysis to explain this complex psychosocial phenomenon in living kidney donation.


Asunto(s)
Fallo Renal Crónico , Trasplante de Riñón , Humanos , Masculino , Femenino , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/psicología , Riñón , Recolección de Tejidos y Órganos , Factores Sexuales , Donadores Vivos/psicología
13.
Qual Health Res ; 34(7): 691-702, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38229412

RESUMEN

The objective of this study was to investigate factors influencing one's decision to become a live kidney donor under the framework of sociotechnical systems, by expanding the focus to include larger organizational influences and technological considerations. Semi-structured interviews were conducted with live kidney donors who donated through University of Louisville Health, Trager Transplant Center, a mid-scale transplant program, in the years 2017 through 2019. The interview transcripts were analyzed for barriers and facilitators to live kidney donation within a sociotechnical system. The most salient facilitators included: having an informative, caring, and available care team; the absence of any negative external pressure toward donating; donating to a family or friend; and the ability to take extra time off work for recovery. The most recurrent barriers included: short/medium-term (<1 year) negative health impacts because of donation; the need to make minor lifestyle changes (e.g., less alcohol consumption) after donation; and mental health deterioration stemming from the donation process. The sociotechnical systems framework promotes a balanced system comprised of social, technical, and environmental subsystems. Assessing the facilitators and barriers from the sociotechnical system perspective revealed the importance of and opportunities for developing strategies to promote integration of technical subsystem, such as social media apps and interactive AI platforms, with social and environmental subsystems to enable facilitators and reduce barriers effectively.


Asunto(s)
Trasplante de Riñón , Donadores Vivos , Humanos , Donadores Vivos/psicología , Femenino , Masculino , Trasplante de Riñón/psicología , Persona de Mediana Edad , Adulto , Entrevistas como Asunto , Investigación Cualitativa , Toma de Decisiones , Anciano
14.
Hum Reprod ; 39(2): 374-381, 2024 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-37995381

RESUMEN

STUDY QUESTION: What are the outcomes regarding health-related quality-of-life, mood, and marital relationship of recipients and donors 5 years after uterus transplantation (UTx) and uterus donation? SUMMARY ANSWER: Both recipients and donors generally demonstrated long-term stability regarding psychosocial outcomes but with negative deviations associated with unsuccessful outcomes. WHAT IS KNOWN ALREADY: UTx is the first infertility treatment for women with absolute uterine factor infertility. The procedure can be performed with either a uterus donation from a live donor (LD), typically a close relative, or from a deceased, multi-organ donor. There are many potential stressful events over several years after UTx both for recipients and for LDs and these events may have impacts on quality-of-life and mental well-being. STUDY DESIGN, SIZE, DURATION: This, prospective observational cohort study includes the nine recipients and LDs of the first human UTx trial. They were assessed in 2017-2018 by questionnaires 5 years after UTx. PARTICIPANTS/MATERIALS, SETTING, METHODS: The nine recipients (ages 32-43 years) and their respective LDs (ages 44-67 years) were either related (n = 8) or friends (n = 1). Eight recipients had congenital uterine absence and one was hysterectomized due to cervical cancer. For two recipients, UTx resulted in early graft failures, while six of the other seven recipients gave birth to a total of eight babies over the following 5 years. Physical and mental component summaries of health-related quality-of-life were measured with the SF-36 questionnaire. Mood was assessed by the Hospital Anxiety and Depression Scale. Relationship with partner was measured with the Dyadic Adjustment Scale. Comparisons were made between the values after 5 years and the values before uterus donation/transplantation. MAIN RESULTS AND THE ROLE OF CHANCE: Five years after primary UTx, the majority of recipients scored above the predicted value of the general population on quality-of-life, except for two women, one of whom had a viable graft but no live birth and one recipient who was strained by quality-of-life changes, possibly related to parenthood transitions. Regarding mood, only one value (anxiety) was above the threshold for further clinical assessment. Recipients showed declining satisfaction with their marital relationships, but all reported scores above the 'at risk for divorce' threshold at the time of the final assessment in our study. The LDs were all found to be stable and above the predicted value of the general population regarding mental components of quality-of-life. Three LDs showed declined physical components, possibly related to older age. Only one LD reported a value in mood (anxiety) that would need further assessment. The marital satisfaction of LDs remained stable and unchanged compared to baseline values. Notably, the two recipients with early graft failures, and their related LDs, regained their mental well-being during the first years after graft failure and remained stable after 5 years. LIMITATIONS, REASONS FOR CAUTION: The restricted sample size and the single-centre study-design are limitations of this study. Additionally the study was limited to LD UTx, as opposed to deceased donor UTx. WIDER IMPLICATIONS OF THE FINDINGS: Our study shows that both LDs and recipients had acceptable or favourable quality-of-life outcomes, including mood assessment, at the 5-year follow-up mark, and that failure to achieve a live birth negatively affected these modalities both for LDs and recipients. Moreover, an important finding was that LDs and recipients are not reacting with depression after hysterectomy, which is common after hysterectomy in the general population. STUDY FUNDING/COMPETING INTEREST(S): Funding was provided by the Jane and Dan Olsson Foundation for Science, Knut and Alice Wallenberg Foundation, Handlanden Hjalmar Svensson Foundation, Swedish Governmental ALF Grant, and Swedish Research Council. There are no conflicts of interest to disclose. TRIAL REGISTRATION NUMBER: NCT01844362.


Asunto(s)
Infertilidad Femenina , Humanos , Femenino , Estudios de Seguimiento , Estudios Prospectivos , Infertilidad Femenina/terapia , Útero/anomalías , Donadores Vivos/psicología , Calidad de Vida
15.
J Eval Clin Pract ; 30(2): 268-280, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38037502

RESUMEN

INTRODUCTION: The organ donation and transplantation (ODT) system in Canada is complex and can be challenging for individuals to navigate. We thus aimed to illuminate the experiences of individuals on transplant journeys using a patient-oriented convergent parallel mixed-methods approach. METHODS: We captured data on adult patients, living donors, and caregivers on transplant journeys across Canada through an online survey (n = 935) and focus groups (n = 21). The survey was comprised of 48 questions about the individuals' experiences with the living donation and transplantation system, which were analyzed descriptively. Qualitative data were analyzed using an inductive conventional content analysis approach. RESULTS: Most participants were female (70.1%), English speaking (92.6%) and White (87.8%). Participants' experiences were represented across six key themes: holistic person-centred care, accountable care, collective impact, navigating uncertainty, connection and advocacy. Quantitative and qualitative data were integrated to identify five opportunities to improve the organ donation and transplantation system in Canada: enhancing mental health support, establishing formal peer support programmes, improving continuity of care, improving knowledge acquisition, and expanding resources and support. CONCLUSION: It is imperative that the ODT system commits to asking, listening, and learning from individuals on transplant journeys and to provide them opportunities to help improve it.


Asunto(s)
Cuidadores , Obtención de Tejidos y Órganos , Adulto , Humanos , Femenino , Masculino , Cuidadores/psicología , Canadá , Donadores Vivos/psicología , Grupos Focales
16.
Liver Transpl ; 30(5): 505-518, 2024 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-37861339

RESUMEN

We surveyed living donor liver transplant programs in the United States to describe practices in the psychosocial evaluation of living donors focused on (1) composition of psychosocial team; (2) domains, workflow, and tools of the psychosocial assessment; (3) absolute and relative mental health-related contraindications to donation; and (4) postdonation psychosocial follow-up. We received 52 unique responses, representing 33 of 50 (66%) of active living donor liver transplant programs. Thirty-one (93.9%) provider teams included social workers, 22 (66.7%) psychiatrists, and 14 (42.4%) psychologists. Validated tools were rarely used, but domains assessed were consistent. Respondents rated active alcohol (93.8%), cocaine (96.8%), and opioid (96.8%) use disorder, as absolute contraindications to donation. Active suicidality (97%), self-injurious behavior (90.9%), eating disorders (87.9%), psychosis (84.8%), nonadherence (71.9%), and inability to cooperate with the evaluation team (78.1%) were absolute contraindications to donation. There were no statistically significant differences in absolute psychosocial contraindications to liver donation between geographical areas or between large and small programs. Programs conduct postdonation psychosocial follow-up (57.6%) or screening (39.4%), but routine follow-up of declined donors is rarely conducted (15.8%). Psychosocial evaluation of donor candidates is a multidisciplinary process. The structure of the psychosocial evaluation of donors is not uniform among programs though the domains assessed are consistent. Psychosocial contraindications to living liver donation vary among the transplant programs. Mental health follow-up of donor candidates is not standardized.


Asunto(s)
Trasplante de Riñón , Trasplante de Hígado , Humanos , Estados Unidos/epidemiología , Donadores Vivos/psicología , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/psicología , Encuestas y Cuestionarios , Hígado
17.
Transpl Int ; 36: 11827, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-38076226

RESUMEN

We performed a systematic literature review of the psychological impact on donors of living kidney donation. We conducted a literature review in PubMed/Medline according to PRISMA guidelines which included both qualitative (based on interviews) and quantitative studies (based on standardized questionnaire). There were 15 quantitative studies and 8 qualitative studies with 2,732 donors. Given that the methodologies of qualitative and quantitative studies are fundamentally different, we narratively synthetized results of studies according to four axes: quality of life, anxiety/depression, consequences of donation on the donor/recipient relationship, overall satisfaction and regret. The quantitative studies reported that donor quality of life remained unchanged or improved. Donor regret rates were very low and donor-recipient relationships also remained unchanged or improved. Qualitative studies reported more complex donation experiences: one can regret donation and still decide to recommend it as in a social desirability bias. In both study types, donor-recipient relationships were closer but qualitative studies reported that post-donation rebonding was required. The qualitative studies therefore highlighted the psychological complexity of donation for donors, showing that living donation impacts the donor's life whether it is successful or not. A better understanding of the impact of donation on donors could provide better care for donors.


Asunto(s)
Trasplante de Riñón , Humanos , Trasplante de Riñón/psicología , Calidad de Vida , Donadores Vivos/psicología , Riñón , Emociones
18.
Transplant Proc ; 55(10): 2403-2409, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37945446

RESUMEN

Black individuals are less likely to receive live donor kidney transplantation (LDKT) compared to others. This may be partly related to their concerns about LDKT, which can vary based on age and gender. We conducted a cross-sectional, secondary analysis of the baseline enrollment data from the Talking about Living Kidney Donation Support trial, which studied the effectiveness of social workers and financial interventions on activation towards LDKT among 300 Black individuals from a deceased donor waiting list. We assessed concerns regarding the LDKT process, including their potential need for postoperative social support, future reproductive potential, recipient and donor money matters, recipient and donor safety, and interpersonal concerns. Answers ranged from 0 ("not at all concerned") to 10 ("extremely concerned"). We described and compared participants' concerns both overall and stratified by age (≥45 years old vs <45 years old) and self-reported gender ("male" versus "female"). The participants' top concerns were donor safety (median [IQR] score 10 [5-10]), recipient safety (5 [0-10]), money matters (5 [0-9]), and guilt/indebtedness (5 [0-9]). Younger females had statistically significantly higher odds of being concerned about future reproductive potential (odds ratio [OR] 3.77, 95% CI 2.77, 4.77), and older males had statistically higher mean concern about postoperative social support (OR 1.79, 95% CI 0.19, 3.38). Interventions to improve rates of LDKT among Black individuals should include education and counseling about the safety of LDKT for both recipients and donors, reproductive counseling for female LDKT candidates of childbearing age, and addressing older males' needs for increased social support.


Asunto(s)
Trasplante de Riñón , Donadores Vivos , Masculino , Humanos , Femenino , Persona de Mediana Edad , Donadores Vivos/psicología , Trasplante de Riñón/psicología , Estudios Transversales , Negro o Afroamericano , Riñón
19.
Transplantation ; 107(12): e355-e362, 2023 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-37653586

RESUMEN

BACKGROUND: As uterus transplantation transitions to a clinical procedure for women with absolute uterine-factor infertility, transplant centers performing uterus transplantation need information about the experience of living donors. This study examined the psychosocial impact on 17 nondirected uterus donors in the Dallas UtErus Transplant Study 1 y following donation. METHODS: A prospective longitudinal study was conducted to measure psychosocial outcomes of depression, anxiety, posttraumatic stress, quality of life, and resilience [measured using the Hospital Anxiety and Depression Scale or Patient Health Questionnaire 9-Item, Generalized Anxiety Disorder 7-Item, Posttraumatic Stress Disorder Checklist for the DSM-5, health-related quality of life Short Form-36, and Connor-Davidson Resilience Scale 10-Item, respectively) assessed at baseline, at 6-mo and 1-y follow-up. Differences among baseline, 6-mo, and 1-y postdonation were analyzed. RESULTS: The median age was 38.0 y, 16 were married, 15 were of non-Hispanic/Latino ethnicity. Most donors did not report psychosocial distress; however, 1 donor reported decline on the role limitations because of Emotional Problems Scale and also showed an increase in depression symptoms at the 6 mo, but at 1 y was below the clinical cutoff for depression. A second donor showed modest decline in emotional well-being. Improvements were seen in other donors on the Physical Functioning Scale and posttraumatic stress symptoms. CONCLUSIONS: Although most nondirected donors appeared to remain stable, both positive and negative changes were observed over the first year. Larger studies are needed to determine psychosocial risks and benefit and what additional resources might be needed to ensure optimal psychosocial outcomes.


Asunto(s)
Calidad de Vida , Útero , Humanos , Femenino , Adulto , Estudios Prospectivos , Estudios Longitudinales , Útero/trasplante , Donadores Vivos/psicología
20.
Med Health Care Philos ; 26(4): 625-634, 2023 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-37620641

RESUMEN

Every year, hundreds of patients in England die whilst waiting for a kidney transplant, and this is evidence that the current system of altruistic-based donation is not sufficient to address the shortage of kidneys available for transplant. To address this problem, we propose a monopsony system whereby kidney donors can opt-in to receive financial compensation, whilst still preserving the right of individuals to donate without receiving any compensation. A monopsony system describes a market structure where there is only one 'buyer'-in this case the National Health Service. By doing so, several hundred lives could be saved each year in England, wait times for a kidney transplant could be significantly reduced, and it would lessen the burden on dialysis services. Furthermore, compensation would help alleviate the common disincentives to living kidney donation, such as its potential associated health and psychological costs, and it would also help to increase awareness of living kidney donation. The proposed system would also result in significant cost savings that could then be redirected towards preventing kidney disease and reducing health disparities. While concerns about exploitation, coercion, and the 'crowding out' of altruistic donors exist, we believe that careful implementation can mitigate these issues. Therefore, we recommend piloting financial compensation for living kidney donors at a transplant centre in England.


Asunto(s)
Trasplante de Riñón , Obtención de Tejidos y Órganos , Humanos , Trasplante de Riñón/psicología , Medicina Estatal , Donadores Vivos/psicología , Inglaterra
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