title: Evaluating living kidney donors: relationship types, psychosocial criteria, and consent processes at US transplant programs.
abstract: We conducted a survey of 132 US kidney transplant programs to examine how they evaluate and select potential living kidney donors, focusing on donor-recipient relationships, psychosocial criteria, and consent processes. There is heterogeneity in donor-recipient relationships that are considered acceptable, although most programs (70%) will not consider publicly solicited donors. Most programs (75%) require a psychosocial evaluation for all potential living donors. Most programs agree that knowledge of financial reward (90%), active substance abuse (86%), and active mental health problems (76%) are absolute contraindications to donation. However, there is greater variability in how other psychosocial issues are considered in the selection process. Consent processes are highly variable across programs: donor and recipient consent for the donor evaluation is presumed in 57% and 76% of programs, respectively. The use of 13 different informed consent elements varied from 65% (alternative donation procedures) to 86% (description of evaluation, surgery and recuperative period) of programs. Forty-three percent use a 'cooling off' period. Findings demonstrate high variability in current practice regarding acceptable donor-recipient relationships, psychosocial criteria, and consent processes. Whether greater consensus should be reached on these donor evaluation practices, especially in the context of more expansive use of living donor kidney transplantation, is discussed.
authors.affiliation: Department of Psychiatry, the Transplant Center, Beth Israel Deaconess Medical Center, Boston, MA, USA. jrrodrig@bidmc.harvard.edu
authors.forename: J R
authors.initials: JR
authors.lastname: Rodrigue
authors.forename: M
authors.initials: M
authors.lastname: Pavlakis
authors.forename: G M
authors.initials: GM
authors.lastname: Danovitch
authors.forename: S R
authors.initials: SR
authors.lastname: Johnson
authors.forename: S J
authors.initials: SJ
authors.lastname: Karp
authors.forename: K
authors.initials: K
authors.lastname: Khwaja
authors.forename: D W
authors.initials: DW
authors.lastname: Hanto
authors.forename: D A
authors.initials: DA
authors.lastname: Mandelbrot
mesh_terms: D000075202:Contraindications; D005190:Family; D005260:Female; D006650:Histocompatibility Testing; D006801:Humans; D007258:Informed Consent; D007668:Kidney; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D019520:Living Donors / Q000523:psychology* / Q000706:statistics & numerical data*; D008297:Male; D008487:Medical History Taking; D018579:Patient Selection; D012959:Socioeconomic Factors; D020858:Tissue and Organ Harvesting / Q000379:methods* / Q000706:statistics & numerical data; D014481:United States