title: Resilience and quality of life in 161 living kidney donors before nephrectomy and in the aftermath of donation: a naturalistic single center study.
abstract: BACKGROUND
  Due to the shortage of cadaveric organs, living kidney donation has begun to serve as the most crucial organ pool. Transplant centers have a legitimate interest in expanding the pool of donors. A psychosocial evaluation is established in transplantation centers to prevent donors from possible emotional harm in the aftermath of donation. We explored if the resilience questionnaire is an appropriate measure of the mental stability. To standardize procedures of psychosocial evaluation and to optimize donor recruitment, we present our evaluation protocol and analyze the causes of exclusion from donation.
  
  
  METHODS
  In a naturalistic design, we compared resilience and quality of life in eligible and excluded donors at the time point of donation. Potential living kidney donors (N = 161) participated in the obligatory psychosomatic evaluation. Quality of life (World Health Organization Quality of Life, WHOQOL-Bref) and resilience (Resilience Scale, RS-12) were measured. Three months after nephrectomy donors quality of life was screened in a follow-up.
  
  
  RESULTS
  In the evaluation interview donors were classified as eligible (n = 142) or excluded (n = 12). Nonrelated donors (n = 3) were excluded from donation significantly more often (p < .011). Eligible donors (M = 78.42, SD = 10.19) had higher values for resilience than excluded donors (M = 72.7, SD = 8.18, p < .04), who showed values comparable to the norm. In all domains of quality of life, eligible donors had significantly higher values than healthy normals (p < .001). After donation health-related quality of life decreased, but was comparable to the norm. A regression analysis showed that resilience was a significant predictor for all dimensions of quality of life before donation (R(2) = 10.2-24.6 %). Post-donation quality of life was significantly correlated with pre-donation resilience scores (p < .05).
  
  
  CONCLUSIONS
  The resilience score predicts high mental quality of life before and after donation. Therefor it can be implemented as a self-rating instrument to further objectify donor's mental stability. Despite the stressful life event of donation, donor candidates presented high resilience and high levels of quality of life. Therefor our findings support health care providers` intentions to improve living donation. In the group of excluded donors nonrelated persons were overrepresented. Guidelines for the admission of nonrelated donors are currently unclear and need to be optimized.
authors.affiliation: Department of Psychosomatic and Psychotherapeutic Medicine, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. yesim.erim@uk-erlangen.de.
authors.forename: Yesim
authors.initials: Y
authors.lastname: Erim
authors.affiliation: Department of Psychosomatic and Psychotherapeutic Medicine, University Hospital, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany. yeliz.kahraman@uk-erlangen.de.
authors.forename: Yeliz
authors.initials: Y
authors.lastname: Kahraman
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, Medical Center, University of Cologne, Cologne, Germany. frank.vitinius@uk-koeln.de.
authors.forename: Frank
authors.initials: F
authors.lastname: Vitinius
authors.affiliation: Department of Psychosomatic Medicine and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Essen, Germany. mingo.beckmann@uni-due.de.
authors.forename: Mingo
authors.initials: M
authors.lastname: Beckmann
authors.affiliation: Department of Medical Psychology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany. skroencke@uke.de.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Kröncke
authors.affiliation: Department for Nephrology, Medical Faculty, University Duisburg-Essen, Essen, Germany. oliver.witzke@uk-essen.de.
authors.forename: Oliver
authors.initials: O
authors.lastname: Witzke
mesh_terms: D000328:Adult; D000368:Aged; D046148:Donor Selection / Q000379:methods*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy; D011184:Postoperative Period; D057234:Preoperative Period; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D011788:Quality of Life / Q000523:psychology*; D055500:Resilience, Psychological; D011795:Surveys and Questionnaires; D055815:Young Adult