Towards a standardized informed consent procedure for live donor nephrectomy: What do surgeons tell their donors?
BACKGROUND
Living kidney donors comprise a unique group of "patients", undergoing an operation for the benefit of others. The informed consent process is therefore valued differently. Although this is a team effort, the surgeon is responsible for performing the donor nephrectomy, and often the one held accountable, should adverse events occur. Although there is some consensus on how the informed consent procedure should be arranged, practices vary. The aim of this study was to evaluate the surgical informed consent procedure for live donor nephrectomy, with special regards to disclosure of complications.


METHODS
A web-based survey was sent to all kidney transplant surgeons (n = 50) in eight transplant centers with questions regarding the local procedure and disclosure of specific details.


RESULTS
Response rate was 98% (n = 49), of which 32 (65%) were involved in living donor education; overall, transplant- (50%), vascular- (31%), and abdominal surgeons (13%), and urologists (6%) performed donor nephrectomies in the eight centers. Informed consent procedures varied, ranging from assumed to signed consent. Bleeding was the only complication every surgeon mentioned. Risk of death was always mentioned by 16 surgeons (50%), sometimes by 13 (41%), three surgeons (9%) never disclosed this disastrous complication. Reported mortality rates ranged from 0.003% to 0.1%. Mentioning frequencies for all other complications varied.


CONCLUSIONS
Important complications are not always disclosed during the surgical informed consent process for live donor nephrectomy. Informed consent procedures vary. To optimally prepare living kidney donors for the procedure, a standardized informed consent procedure for live donor nephrectomy is highly recommended.
Dept. of Surgery, Division of HPB & Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Kirsten
K
Kortram
Dept. of Surgery, Division of HPB & Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Jan N M
JN
Ijzermans
Dept. of Surgery, Division of HPB & Transplant Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands. Electronic address: Frank.dor@imperial.nhs.uk.
Frank J M F
FJ
Dor
D030881:Disclosure / Q000941:ethics / Q000592:standards; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D016030:Kidney Transplantation; D019520:Living Donors / Q000941:ethics*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000941:ethics*; D066231:Surgeons / Q000941:ethics*; D011795:Surveys and Questionnaires; D020858:Tissue and Organ Harvesting / Q000009:adverse effects / Q000941:ethics
Complications; Informed consent; Kidney donation; Live donor nephrectomy