title: Social and Financial Outcomes of Living Liver Donation: A Prospective Investigation Within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2).
abstract: Because results from single-center (mostly kidney) donor studies demonstrate interpersonal relationship and financial strains for some donors, we conducted a liver donor study involving nine centers within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study 2 (A2ALL-2) consortium. Among other initiatives, A2ALL-2 examined the nature of these outcomes following donation. Using validated measures, donors were prospectively surveyed before donation and at 3, 6, 12, and 24 mo after donation. Repeated-measures regression models were used to examine social relationship and financial outcomes over time and to identify relevant predictors. Of 297 eligible donors, 271 (91%) consented and were interviewed at least once. Relationship changes were positive overall across postdonation time points, with nearly one-third reporting improved donor family and spousal or partner relationships and >50% reporting improved recipient relationships. The majority of donors, however, reported cumulative out-of-pocket medical and nonmedical expenses, which were judged burdensome by 44% of donors. Lower income predicted burdensome donation costs. Those who anticipated financial concerns and who held nonprofessional positions before donation were more likely to experience adverse financial outcomes. These data support the need for initiatives to reduce financial burden.
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.|Department of Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: A
authors.initials: A
authors.lastname: DiMartini
authors.affiliation: Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA.|Department of Psychology, University of Pittsburgh, Pittsburgh, PA.|Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.|Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA.
authors.forename: M A
authors.identifier: 0000-0002-4666-1870
authors.initials: MA
authors.lastname: Dew
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors.forename: Q
authors.initials: Q
authors.lastname: Liu
authors.affiliation: Lahey Hospital and Medical Center Clinical Research and Education, Burlington, MA.|Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: M A
authors.initials: MA
authors.lastname: Simpson
authors.affiliation: Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Chicago, IL.|Comprehensive Transplant Center, Northwestern University, Chicago, IL.
authors.forename: D P
authors.initials: DP
authors.lastname: Ladner
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI.|Department of Biostatistics, University of Michigan, Ann Arbor, MI.
authors.forename: A R
authors.initials: AR
authors.lastname: Smith
authors.affiliation: Arbor Research Collaborative for Health, Ann Arbor, MI.
authors.forename: J
authors.initials: J
authors.lastname: Zee
authors.affiliation: Department of Psychiatry, University of Toronto and University Health Network, Toronto, ON, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Abbey
authors.affiliation: Department of Biostatistics, University of Michigan, Ann Arbor, MI.
authors.forename: B W
authors.initials: BW
authors.lastname: Gillespie
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
authors.forename: R
authors.initials: R
authors.lastname: Weinrieb
authors.affiliation: Department of Anesthesiology, University of Colorado, Denver, CO.
authors.forename: M S
authors.initials: MS
authors.lastname: Mandell
authors.affiliation: Department of Transplant Surgery, Virginia Commonwealth University, Richmond, VA.|Beth Israel Deaconess Department of Surgery, Harvard University, Boston, MA.
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.affiliation: Department of Surgery, Columbia University Medical Center, New York, NY.
authors.forename: J C
authors.initials: JC
authors.lastname: Emond
authors.affiliation: Department of Surgery, University of California at San Francisco, San Francisco, CA.
authors.forename: C E
authors.initials: CE
authors.lastname: Freise
authors.affiliation: Liver Diseases Research Branch, Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD.
authors.forename: A H
authors.initials: AH
authors.lastname: Sherker
authors.affiliation: Northwestern University Transplant Outcomes Research Collaborative (NUTORC), Chicago, IL.|Comprehensive Transplant Center, Northwestern University, Chicago, IL.|Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL.|Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Z
authors.initials: Z
authors.lastname: Butt
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D016031:Liver Transplantation; D019520:Living Donors / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012944:Social Support; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D009927:Tissue and Organ Procurement / Q000191:economics*
keywords: basic (laboratory) research/science; donors and donation: donor follow-up; donors and donation: living; income; liver transplantation/hepatology; liver transplantation: living donor