title: Psychological Outcomes of Living Liver Donors From a Multicenter Prospective Study: Results From the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2).
abstract: Although single-center and cross-sectional studies have suggested a modest impact of liver donation on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. We conducted one of the largest, prospective, multicenter studies of psychological outcomes in living liver donors within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study2 (A2ALL-2) consortium. In total, 271 (91%) of 297 eligible donors were interviewed at least once before donation and at 3, 6, 12, and 24 mo after donation using validated measures. We found that living liver donors reported low rates of major depressive (0-3%), alcohol abuse (2-5%), and anxiety syndromes (2-3%) at any given assessment in their first 2 years after donation. Between 4.7% and 9.6% of donors reported impaired mental well-being at various time points. We identified significant predictors for donors' perceptions of being better people and experiencing psychological growth following donation, including age, sex, relationship to recipient, ambivalence and motivation regarding donation, and feeling that donation would make life more worthwhile. Our results highlight the need for close psychosocial monitoring for those donors whose recipients died (n=27); some of those donors experienced guilt and concerns about responsibility. Careful screening and targeted, data-driven follow-up hold promise for optimizing psychological outcomes following this procedure for potentially vulnerable donors.
authors.affiliation: Departments of Medical Social Sciences, Surgery & Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL.
authors.forename: Z
authors.initials: Z
authors.lastname: Butt
authors.affiliation: Departments of Psychiatry, Surgery, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA.
authors.forename: M A
authors.identifier: http://orcid.org/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: Department of Transplantation, Lahey Hospital and Medical Center, Burlington, MA.
authors.forename: M A
authors.initials: MA
authors.lastname: Simpson
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 Biostatistics, University of Michigan, Ann Arbor, MI.
authors.forename: B W
authors.initials: BW
authors.lastname: Gillespie
authors.affiliation: Department of Psychiatry and Transplantation, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: S E
authors.initials: SE
authors.lastname: Abbey
authors.affiliation: Departments of Medical Social Sciences, Surgery & Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL.
authors.forename: D P
authors.initials: DP
authors.lastname: Ladner
authors.affiliation: Department of Psychiatry, University of Pennsylvania, Philadelphia, PA.
authors.forename: R
authors.initials: R
authors.lastname: Weinrieb
authors.affiliation: Division of Transplantation, The Transplant Institute Beth Israel Deaconess Medical Center, Harvard University, Boston, MA.
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.affiliation: Department of Psychiatry, Columbia University, New York, NY.
authors.forename: S
authors.initials: S
authors.lastname: Hafliger
authors.affiliation: Departments of Medicine and Surgery, University of California at San Francisco, San Francisco, CA.
authors.forename: N
authors.initials: N
authors.lastname: Terrault
authors.affiliation: Department of Medicine, University of Colorado, Denver, Aurora, CO.
authors.forename: J
authors.initials: J
authors.lastname: Burton
authors.affiliation: 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: Departments of Psychiatry, Surgery, and Clinical and Translational Science, University of Pittsburgh, Pittsburgh, PA.
authors.forename: A
authors.initials: A
authors.lastname: DiMartini
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000523:psychology*; D019520:Living Donors / Q000523:psychology*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: clinical research/practice; depression; donors and donation; donors and donation: donor evaluation; donors and donation: donor follow-up; donors and donation: living; liver transplantation/hepatology