Living liver donation can be psychologically as well as physically demanding for donors. While single-center and cross-sectional studies have suggested that liver donation has a modest impact on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. Using data from the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL-2), one of the largest, prospective, multi-center studies of psychological outcomes in living liver donors, researchers evaluated trends in psychological outcomes over time and potential predictors of these outcomes.
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 two years after donation. Donors reported mental well-being that is consistent with or better than that of the general population, on average.
While it is generally good news that few donors experience these psychiatric syndromes, the fact that alcohol abuse was reported among liver donors at all is worrisome. Especially given the timeframe for liver regeneration in donors, living liver donors should be more closely monitored for their alcohol use both before and after donation.
Donors whose recipients had died were more likely to report unwillingness to donate again, compared to donors whose recipients did not die. Furthermore, a third of those donors whose recipients died felt guilty and approximately one out of five donors felt responsible at some point for their recipient’s death. These donors may benefit from additional monitoring to ensure that they receive adequate psychosocial support and treatment.
“One of the great impacts of this study is that it allows us to better counsel our patients what they may expect in terms of their emotional well-being after their donation surgery,” said lead author Dr. Zeeshan Butt. “For the lion’s share of donors, the psychological outcomes are quite good, but some donors may benefit from more careful monitoring.”
Careful screening and targeted follow-up holds promise for improving psychological outcomes following living liver donation for potentially vulnerable donors. Future research on longer-term psychological outcomes is needed, as some key psychological outcomes may not become apparent until much later after donation.
Butt Z, Dew MA, Liu Q, Simpson MA, Smith AR, Zee J, Gillespie BW, Abbey SE, Ladner DP, Weinrieb R, Fisher RA, Hafliger S, Terrault N, Burton J, Sherker AH, Di Martini A. Psychological Outcomes of Living Liver Donors from a Multicenter, Prospective Study: Results from the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Am J Transplant. 2016 Nov 19. [Epub ahead of print]
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December 14, 2016