Psychosocial Outcomes 3 to 10 Years After Donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL)

Previous studies of living liver donors’ psychological and social outcomes have focused on short-term outcomes and rely largely on measures not specific to donation. In a recent paper published in a special issue on living donation in Transplantation, researchers examined long-term psychosocial outcomes of living donors, focusing on a more specific assessment of donors’ potential problems.

Researchers surveyed liver donors who donated 3-10 years earlier at hospitals participating in the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL). In addition to general quality-of-life measures, researchers assessed outcomes in three domains:

  1. physical health and symptoms related to donation; 
  2. emotional well-being and response to donation;
  3. and socioeconomic concerns arising from donation.

Relative to US population norms, donors reported significantly better quality-of-life overall. However, fifteen percent reported current donation-related medical problems, and forty-eight percent expressed health worries due to donation. Finances can also present a problem for living liver donors. Fifteen percent of donors reported that expenditures related to their liver donation were burdensome, and some reported job changes, permanent income reductions, and problems obtaining or keeping health or life insurance due to donation. At the same time, however, many donors had positive psychological outcomes, reporting, for example, that they experienced personal growth as a result of the experience or felt like better persons for having helped someone else.

Lead author Dr. Mary Amanda Dew reflected, “The fact that some donors were reporting difficulties that they attributed to donation even 3-10 years later was quite striking and suggests that donation can be a life-changing event that leads to permanent changes, long after recovery from surgery.”

The researchers used cluster analysis to identify distinct donor groups based on responses to the questions about their donation. In this case, cluster analysis revealed five donor groups. One group showed high psychological benefit, with low levels of physical or socioeconomic concerns (fifteen percent of donors). Four groups were less favorable, with varying combinations of difficulties. The largest such group showed high physical concerns and financial expenditures, and only modest psychological benefit (thirty-one percent of donors).

The researchers then examined whether demographic and medical factors from around the time of donation predicted membership in the donor groups. Men and non-Hispanic whites were most likely to fall into unfavorable cluster groups, as were older donors.

These results may allow for better targeting of clinical surveillance and care, and additional education both pre- and postdonation regarding donation-related risks and potential health concerns. Future research is needed to explore why certain demographic groups would be less likely to fall into favorable profiles, but this research is an important step in ensuring that living donation remains a viable option for future transplant candidates.

CITATION:Dew MA, DiMartini AF, Ladner DP, Simpson MA, Pomfret EA, Gillespie BW, Merion RM, Zee J, Smith AR, Holtzman S, Sherker AH, Weinrieb R, Fisher RA, Emond JC, Freise CE, Burton JR, Butt Z. Psychosocial outcomes 3 to 10 years after donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study. Transplantation 2016;100(6):1257-1269.
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