Transplant Trial Watch

Psychological Impact of Living Kidney Donation: A Systematic Review by the EAU-YAU Kidney Transplant Working Group.

Cazauvieilh, V., et al.

Transplant International 2023; 36: 11827


Aims
This study aimed to examine the psychological effects of donating a kidney on living donors.

Interventions
A literature search was performed using Pubmed and Medline. Study screening and data extraction were performed by two independent reviewers. The ROBINS-I tool was used to assess the risk of bias.

Participants
23 studies were included in the review.

Outcomes
The main outcomes of interest included assessment of quality of life, anxiety/ depression, regret of donation, psychological impact over failure of transplant/death, and consequence of donation on donor/recipient relationship.

Follow-up
N/A

CET Conclusions
This is an interesting, well-conducted, and well-written, systematic review in living donation that gives a good description of the complexity in the donor-recipient relationship and the psychological outcome for the donor. Two independent reviewers screened references, extracted data and performed the risk-of bias assessment, which is clearly presented. A broad search was done, albeit only within pubmed/medline. 23 studies were included, comprised of a total 2,732 donors. The authors give a detailed description of the studies in narrative review. There is quantitative evidence from 3 studies that quality of life is the same pre and post-donation, whilst another 4 studies found quantitative evidence of improved quality of life at 1 year post-donation. These studies indicate risk factors that may be predictive of decreased donor quality of life such as donor fatigue, anxiety, depression, lack of social support, the donor-recipient relationship and any complications for the recipient. Three studies found no evidence of an impact of socio-economic status on quality-of-life post-donation. In general, studies found that the relationship between donors and recipients remained unchanged or improved/became closer. Some donors expected that their role as a carer for the recipient would decrease after donation. If this did not happen, donors felt disappointed or frustrated. In the majority of cases, donors were satisfied and did not regret donation. Importantly it was clearly demonstrated that it was possible to regret donation oneself, but to still recommend it for others. All studies showed a low rate of regret. There was some evidence of correlation between regret and the recipient’s outcome from the transplant, but evidence was conflicting. One interesting complexity highlighted by the study is that donors used conscious or unconscious strategies to influence the transplant team to select them as a donor. This may make it difficult to interpret the results of pre and post-donation comparisons. The authors also acknowledge the impact of social desirability bias, which may have affected donor responses to questionnaires.

Trial registration
N/A

Funding source
Not reported