Gennaio Febbraio 2021

Psychiatric and psychological evaluation in living donor kidney transplantation: a single center experience

Abstract

Background: Living donor kidney transplantation (LDKT) is the treatment of choice for end stage renal disease. LDKT involves complex psychosocial issues, which remain partially unexplored.
Methods: The study involved all potential living donors and recipient pairs consecutively referred for psychosocial evaluation from the nephrologist. Clinical and sociodemographic variables including prior psychiatric history, previous and current use of psychopharmacological therapy, motivation and information about the transplant procedure were collected. Study participants completed the Symptom Checklist-90-R (SCL-90-R) to assess psychopathological distress.
Results: Fifty-three donor/recipient pairs underwent psychiatric and psychological evaluation. Seven subjects (13%) in the recipient group and 13 subjects (25%) in the donor group reported a history of psychological distress and/or psychiatric conditions. A psychiatric diagnosis was confirmed in 4 recipients (7.5% of the study sample, including autism spectrum disorder, histrionic personality disorder, and anxiety-depressive disorders) and 5 donors (9%, including narcissistic personality disorder in one case and anxiety-depressive disorders). SCL-90-R GSI mean scores were 0.3 ±0.3 and 0.2 ±0.2 for the recipient and donor groups, respectively. Overall, 8 couples (15%) suspended the living donation pathway before transplantation. Four couples were excluded for a new onset medical condition. The psychological and psychiatric evaluation excluded one candidate. One couple dropped out before completing the scheduled exams. One recipient refused to undergo crossover renal transplantation, while 1 donor candidate withdrew her consent for transplantation at the end of the evaluation process.
Conclusions: Limited but significant psychopathological distress in donors and recipients supports the usefulness of psychiatric and psychological competencies within the transplant team.

Keywords: living donor kidney transplantation, psychiatric disorders, psychological distress

Introduction

Living donor kidney transplantation (LDKT) is a well-established treatment for end stage renal disease, in terms of recipient’s survival and quality of life [1]. LDKT is a complex procedure that raises psychological and ethical issues. More than 30% of living donations come from biologically unrelated donors, mainly partners or friends with a longstanding emotional connection to the recipient [2]. International guidelines clearly recommend a detailed psychosocial evaluation including the assessment of a donor’s psychological status, their motivations, knowledge and expectations about transplant and donation, and the potential for undue emotional pressure to donate [35]. Indeed, the safety and wellbeing of living donors represents a high priority in organ transplantation.

 

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