Living Donor Psychosocial Evaluation
In addition to a physical evaluation, living donors also
go through a psychosocial evaluation, which measures a potential
donor's psychological well being as it pertains to the donation.
Standard procedures for a living donor psychosocial evaluation do not exist.
However, the Living Donor Committee of UNOS proposed standards in 2007.
The proposal was not accepted, but here is the content they
suggested since it is representative of the kinds of topics covered in a typical psychosocial evaluation:
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History and current state. Obtain standard
background information such as the prospective donor's education level,
living situation, cultural background, religious beliefs and practices,
significant relationships, family psychosocial history, employment,
lifestyle, community activities, legal offense history, and citizenship.
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Capacity. Ensure that the prospective donor's
cognitive status and capacity to comprehend information are not
compromised and do not interfere with judgment; determine risk for
exploitation.
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Psychological status. Establish the presence or
absence of current and prior psychiatric disorder, including but not
limited to mood, anxiety, substance abuse, and personality disorders.
Review current or prior therapeutic interventions (counseling,
medications); physical, psychological or sexual abuse; curren stressors
(e.g., relationships, home, work); recent losses; and chronic pain
management. Assess repertoire of coping skills to manage previous life
or health-related stressors.
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Relationship with the transplant candidate. Review
the nature and degree of closeness (if any) to the recipient (i.e.,
how the relationship developed), and whether the transplant would
impose expectations or perceived obligations on the part of either the
donor or the recipient.
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Motivation. Explore the rationale and reasoning for
volunteering to donate, i.e., the "voluntariness", including whether
donation would be consistent with past behaviors, apparent values,
beliefs, moral obligations or lifestyle. Determine whether it would be
free of coercion, inducements, ambivalence, implusivity, or ulterior
motives (e.g., to atone or gain approval, to stablize self-image, or to
remedy a psychological malady).
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Donor knowledge, understanding, and preparation.
Explore the propective donor's awareness of the following:
> Any potential short- and long-term risks for surgical
complications and health outcomes, both for the donor and the
transplant candidate;
> Recovery and recuperation time;
> Availability of alternative treatments for the transplant
candidate; and
> Financial ramifications (including possible insurance risk).
Make sure that the donor understands the data on long-term donor health
and psychosocial outcomes continue to be sparse. Assess the prospective
donor's understanding, acceptance, and respect for the specific donor
protocol, e.g., willingness to accept potential lack of communication
from the recipient and the donor's willingness to undergo future donor
follow up.
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Social support. Evalute support networks available
to the prospective donor on an ongoing basis as well as during the
donor's recovery from surgery. Consider significant others, family
members, social contacts, and employers.
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Financial suitability. Determine whether the
prospective donor is financially stable and free of financial hardship;
has resources available to cover financial obligations for expected and
unexpected donation-related expenses; is able to take time away from
work or established role, including unplanned extended recovery time;
and has disability and health insurance.
Keep in mind that policies and procedures vary from
transplant
team to transplant team. You should confirm the actual
psychosocial evaluation process with your transplant team.
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