Guidelines Issued on Evaluating Kidney Donors

SAN FRANCISCO – A panel of 70 transplant professionals has published a consensus document on the psychosocial evaluation of living unrelated kidney donors, Dr. Francis L. Delmonico reported at the American Transplant Congress.

The guidelines are intended to help transplant centers exclude donors who are unsuitable for a variety of nonmedical reasons, such as coercion, unrealistic expectations, and psychological disorders. “The objective was to assess the characteristics of a prospective unrelated donor that might either increase the risk or serve as a protective factor against a poor donor psychosocial outcome,” said Dr. Delmonico, professor of surgery at Harvard Medical School, Boston.

Describing the current situation as “an era of changing donor-recipient relationships,” Dr. Delmonico said that the guidelines will likely allow transplant centers to be “somewhat more secure in proceeding ahead in very careful assessment and within an ethical framework.”

The new guidelines are the result of a meeting convened in May 2006 by the United Network for Organ Sharing in collaboration with the American Society of Transplant Surgeons and the American Society of Transplantation. That panel recommended several revisions to earlier consensus statements on living donors and offered a new list of required components for the psychosocial evaluation of living unrelated kidney donors. (See box.)

The new document notes that biologically unrelated donors constitute 35% of the living kidney donors in the United States. Among living donors, the percentage without a biologic or close emotional relationship to the recipient rose from 6.5% to 23% between 1996 and 2006 (Am. J. Transplant. 2007;7:1047–54).

Some of the factors that would tend to increase the risks of living unrelated kidney donation are significant psychiatric symptoms or disorders; substance abuse or dependence; a lack of health insurance; a limited capacity to understand risks; motives reflecting a desire for recognition; a subordinate relationship to the patient, such as employee or employer; or an expectation of secondary gain.

Several other factors would tend to decrease the risk, including financial resources that could cover unexpected costs, realistic expectations about the donation experience, little or no ambivalence, a history of medical altruism, an absence of recent significant life stressors, and support from family for the donation.

In its changes to earlier consensus statements, the panel noted that novel forms of donor solicitation, such as Internet sites, point to an increased need to ascertain that the prospective donor was not pressured and does not expect financial gain.

This meeting was cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

Assessing Unrelated Prospective Donors

The following are the required components of psychosocial evaluations for living unrelated kidney donors, as agreed to by a panel convened by the United Network for Organ Sharing, the American Society of Transplant Surgeons, and the American Society of Transplantation:

▸ History and current status. Assess factors such as the prospective donor's educational level, employment, legal offense history, and citizenship.

▸ Capacity. Ensure that the prospective donor's cognitive status and capacity to comprehend information are not compromised.

▸ Psychological status. Determine whether the prospective donor has ever had any psychiatric disorders.

▸ Relationship with the transplant candidate. How close is the relationship, and would the transplant impose expectations or perceived obligations?

▸ Motivation. Determine the voluntariness of the proposed donation. Is it consistent with past behaviors and values? Is it free of coercion, inducements, ambivalence, impulsivity, and ulterior motives?

▸ Donor knowledge, understanding, and preparation. Does the prospective donor understand potential short- and long-term risks, including recuperation time and financial ramifications?

▸ Social support. Evaluate familial, social, and employer support networks available to the prospective donor.

▸ Financial suitability. Determine whether the prospective donor is financially stable and has resources available to cover expected and unexpected donation-related expenses.

Source: Am. J. Transplant. 2007;7:1047–54.

SAN FRANCISCO – A panel of 70 transplant professionals has published a consensus document on the psychosocial evaluation of living unrelated kidney donors, Dr. Francis L. Delmonico reported at the American Transplant Congress.

The guidelines are intended to help transplant centers exclude donors who are unsuitable for a variety of nonmedical reasons, such as coercion, unrealistic expectations, and psychological disorders. “The objective was to assess the characteristics of a prospective unrelated donor that might either increase the risk or serve as a protective factor against a poor donor psychosocial outcome,” said Dr. Delmonico, professor of surgery at Harvard Medical School, Boston.

Describing the current situation as “an era of changing donor-recipient relationships,” Dr. Delmonico said that the guidelines will likely allow transplant centers to be “somewhat more secure in proceeding ahead in very careful assessment and within an ethical framework.”

The new guidelines are the result of a meeting convened in May 2006 by the United Network for Organ Sharing in collaboration with the American Society of Transplant Surgeons and the American Society of Transplantation. That panel recommended several revisions to earlier consensus statements on living donors and offered a new list of required components for the psychosocial evaluation of living unrelated kidney donors. (See box.)

The new document notes that biologically unrelated donors constitute 35% of the living kidney donors in the United States. Among living donors, the percentage without a biologic or close emotional relationship to the recipient rose from 6.5% to 23% between 1996 and 2006 (Am. J. Transplant. 2007;7:1047–54).

Some of the factors that would tend to increase the risks of living unrelated kidney donation are significant psychiatric symptoms or disorders; substance abuse or dependence; a lack of health insurance; a limited capacity to understand risks; motives reflecting a desire for recognition; a subordinate relationship to the patient, such as employee or employer; or an expectation of secondary gain.

Several other factors would tend to decrease the risk, including financial resources that could cover unexpected costs, realistic expectations about the donation experience, little or no ambivalence, a history of medical altruism, an absence of recent significant life stressors, and support from family for the donation.

In its changes to earlier consensus statements, the panel noted that novel forms of donor solicitation, such as Internet sites, point to an increased need to ascertain that the prospective donor was not pressured and does not expect financial gain.

This meeting was cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

Assessing Unrelated Prospective Donors

The following are the required components of psychosocial evaluations for living unrelated kidney donors, as agreed to by a panel convened by the United Network for Organ Sharing, the American Society of Transplant Surgeons, and the American Society of Transplantation:

▸ History and current status. Assess factors such as the prospective donor's educational level, employment, legal offense history, and citizenship.

▸ Capacity. Ensure that the prospective donor's cognitive status and capacity to comprehend information are not compromised.

▸ Psychological status. Determine whether the prospective donor has ever had any psychiatric disorders.

▸ Relationship with the transplant candidate. How close is the relationship, and would the transplant impose expectations or perceived obligations?

▸ Motivation. Determine the voluntariness of the proposed donation. Is it consistent with past behaviors and values? Is it free of coercion, inducements, ambivalence, impulsivity, and ulterior motives?

▸ Donor knowledge, understanding, and preparation. Does the prospective donor understand potential short- and long-term risks, including recuperation time and financial ramifications?

▸ Social support. Evaluate familial, social, and employer support networks available to the prospective donor.

▸ Financial suitability. Determine whether the prospective donor is financially stable and has resources available to cover expected and unexpected donation-related expenses.

Source: Am. J. Transplant. 2007;7:1047–54.

SAN FRANCISCO – A panel of 70 transplant professionals has published a consensus document on the psychosocial evaluation of living unrelated kidney donors, Dr. Francis L. Delmonico reported at the American Transplant Congress.

The guidelines are intended to help transplant centers exclude donors who are unsuitable for a variety of nonmedical reasons, such as coercion, unrealistic expectations, and psychological disorders. “The objective was to assess the characteristics of a prospective unrelated donor that might either increase the risk or serve as a protective factor against a poor donor psychosocial outcome,” said Dr. Delmonico, professor of surgery at Harvard Medical School, Boston.

Describing the current situation as “an era of changing donor-recipient relationships,” Dr. Delmonico said that the guidelines will likely allow transplant centers to be “somewhat more secure in proceeding ahead in very careful assessment and within an ethical framework.”

The new guidelines are the result of a meeting convened in May 2006 by the United Network for Organ Sharing in collaboration with the American Society of Transplant Surgeons and the American Society of Transplantation. That panel recommended several revisions to earlier consensus statements on living donors and offered a new list of required components for the psychosocial evaluation of living unrelated kidney donors. (See box.)

The new document notes that biologically unrelated donors constitute 35% of the living kidney donors in the United States. Among living donors, the percentage without a biologic or close emotional relationship to the recipient rose from 6.5% to 23% between 1996 and 2006 (Am. J. Transplant. 2007;7:1047–54).

Some of the factors that would tend to increase the risks of living unrelated kidney donation are significant psychiatric symptoms or disorders; substance abuse or dependence; a lack of health insurance; a limited capacity to understand risks; motives reflecting a desire for recognition; a subordinate relationship to the patient, such as employee or employer; or an expectation of secondary gain.

Several other factors would tend to decrease the risk, including financial resources that could cover unexpected costs, realistic expectations about the donation experience, little or no ambivalence, a history of medical altruism, an absence of recent significant life stressors, and support from family for the donation.

In its changes to earlier consensus statements, the panel noted that novel forms of donor solicitation, such as Internet sites, point to an increased need to ascertain that the prospective donor was not pressured and does not expect financial gain.

This meeting was cosponsored by the American Society of Transplant Surgeons and the American Society of Transplantation.

Assessing Unrelated Prospective Donors

The following are the required components of psychosocial evaluations for living unrelated kidney donors, as agreed to by a panel convened by the United Network for Organ Sharing, the American Society of Transplant Surgeons, and the American Society of Transplantation:

▸ History and current status. Assess factors such as the prospective donor's educational level, employment, legal offense history, and citizenship.

▸ Capacity. Ensure that the prospective donor's cognitive status and capacity to comprehend information are not compromised.

▸ Psychological status. Determine whether the prospective donor has ever had any psychiatric disorders.

▸ Relationship with the transplant candidate. How close is the relationship, and would the transplant impose expectations or perceived obligations?

▸ Motivation. Determine the voluntariness of the proposed donation. Is it consistent with past behaviors and values? Is it free of coercion, inducements, ambivalence, impulsivity, and ulterior motives?

▸ Donor knowledge, understanding, and preparation. Does the prospective donor understand potential short- and long-term risks, including recuperation time and financial ramifications?

▸ Social support. Evaluate familial, social, and employer support networks available to the prospective donor.

▸ Financial suitability. Determine whether the prospective donor is financially stable and has resources available to cover expected and unexpected donation-related expenses.

Source: Am. J. Transplant. 2007;7:1047–54.