The Psychosocial and Independent Living Donor Advocate Evaluation and Post-surgery Care of Living Donors
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Solid organ transplantation as a treatment for end stage organ failure has been an accepted treatment option for decades. Despite advances in medicine and technology, and increased awareness of organ donation and transplantation, the gap between supply and demand continues to widen. Living donation has been an option that has increased the number of transplants despite the continued shortage of deceased organs. In the early 2000s live donor transplantation reached an all-time high in the United States. As a result, a consensus meeting was convened in 2000 to increase the oversight of living donor transplantation. Both the Centers for Medicare and Medicaid Services and the United Network for Organ Sharing developed regulations that transplant programs performing live donor transplantation. These regulations and guidelines involve the education, evaluation, informed consent process and living donor follow-up care. Two areas in which had significant changes included the psychosocial and the independent living donor advocate (ILDA) evaluation. The purpose of this paper was to outline the current regulations and guidelines associated with the psychosocial and ILDA evaluation as well as provide further recommendations for the administration of a high quality evaluation of living donors. The goals and timing of the evaluation and education of donors; qualifications of the health care providers performing the evaluation; components of the evaluation; education provided to donors; documentation of the evaluation; participation in the selection committee meeting; post-decline and post-donation care of donors is described. Caveats including the paired donor exchange programs and non-directed and directed donation are also considered
KeywordsLiving donor Transplantation Psychosocial evaluation Independent living donor advocate Evaluation Education
To all the donors who allow us to vicariously experience giving the gift of life to others.
Compliance with Ethical Standards
Conflict of interest
Dianne LaPointe Rudow, Kathleen Swartz, Chelsea Phillips, Jennifer Hollenberger, Taylor Schmick, Jennifer Steel declare that they have no conflict of Interest.
Human and Animal Rights and Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study.
- Abecassis, M., Adams, M., Adams, P., Arnold, R. M., Atkins, C. R., Barr, M. L., … Liver Organ Donor Consensus Group. (2000). Consensus statement on the live organ donor. JAMA, 284(22), 2919–2926.Google Scholar
- Abecassis, M. M., Fisher, R. A., Olthoff, K. M., Freise, C. E., Rodrigo, D. R., Samstein, B., … A2ALL Study Group. (2012) Complications of living donor hepatic lobectomy—A comprehensive report. American Journal of Transplantation, 12(5), 1208–1217.Google Scholar
- Clemens, K. K., Thiessen-Philbrook, H., Parikh, C. R., Yang, R. C., Karley, M. L., Boudville, N., … Donor Nephrectomy Outcomes Research (DONOR) Network. (2006). Psychosocial health of living kidney donors: A systematic review. American Journal of Transplantation, 6, 2965–2977.Google Scholar
- Center for Medicare and Medicaid Services (CMS). (2007). Medicare program; hospital conditions of participation: Requirements for approval and re-approval of transplant centers to perform organ transplants; final rule. Federal Register, 72(61), 15197. Retrieved December 11, 2014 from http://www.cms.gov/Medicare/Provider-Enrollment-and-certification/CertificationandComplicance/downloads/trasnplantfinal.pdf.
- CMS survey and certification letter: Organ transplant interpretive guidelines. Retrieved December 11, 2014 from http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCLetter08-25.pdf.
- Freise, C. E., Gillespie, B. W., Koffron, A. J., Lok, A. S., Puett T. L., Emond, J. C., … A@ALL Study Group. (2008). Recipient morbidity after living and deceased donor liver transplantation: Findings from the A2AKK retrospective cohort study. American Journal of Transplantation, 12(12):2569–2579.Google Scholar
- Federal Register, Vol. 72, No. 61; March 30, 2007; Section 482.98(d).Google Scholar
- Gross, C. R., Messersmith, E. E., Hong, B. A., Jowsey, S. G., Jacobs, C., Gillespie, B. W., … RELIVE Study Group. (2013). Health-related quality of life in kidney donors from the last five decades: Results from the RELIVE study. American Journal of Transplantation, 13, 2924–2934.Google Scholar
- Hays, R. E., LaPointe Rudow D., Dew, M. A., Taler, S. J., Spicer, H., & Mandelbrot, D. A. (2015). The independent living donor advocate: A guidance document from the American Society of Transplantation’s Living Donor Community of Practice. American Journal of Transplantation, 15, 518–525.CrossRefPubMedGoogle Scholar
- Ibrahim, H. N., Foley, R., Tan, L., Rogers, T., Bailey R. F., Guo, H., … Mtas A. J. (2009). Long term consequences of kidney donation. The New England Journal of Medicine, 360(5), 459–469.Google Scholar
- Jowsey, S. G., Jacobs, C., Gross, C. R., Hong, B. A., Messersmith, E. E., Gillespie, B.W., … RELIVE Study Group. (2014). Emotional well-being of living kidney donors: Findings from the RELIVE Study. American Journal of Transplantation, 14, 2535–2544.Google Scholar
- Kim-Schluger, L., Florman, S. S., Schiano, T., O’Rourke, M., Gagliardi, R., Drooker, M., … Miller, C. M. (2002). Quality of life after lobectomy for adult liver transplantation. Transplantation, 73(10), 1593–1597.Google Scholar
- Ladner, D. P., Dew, M. A., Forney, S., Gillespie, B. W., Brown, R. S., Merion, R. M., … Butt, Z. (2015). Long-term quality of life after liver donation in the adult to adult living donor livers transplantation cohort study (A2ALL). Journal of Hepatology, 62, 346–353.Google Scholar
- Murphy, B. D., Zuker, R. M., & Borschel, G. H. (2013). Vascularized composite allotransplantation: An update on medical and surgical progress and remaining challenges, Journal of Plastic, Reconstructive, and Aesthetic Surgeons, 66(11), 1449 http://www.ncbi.nlm.nih.gov/pubmed/23867239.
- National Organ Transplant Act. (1984). Public Law 98-507, Oct. 19, 1984; Title III Sec. http://optn.transplant.hrsa.gov/ContentDocuments/Guidance_InformedConsentLiving_Donors.pdf. Accessed 17 Dec 2014.
- Oltoff, K. M., Abecassis, M. M., Emond, J. C., Kam, I., Merion, R. M., Gillespie, B. W., … A2ALL Study Group. (2011). Outcomes of adult to adult living donor transplantation: Comparison of the adult-to adult living donor liver transplantation cohort study and national experience. Liver Transplantation, 17, 789–797.Google Scholar
- Olthoff, K. M., Merion, R. M., Ghobrial, R. M., Abecassis, M. M., Fair, J. H., Fisher, R. A., … A2ALL Study Group. (2005). Outcomes of 385 adult-to-adult living donor liver transplant recipients: A report from the A2ALL Consortium. Annals of Surgery, 242(3), 314–23.Google Scholar
- Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR). (2014). OPTN/SRTR 2012 annual data report. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation.Google Scholar
- Organ Transplantation and Procurement Network. Policy 14, living donation. Retrieved December 11, 2014 from http://optn.transplant.hrsa.gov/ContentDocuments/OPTN/Policies.pdf.
- Purnell, T. S., Auguste, P., Crews, D. C., Lamprea-Montealegre, J., Olufade, T., Greer, R., … Boulware, L. E.(2013). Comparison of life participation activities among adults treated by hemodialysis, peritoneal dialysis, and kidney transplantation: A systematic review. American Journal of Kidney Diseases, 62, 953–973.Google Scholar
- Seem, D. L., Lee, I., Umscheid, C. A., & Kuehnert, M. J. (2013). PHS guideline for reducing human immunodeficiency virus, hepatitis B virus, and hepatitis C virus transmission through organ transplantation. Public Health Reports, 128, 247–343.Google Scholar
- Segev, D. L., Muzzaale, A. D., Caffo, B. S., Mehta, S. H., Singer, A. L., Taranto, S. E., … Montgomery, R. A. (2010). Perioperative mortality and long term survival following live kidney donation. JAMA, 303(10), 959–966.Google Scholar
- Steel, J. L., Dunlavy, A., Friday, M., Kingsley, K., Brower, D., Unruh, M., … Humar, A. (2012). A national survey of independent living donor advocates: The need for practice guidelines. American Journal of Transplantation, 12(8), 2141–2149.Google Scholar
- Steel, J. L., Dunlavy, A., Friday, M., Kingsley, K., Brower, D., Unruh, M., … Humar, A. (2013). The development of practice guidelines for ILDAs. Clinical Transplantation, 27(2), 178–184.Google Scholar
- US Renal Data System, USRDS. (2013). Annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.Google Scholar