The study of living kidney donor decision-making and psychosocial outcomes

McNeill, Yvonne L. (2011) The study of living kidney donor decision-making and psychosocial outcomes. D Clin Psy thesis, University of Glasgow.

Abstract

Background:
Individuals with end-stage kidney disease need dialysis or a kidney transplant. Kidney
transplantation from a living donor is the preferred treatment. Live kidney donor
transplantation, however, is an invasive surgery performed on a healthy individual for the
benefit of another person. Therefore, donors should be fully informed of the risks involved in
donation. The medical outcomes for kidney donors are well known, however, the research
investigating the psychosocial impact of donation is limited. Understanding the psychosocial
outcome of living kidney donation would promote informed consent, allow donors to plan
their postoperative recovery period, and guide the development of services that maintain the
long-term health of donors.
Aims:
This study aimed to investigate the postoperative quality of life of live kidney donors, to
investigate which variables predict postoperative psychosocial outcome, with particular
interest in the variable of coping style and to gather information regarding how individuals
decide to become living kidney donors and how satisfied they are with their pre- and postoperative
care.
Methods:
Living kidney donors at Glasgow Western Infirmary, Manchester Royal Infirmary and St.
James’ Hospital, Leeds were asked to complete a preoperative assessment consisting of the
SF-36, HADS, COPE and The Donor Decision Control Scale. Four weeks postoperative,
donors were asked to again complete these questionnaires, and in addition The Living Donor
Survey.
Results:
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Complete data was available for thirteen donors. The results indicate that live kidney
donation had a significant adverse affect on the physical wellbeing of the donors; the
postoperative scores on the PCS and all of the corresponding domains were significantly
lower and with a large effect size. Five (38%) of the donors experienced postoperative
complications, three of whom were readmitted to hospital. With respect to psychological
wellbeing, donors’ scores on the MCS did not differ significantly from their preoperative
scores. With respect to anxiety, for the group as a whole, postoperative HADS anxiety scores
were lower and the severity and prevalence of anxiety symptoms reduced. For depression
there was only a marginal increase in HADS depression scores. Analysis of each individual’s
outcomes indicated that there was a marked difference in the impact of donation. The results
suggest that poor psychosocial outcome following donation was marginally associated with
relying on mental disengagement as a coping strategy. Improved outcome in the
postoperative period was associated with seeking social support
Conclusions:
The physical health of donors is adversely affected by live kidney donation. Four weeks
postoperatively live kidney donors report their physical health as being worse than those with
long-standing illness. The psychological wellbeing of the majority of donors appears to be
largely unaffected by live kidney donation. However, a minority of donors report a poorer
psychological wellbeing following donation. Individuals who use active coping strategies
have higher postoperative MCS scores, reflecting better psychological wellbeing. However,
this conclusion should be interpreted with caution due the small sample size and therefore the
possibility of a type I error.

• Item Type: Thesis (D Clin Psy)
• Qualification Level: Doctoral
• Keywords: living kidney donor, psychosocial outcomes, donor decision making
• Subjects: R Medicine > R Medicine (General); B Philosophy. Psychology. Religion > BF Psychology
• Colleges/Schools: College of Medical Veterinary and Life Sciences
• Supervisor's Name: Millar, Prof. Keith
• Date of Award: 2011
• Depositing User: Dr Yvonne McNeill
• Unique ID: glathesis:2011-3498
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 03 May 2013 15:47
• Last Modified: 03 May 2013 15:49
• URI: https://theses.gla.ac.uk/id/eprint/3498