Exploring the Mental Health of Living Kidney Donors

Abstract Living donor kidney transplantation is the best option for extending and improving the lives of patients with end-stage renal disease. The benefits for the donor are less straightforward: a donor is a healthy person who undergoes a surgery in the first place for the benefit of another person. It is therefore of great importance to minimize negative medical and psychologi¬cal outcomes after living kidney donation and optimize positive outcomes. There is little research on the psychological outcomes after living kidney donation and how donors should be supported in order to prevent negative psychological outcomes. Therefore the aims of this thesis were to examine whether there is a change in mental health between predonation and postdonation among living kidney donors and to identify the socio-demographic, psychological, and medical factors that have an influence on (change in) living kidney donors’ mental health. The main conclusion is that mental health remained the same for the majority of living kidney donors till one year after donation, while mental health im¬proved or deteriorated for a minority after donation. However, the changes among the minority of donors were not more or less than the changes found in mental health among the general population. This indicates that the changes among donors are not triggered by the donation process. Therefore, we did not find evidence to reject potential donors based on psychological reasons, except for donor candidates who are incompetent to give informed consent due to an impaired mental health status. In addition, we identified a number of donors who may benefit from additional psycho¬logical support during the donation process. It is recommended that professionals examine the risk profile prior and during the donation process and the need for additional psychological support in the case of one or more risk factors. Interventions could be focused on decreasing stress/psychological symptoms, increasing wellbeing, and/or the risk factors, such as an intervention on unrealistic expectations. These recommendations will strengthen the psychosocial support of living kidney donors

Exploring Knowledge About Dialysis, Transplantation, and Living Donation Among Patients and Their Living Kidney Donors

Background: In order to make a well-considered decision and give informed consent about renal replacement therapy, potential living kidney donors and recipients should have sufficient understanding of the options and risks. Purpose: We aimed to explore knowledge about Dialysis & Transplantation (DT) and Living Donation (LD) among prospective living kidney donors and recipients. Methods: Eighty-five donors and 81 recipients completed the Rotterdam Renal Replacement Knowledge-Test (R3K-T) 1 day before surgery. The questionnaire was available in various languages. Results: Recipients knew significantly more about DT than donors (p < 0.001); donors knew more about LD than recipients (p < 0.001). A minority of donors (15 %) and recipients (17 %) had a score that was comparable to the knowledge level of the naïve general population. Recipients and donors knew less about DT and LD if their native language was not Dutch. In addition, recipients knew less about DT if they were undergoing pre-emptive transplantation. Conclusions: We conclude that recipients and donors retain different information. The decision to undergo living donation appears to be not always based on full knowledge of the risks. We recommend that professionals assess knowledge of prospective donors and recipients during the education process using the R3K-T, and extra attention is required for non-native speakers

An ELPAT definition of the concept ‘Psychosocial’ in the context of Screening Living Organ Donors in Europe: A Concept Mapping approach

Introduction: Across Europe, transplant centers vary in the set of psychosocial screening criteria/guidelines used for the selection of eligible living donors. Our aim was to explore whether a common framework underlies this variation in screening criteria and, based on this framework, to develop a consensus on the essential elements of psychosocial screening of living liver and kidney donors. In order to do so, a research question was set out to define a conceptual framework of the concept ‘Psychosocial’ in the context of screening living organ donors in Europe. We formulated the following research question: Which psychosocial screening criteria are most commonly reported and considered as most important or effective in selecting eligible kidney and liver donors? Method: Concept mapping methodology was used to create a visual representation of the complex topic ‘Psychosocial’ in the context of screening living organ donors in Europe, in which underlying concepts, the relative importance of these concepts and the interplay between different concepts are organized. Initial psychosocial screening criteria (N=83) were derived from an extensive systematic literature review on guidelines, protocols and consensus statements on psychosocial screening practices, complemented by group brainstorm sessions. These criteria were then sorted and rated for their importance and effectiveness by 26 project participants. The data were analyzed using the Concept System Core© Software, which provided us with graphical depictions (concept maps) illustrating the view of project participants on these screening criteria. Pattern Matches and Go-Zones showed us the highlycommon, important and effective criteria. Results: The concept map procedure resulted in six clusters of psychosocial screening criteria: (1) Motivation and decision making (2) Personal resources (3) Psychopathology (4) Social resources (5) Ethical and Legal factors (6) Information and risk processing. Bivariate rating of these criteria revealed which important criteria are already frequently used for screening and which require more attention. Based on the cluster map and bivariate ratings we constructed a conceptual framework for non-medical risk factors that need to be considered when screening potential living organ donors. Conclusion: We provided a conceptual framework of psychosocial screening criteria which can serve as a practical recommendation for the psychosocial screening of potential living organ donors

Development of the Rotterdam Renal Replacement Knowledge-Test (R3K-T)

Introduction: There is currently a lack of validated or standardized measures to test the level of knowledge among renal patients regarding kidney disease and available treatment options. We conducted a pilot study to develop a questionnaire measuring knowledge of kidney disease, dialysis and transplantation options. The main aim of this study was to develop such an instrument for further use in research and practice. Method: An initial 61 item pool was generating by searching the literature and consulting experts in this area for additional items. This questionnaire was completed by 182 renal disease patients from 4 dialysis centers in the Rotterdam municipality. A factor analysis was conducted using the maximum likelihood factor method followed by direct oblimin rotation to obtain variance explained by each factor. Questions that loaded ≥ .30 on a factor were included. Results: Twenty-seven patients (24%) were in the pre-RRT phase, 60 (54%) were undergoing haemodialysis, 16 (14%) were undergoing peritoneal dialysis, and 9 (8%) had a graft failure. Forty (36%) were female and 72 (64%) were male. Age range 19-87 (median = 59). A factor analys

Transcriptomic-based clustering of human atherosclerotic plaques identifies subgroups with different underlying biology and clinical presentation

Histopathological studies have revealed key processes of atherosclerotic plaque thrombosis. However, the diversity and complexity of lesion types highlight the need for improved sub-phenotyping. Here we analyze the gene expression profiles of 654 advanced human carotid plaques. The unsupervised, transcriptome-driven clustering revealed five dominant plaque types. These plaque phenotypes were associated with clinical presentation and showed differences in cellular compositions. Validation in coronary segments showed that the molecular signature of these plaques was linked to coronary ischemia. One of the plaque types with the most severe clinical symptoms pointed to both inflammatory and fibrotic cell lineages. Further, we did a preliminary analysis of potential circulating biomarkers that mark the different plaques phenotypes. In conclusion, the definition of the plaque at risk for a thrombotic event can be fine-tuned by in-depth transcriptomic-based phenotyping. These differential plaque phenotypes prove clinically relevant for both carotid and coronary artery plaques and point to distinct underlying biology of symptomatic lesions

Predonation psychosocial evaluation of living kidney and liver donor candidates: A systematic literature review

Evaluating a person's suitability for living organ donation is crucial, consisting not only of a medical but also of a thorough psychosocial screening. We performed a systematic literature review of guidelines, consensus statements, and protocols on the content and process of psychosocial screening of living kidney and liver donor candidates. We searched PubMed, Embase, CINAHL, and PsycINFO until June 22, 2011, following the PRISMA guidelines, complemented by scrutinizing guidelines databases and references of identified publications. Thirty-four publications were identified, including seven guidelines, six consensus statements, and 21 protocols or programs. Guidelines and consensus statements were inconsistent and lacked concreteness for both their content and process, possibly explaining the observed variability in center-specific evaluation protocols and programs. Overall, recommended screening criteria are not evidence-based and an operational definition of the concept "psychosocial" is missing, causing heterogeneity in terminology. Variation also exists on methods used to psychosocially evaluate potential donors. The scientific basis of predonation psychosocial evaluation needs to be strengthened. There is a need for high-quality prospective psychosocial outcome studies in living donors, a uniform terminology to label psychosocial screening criteria, and validated instruments to identify risk factors

SMART TEXTILE BASED REMOTE IDENTIFICATION SYSTEM

Within this research a smart textile based light sensor was developed and integrated into a technical demonstrator of a remote identification system. This sensor is based on polymeric optical fibers (POFs) which contain fluorescent dopants and allows a remote detection using an optical laser pulse for identification. A possible use case for this system is remote identification to avoid &ldquo;friendly fire&rdquo; incidents. The smart textile sensor can be integrated with a very low footprint in protective textiles or other equipment of the individual. Besides defense applications, the system could also be adopted for applications in which a safe, secure and fast remote identification is needed

Psychologic functioning of unspecified anonymous living kidney donors before and after donation

BACKGROUND: There has been discussion regarding the psychologic functioning of living donors who donate their kidney to an unrelated and unknown patient ("unspecified living donors"). This is the first prospective study to investigate group- and individual-level changes in psychologic functioning among a large group of unspecified donors. METHODS: Forty-nine medically and psychologically screened unspecified living kidney donors completed the Symptom Checklist before and after donation. RESULTS: Group-level analysis showed that overall psychologic symptoms increased after donation (P=0.007); the means remained within the average range of the normal population. Individual-level analysis showed that 33 donors showed no statistically significant change, 3 donors showed a statistically significant decrease, and 13 donors showed a statistically significant increase in psychologic symptoms. Two of the latter donors showed a clinically significant increase. CONCLUSIONS: We found more increases in psychologic symptoms than decreases, particularly if follow-up time was longer. However, for almost all donors, these increases were not clinically significant and the clinically significant changes found are comparable with natural fluctuations in psychologic symptoms in the general population. Possibly, the donors underreported their psychologic symptoms before donation to pass the screening. Due to the low level of predonation symptoms reported, regression to the mean could also explain the results. Although we found that changes were not associated with donation-related factors, it is possible that other donation-related factors or other life events not measured have an influence on psychologic functioning. Therefore, further research is needed to investigate whether the fluctuations are related to the donation process.Copyrigh

Predicting mental health after living kidney donation: The importance of psychological factors

Objectives: Living donor kidney transplantation offers advantages to the patient, however involves risks to the donor. To optimize donors' mental health after donation, we studied the influence of psychological factors on this outcome. Potential predictors were based on models of Lazarus () and Ursin and Eriksen () that describe predictors of mental health mediated by stress. Design: Prospective design. Methods: Living kidney donors (n = 151) were interviewed before donation and completed questionnaires 2.5 months before and 3 and 12 months post-donation. Using multilevel regression models, we examined whether appraisals, expectations, knowledge, social support, coping, life events, and sociodemographic characteristics predicted psychological symptoms and well-being and whether these relationships were mediated by stress. Results: A greater increase in psychological symptoms over time was found among donors without a partner. Younger age, lack of social support, expectations of interpersonal benefit, lower appraisals of manageability, and an avoidant coping style were related to more psychological symptoms at all time points. The latter three were mediated by stress. No religious affiliation, unemployment, history of psychological problems, less social support, expectations of negative health consequences, and less positive appraisals were related to lower well-being at all time points. Conclusions: This stud