Quality of life of living kidney donors: the short-form 36-item health questionnaire survey

doi:10.1016/S0090-4295(02)01865-4

Urology

Volume 60, Issue 4, October 2002, Pages 588-592

https://doi.org/10.1016/S0090-4295(02)01865-4 Get rights and content

Abstract

Objectives

To determine the psychological and social effects of kidney donation on kidney donors by using the short-form 36-item health survey (SF-36) as the quality-of-life questionnaire.

Methods

A total of 104 living donor nephrectomies have been performed at Kobe University Hospital and Nishinomiya Prefectural Hospital. We mailed the questionnaires to donors or handed them out directly at the outpatient clinic. The first part of the questionnaire consisted of the SF-36 (limitations on physical functioning because of health problems) and the second part consisted of 15 questions about donation-related stress, expenses incurred, physical changes, and pre-existing factors such as relationship to the recipients.

Results

The SF-36 and the questionnaire about donor satisfaction were completed by 69 donors (48 women and 21 men; mean age 52.1 ± 8.2 years), only 6 of whom (9%) reported minor complications with the donor operation. The SF-36 scores of our donors were not significantly different from that of the general U.S. population and U.S. donors. In some categories (physical functioning, role-physical, bodily pain, general health, vitality, and mental health), our donors scored slightly higher than the U.S. general population. Although 97% of the donors would make the same choice again, 3% believed that donating had had a negative impact on their health, and 16% reported negative financial consequences.

Conclusions

The quality of life for kidney donors was not affected by donor nephrectomy. Living kidney transplantation seems to be suitable for the rescue of patients with end-stage renal disease. Better psychological and technical preparation for surgery and more consistent follow-up may reduce the negative outcomes even further.

Section snippets

Material and methods

Between 1981 and 2001, 104 living donor nephrectomies were performed at Kobe University Hospital and Nishinomiya Prefectural Hospital using the retroperitoneal flank or paramedian approach. All donors always underwent physical examination, routine biochemical blood tests, urinalysis, creatinine clearance, and renal sonography preoperatively. At 1, 2, 3, and 6 months postoperatively, we checked routine biochemical blood tests, urinalysis, and creatinine clearance. Some of the patients could be

Donor nephrectomy

The mean observation time after transplantation was 6.95 ± 4.34 years (range 0.3 to 14). The left kidney was removed from 41 donors and the right from the remaining 28. The mean operative time was 2 hours, 45 minutes (range 55 minutes to 6 hours, 5 minutes). The mean operative blood loss (as estimated by the anesthesiologist) was 299 ± 179 mL (range 20 to 810). Six complications were noted. One was a pneumothorax that did not require thorax drainage. Wound hematomas or seromas that did not need

Comment

Many reports have stated that living kidney donation appears to be safe.1, 2, 3, 4, 5 The results of our study also support the notion that kidney donation is safe, because only six minor complications (9%) were noted among the 69 donor operations. In our series, no donor death occurred. No kidneys were lost for technical reasons.

Our series did not show any significant differences from the general U.S. population in the SF-36 scores. In some categories of the SF-36 quality of life (physical

Conclusions

The mean SF-36 scores of our donors were not significantly different from those of the general U.S. population. The quality of life of living kidney donors was not affected by the donor nephrectomy, which was also considered to be safe and was confirmed as a method with few complications. Living kidney transplantation thus seems to be suitable for the rescue of patients with end-stage renal disease. However, living donors should remain under long-term follow-up.

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In some aspects (physical functioning, pain, general health, vitality and mental health), the donors' QoL was slightly higher compared to the general population. Furthermore, the donors' age did not play a significant role [22]. Using the WHOQoL scale, Lumsdaine et al. conducted a long-term prospective observation on 52 donor-recipient pairs, among which 23 of donors were recipients' parents, 11 were siblings, 16 a partner and 2 had other relation.
Due to its numerous advantages, transplantation from a living kidney donor is the best method of renal replacement therapy. However, the characteristics of the procedure require to consider well-being of not only the recipient, but also the donor - a person who suddenly becomes a patient despite former good health. The living donation is a selfless act, but also a decision that may endanger one's own health.
The aim of this article was to review the current knowledge concerning the quality of life, symptoms of anxiety and depression occurring among living kidney donors and recipients. In order to do that, we performed a systematic research in the PubMed, Google Scholar and CINAHL databases for the years 2000–2019 with the use of key words. The inclusion and exclusion criteria were met by only 15 articles.
This study shows that the mental state of donors is generally better than that of recipients. Additionally, reduction of anxiety and depression as well as increase in the quality of life occurs in both donors and recipients in the post-transplant period compared to the time before surgery. Further research is needed on this topic in order to improve psychological aspects of care of live kidney donors and recipients.
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This should be interpreted as indicating that those donors with somatic symptoms need to be evaluated further. In keeping with ﬁndings from other studies [2,16,18,19], donors reported their relationship to the recipient to be unchanged or even improved after the operation. This was found to be related to lower depression scores.
The aims of this study were to (1) determine psychological states and wellbeing of living kidney donors and (2) assess their interaction and association with subjective evaluations of donors. This retrospective, cross-sectional study was conducted with 208 living kidney donors (123 women; 59.1%), aged between 22 and 79 years (48.74 ± 11.78) who underwent a nephrectomy between 2006 and 2017. All donors were evaluated face-to-face. The sociodemographic data collection form, a 4-question survey developed by researchers for subjective evaluations, the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and Contentment with Life Assessment Scale (CLAS) were administered. Only few donors, 3.8% and 7.2% respectively, were above the clinical cut off scores of the BDI and BAI. This was equivalent to the normal population. Eighty percent of respondents were satisfied with life. Only 5 donors (2.4%) claimed to have any regrets about their experience and scored higher for depression and lower for life satisfaction (P < .001). Similarly, 33 (15.9%) donors having thoughts of getting ill easily after the operation were found to be more depressive and anxious, with lower life satisfaction (P < .001). In most cases their relationship to the recipient was reported not to be changed (64.4%) or even improved (32.5%), and that was found to be related to lower depression scores (P < .001). Respondents within the first year of donation reported higher depression (P = .019) and lower life satisfaction (P = .001) scores. Finally, postoperative complications were found to increase anxiety and lower life satisfaction (P = .018, P = .026). Degree of affinity between donors and recipients showed no difference in postoperative psychological outcomes and life satisfaction. These results suggest that overall, living kidney donation does not have a negative impact on donors’ life satisfaction and mental status in the long term. However, the results of the unvalidated additional survey questions underlined the importance of follow-up of donors, especially in the first year, and screening of donors’ subjective experiences in gaining additional insight about donors' mental well-being.
Estimating the Net Utility Gains Among Donors and Recipients of Adult Living Donor Kidney Transplant
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Living donor kidney transplant relieves the disease burden of patients with end-stage renal disease but may shorten donor life expectancy; however, their quality of life (QOL) is preserved. Nevertheless, the magnitude of the net gain of this procedure is unknown. We evaluated the QOL of both donors and recipients concurrently and calculated the net utility gain.
We recruited 210 subjects who visited the kidney transplantation clinic of a university hospital. Subjects were asked to complete the 5-level EQ-5D-based questionnaire, and patient characteristics were extracted from their medical records. We performed multivariate tobit models analysis to evaluate the QOL change caused by transplant surgery and subsequently ran computational simulations to determine the net utility gains of donors and recipients. We also performed sensitivity analyses.
After excluding 16 answers with missing data, we analyzed 203 answers in total. After the transplant surgery, recipients gained 0.07 in utility value while donors lost 0.04. In the net utility analysis, we found that the quality-adjusted life years gained ranged from 7.2 to 7.8 in the most favorable case observed in the combination of middle-aged recipients and elderly donors. Assuming no utility discount, the most favorable combination was that with older donors and younger recipients.
These findings indicated that the QOL improvement in recipients was larger than the loss among donors. When calculating the net utilities, a combination of middle-aged recipients and elderly donors yielded the largest net utility, but this was likely derived from assumption in the discount of QOL.
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While most living kidney donors are satisfied with their decision and do not regret donating, few studies have been conducted on the determinants related to the effectiveness and regret of the decision. This study aims to explore the relationship between basic attributes, quality of life, positive affect, negative affect, effectiveness of decision-making, and regret in living kidney donors.
In this cross-sectional study, living kidney donors were recruited from urology and kidney transplant outpatient services. The structured questionnaire used to collect the data included the Positive and Negative Affect Schedule, Medical Outcomes Study 12-Item Short-Form Health Survey, Decision Conflict Scale, and Decision Regret Scale.
The findings indicate that living donors with better health status, 24-hour creatinine clearance, physical health-related quality of life (HRQOL), and positive affect experienced greater feelings of effective decision-making. Moreover, women and donors with better physical HRQOL, positive affect, and decision effectiveness were less regretful about the decision of kidney donation.
Health status, physical HRQOL, and positive affect are related to decision validity and regret of living donors. Therefore, clinical care providers should regularly assess the mood and health of living kidney donors. Furthermore, activities promoting their health should be encouraged, especially for men.
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Adult urologyQuality of life of living kidney donors: the short-form 36-item health questionnaire survey

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Material and methods

Donor nephrectomy

Comment

Conclusions

Am J Kidney Dis

Lancet

Transplant Proc

J Urol

Kidney donors live longer

Transplantation

Evaluation of living renal donorsthe current practice of US transplant centers

Transplantation

Does kidney donation threaten the quality of life of the donor?

Transplant Proc

Quality of life in Norwegian kidney donors

Nephrol Dial Transplant

Adult urology
Quality of life of living kidney donors: the short-form 36-item health questionnaire survey