Quality of Life in Kidney Donors

[Clark]

http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2011.03517.x/abstract;jsessionid=9B7B8EEACCF002923109B1DE4F34EE01.d02t01

Quality of Life in Kidney Donors
G. Mjøen, K. Stavem, L. Westlie, K. Midtvedt, P. Fauchald, G. Norby, H. Holdaas
Article first published online: 12 APR 2011
DOI: 10.1111/j.1600-6143.2011.03517.x
American Journal of Transplantation

Reports on quality of life of kidney donors include small populations with variable response rates. The aim was to evaluate quality of life in kidney donors in a large cross-sectional study. Through the Norwegian Renal Registry we contacted all 1984 kidney donors in the period 1963–2007 with a response rate of 76%. All received the Short-Form-36 (SF - 36) survey form and a questionnaire specifically designed for kidney donors. SF - 36 scores for a subgroup (n = 1414) of kidney donors were not inferior to a general population sample, adjusted for age, gender and education. When asked to reconsider, a majority stated that they still would have consented to donate. Risk factors for having doubts were graft loss in the recipient (OR 3.1, p < 0.001), medical problems after donation (OR 3.7, p < 0.001), unrelated donor (OR 2.2, p = 0.01) and less than 12 years since donation (OR 1.8, p = 0.04). Older age at donation was associated with lower risk (OR 0.98, p = 0.03). Compared with other donors, those expressing doubts had inferior SF - 36 scores. Norwegian kidney donors are mostly first-degree relatives. They are fully reimbursed and offered life-long follow-up. All inhabitants are provided universal healthcare. This should be considered when extrapolating these results to other countries.

[livingdonor101]

First off, it's Norway. They have a completely different lifestyle than the US (not to mention the universal health care).

Second, why didn't 24% respond? Are they dead, or really angry cuz they were physically or emotionally damaged? Unlocatable? It's a pretty important distinction.

Third, what were the questions on the survey? It's incredibly easy to craft statements leading to particular conclusions. For example: asking LDs if they 'regret' donating, especially when most are first degree relatives. The researchers are essentially asking the living donors if they regret trying to help someone they love. How many people would answer affirmatively to such a query? Yet study authors repeatedly use this result as 'proof' that living donation is ethically acceptable. It's a bogus question.

Finally, in countries with universal health care, the priority is on minimizing risk and keeping costs down. As a result, they are much more careful in their evaluation and selection of living donors than in the US (cuz they have to foot the bill for the living donors' long-term care). This prospective conservatism will also be reflected in short and long-term studies such as this one.