Living Donor Psychosocial Evaluation
In addition to a physical evaluation, living donors also go through a psychosocial evaluation, which measures a potential donor’s psychological well-being as it relates to the donation. Standard procedures for a living donor psychosocial evaluation do not exist. However, the Living Donor Committee of UNOS proposed standards. The proposal was not accepted, but here is the content they suggested since it is representative of the kinds of topics covered in a typical psychosocial evaluation:
- History and current state. Obtain standard background information such as the prospective donor’s education level, living situation, cultural background, religious beliefs and practices, significant relationships, family psychosocial history, employment, lifestyle, community activities, legal offense history, and citizenship.
- Capacity. Ensure that the prospective donor’s cognitive status and capacity to comprehend information are not compromised and do not interfere with judgment; determine risk for exploitation.
- Psychological status. Establish the presence or absence of current and prior psychiatric disorders, including but not limited to mood, anxiety, substance abuse, and personality disorders. Review current or prior therapeutic interventions (counseling, medications); physical, psychological or sexual abuse; current stressors (e.g., relationships, home, work); recent losses; and chronic pain management. Assess repertoire of coping skills to manage previous life or health-related stressors.
- Relationship with the transplant candidate. Review the nature and degree of closeness (if any) to the recipient (i.e., how the relationship developed), and whether the transplant would impose expectations or perceived obligations on the part of either the donor or the recipient.
- Motivation. Explore the rationale and reasoning for volunteering to donate, i.e., the “voluntariness”, including whether donation would be consistent with past behaviors, apparent values, beliefs, moral obligations or lifestyle. Determine whether the donation would be free of coercion, inducements, ambivalence, implusivity, or ulterior motives (e.g., to atone or gain approval, to stablize self-image, or to remedy a psychological malady).
- Donor knowledge, understanding, and preparation. Explore the propective donor’s awareness of the following:> Any potential short- and long-term risks for surgical complications and health outcomes, both for the donor and the transplant candidate;
> Recovery and recuperation time;
> Availability of alternative treatments for the transplant candidate; and
> Financial ramifications (including possible insurance risk).
Make sure that the donor understands the data on long-term donor health and psychosocial outcomes continue to be sparse. Assess the prospective donor’s understanding, acceptance, and respect for the specific donor protocol, e.g., willingness to accept potential lack of communication from the recipient and the donor’s willingness to undergo future donor follow up.
- Social support. Evalute support networks available to the prospective donor on an ongoing basis as well as during the donor’s recovery from surgery. Consider significant others, family members, social contacts, and employers.
- Financial suitability. Determine whether the prospective donor is financially stable and free of financial hardship; has resources available to cover financial obligations for expected and unexpected donation-related expenses; is able to take time away from work or established role, including unplanned extended recovery time; and has disability and health insurance.
Keep in mind that policies and procedures vary from transplant team to transplant team. You should confirm the actual psychosocial evaluation process with your transplant team.