The Psychosocial Evaluation of Living Kidney Donation: Time for Standardization

Clark · August 26, 2025, 10:36:47 AM

https://journals.lww.com/transplantjournal/fulltext/2024/11000/the_psychosocial_evaluation_of_living_kidney.6.aspx

The Psychosocial Evaluation of Living Kidney Donation: Time for Standardization in Practice
Levan, Macey L. JD, PhD1; LaPointe Rudow, Dianne ANP-BC, DNP, FAAN2
Transplantation 108(11):p e342-e343, November 2024. | DOI: 10.1097/TP.0000000000005084

INTRODUCTION
The transplant community has an opportunity to improve clinical follow-up and data collection opportunities, to implement standardized psychometrics instruments in the living kidney donor evaluation process and optimize psychosocial team structures. Clifton et al1 was an American Society of Transplantation Living Donor Community of Practice Mental Health Working Group product. Their survey reached 53% of active US living donor programs with the intent of understanding composition of psychosocial teams evaluating donor candidates, what the evaluation process entailed, and postdonation psychosocial follow-up. Although policy has been established for more than a decade, there is much transplant hospital variation in living donor evaluation screening mechanisms, acceptance practices, and support offered.
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Clark · August 26, 2025, 10:39:59 AM

https://journals.lww.com/transplantjournal/abstract/2024/11000/psychosocial_evaluation_of_living_kidney_donors__a.21.aspx

Psychosocial Evaluation of Living Kidney Donors: A Survey of Current Practices in the United States
Clifton, Erin PhD1; et al.
Transplantation 108(11):p e382-e389, November 2024. | DOI: 10.1097/TP.0000000000005095

Abstract
Background.
Best practices in psychosocial evaluation and care of living donor candidates and donors are not well established.
Methods.
We surveyed 195 living kidney donor (LKD) transplant centers in United States from October 2021 to April 2022 querying (1) composition of psychosocial teams, (2) evaluation processes including clinical tools and domains assessed, (3) selection criteria, and (4) psychosocial follow-up post-donation.
Results.
We received 161 responses from 104 programs, representing 53% of active LKD programs and 67% of LKD transplant volume in 2019. Most respondents (63%) were social workers/independent living donor advocates. Over 90% of respondents indicated donor candidates with known mental health or substance use disorders were initially evaluated by the psychosocial team. Validated psychometric or transplant-specific tools were rarely utilized but domains assessed were consistent. Active suicidality, self-harm, and psychosis were considered absolute contraindications in >90% of programs. Active depression was absolute contraindication in 50% of programs; active anxiety disorder was excluded 27%. Conditions not contraindicated to donation include those in remission: anxiety (56%), depression (53%), and posttraumatic stress disorder (41%). There was acceptance of donor candidates using alcohol, tobacco, or cannabis recreationally, but not if pattern met criteria for active use disorder. Seventy-one percent of programs conducted post-donation psychosocial assessment and use local resources to support donors.
Conclusions.
There was variation in acceptance of donor candidates with mental health or substance use disorders. Although most programs conducted psychosocial screening post-donation, support is not standardized and unclear if adequate. Future studies are needed for consensus building among transplant centers to form guidelines for donor evaluation, acceptance, and support.

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The Psychosocial Evaluation of Living Kidney Donation: Time for Standardization

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