The live donor assessment tool: a psychosocial assessment tool for live organ donors.

BACKGROUND: Psychosocial evaluation is an important part of the live organ donor evaluation process, yet it is not standardized across institutions, and although tools exist for the psychosocial evaluation of organ recipients, none exist to assess donors. OBJECTIVE: We set out to develop a semistructured psychosocial evaluation tool (the Live Donor Assessment Tool, LDAT) to assess potential live organ donors and to conduct preliminary analyses of the tool's reliability and validity. METHODS: Review of the literature on the psychosocial variables associated with treatment adherence, quality of life, live organ donation outcome, and resilience, as well as review of the procedures for psychosocial evaluation at our center and other centers around the country, identified 9 domains to address; these domains were distilled into several items each, in collaboration with colleagues at transplant centers across the country, for a total of 29 items. Four raters were trained to use the LDAT, and they retrospectively scored 99 psychosocial evaluations conducted on live organ donor candidates. Reliability of the LDAT was assessed by calculating the internal consistency of the items in the scale and interrater reliability between raters; validity was estimated by comparing LDAT scores between those with a "positive" evaluation outcome and "negative" outcome. RESULTS: The LDAT was found to have good internal consistency, inter-rater reliability, and showed signs of validity: LDAT scores differentiated the positive vs. negative outcome groups. CONCLUSIONS: The LDAT demonstrated good reliability and validity, but future research on the LDAT and the ability to implement the LDAT prospectively is warranted.

The role of the independent donor advocacy team in the case of a declined living donor candidate.

Many controversies arise when living donor candidates present themselves for consideration as donors for urgent liver transplants. Nonparent living donors for urgent pediatric transplant recipients are a unique donor candidate population with specific considerations that need to be acknowledged and addressed by the independent donor advocacy team. Such a team educates about donation, identifies potential contraindications, examines the distant relationships between donor and recipient, and considers ethical issues about the ability to make an informed decision in an urgent situation. A center for living donation dealt with such ethical issues when a donor candidate with a distant relationship was evaluated for living donation. Multiple relative contraindications were identified, and the donor candidate was declined. Careful management by the independent donor advocacy team is necessary to ensure the psychosocial safety and to provide needed psychosocial support and intervention for donor candidates with psychological contraindications to donation. Standard follow-up protocols need to be developed for declined donor candidates.