Date of Award

10-19-2009

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Chirag Parikh

Abstract

Living kidney donation rates are increasing in the United States and internationally. Major consensus statements on the care of living kidney donors recommend communicating all potential health and psychosocial risks to donors. We evaluated the degree of international variation in the process of informed consent of potential donors during their evaluation. Transplant professionals attending the 2006 World Transplant Congress responded to a survey assessing their informed consent processes, donor evaluation and risk communication to living donors. US based respondents were compared to non-US respondents. There were 221 respondents from 177 transplant centers and 40 countries (48% US respondents). Across US and non-US transplant centers, potential donors were most likely to receive written material about living donor risk by mail prior to evaluation, receive risk information in person during evaluation, have a psychosocial evaluation, which usually lasted longer than 30 minutes, and sign an official donation consent form presented to them by a surgeon or a nephrologist. Although over 75% of respondents stated that donors received information about medical risks such as hypertension, chronic kidney disease, and potential need for dialysis, there was less consistency regarding whether or not respondents conveyed an increased risk of these medical complications to donors. Additionally, the financial and psychosocial costs associated with being a living donor were inconsistently communicated to donors during the informed consent process. Compared to non-US respondents, US respondents were more likely to use written material and visual aids to convey risks to donors, have mandatory psychosocial evaluations, and provide access to donor support groups. US transplant centers were also more likely to discuss the possibility of the donor needing dialysis or a transplant if their remaining kidney fails in the future, possible travel expenses and loss of work income due to donation recovery. Conversely, the US respondents centers were less likely to offer long-term follow up and to utilize nephrologists to obtain written donor consent for donation. As dependence on living organ donation increases best practices for informed consent, donor evaluation and uniform risk conveyance need to be established. This may be accomplished by using a model informed consent template to ensure that informed consent from donors is consistently obtained.

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