Mental Health, Disorders and Symptoms in Living Donors: Where are Areas for Improvement?

The success of living donor transplantation is a testament to the dedicated transplant clinicians and programs who make donor safety and wellbeing their utmost priority. From a psychosocial perspective, additional safeguards are provided by national and international organizations requiring a comprehensive psychosocial assessment by qualified professionals to identify and address any psychosocial issues, including mental health issues, that could complicate post-donation recovery. Overall, in carefully selected donor cohorts, the literature shows donor psychologic wellbeing and mental health, on average, is similar to or exceeds that reported in the general population. However, the literature also reveals clinically relevant higher-risk subgroups, a consistent pattern across liver and kidney donors of risk factors for poorer mental health outcomes: pre-donation characteristics and post-donation events and experiences related to donation. In this overview, we review the literature primarily from the past decade and also additionally use earlier key articles to highlight important mental health outcomes (eg, depression, anxiety). We focus on poorer mental health outcomes with the intent of learning how to improve pre-donation evaluation and post-donation care. We suggest ways to improve donor psychosocial assessments, consider strategies across the donation process that could be used to improve donor follow-up clinical care, and review donation-specific interventions. Closer follow-up of donors’ mental health after donation and interventions applied either before or following donation are important areas for future work.