A minority of living kidney donors have poor psychological outcomes after donation. There is mixed evidence as to the influence of the medical process on these outcomes. We examined whether the medical process experienced by donors and recipients influenced donors' mental health up to one year post-donation. One-hundred forty-five donors completed validated questionnaires on wellbeing (Positive And Negative Affect Schedule, Mental Health Continuum Short Form) and psychological symptoms (Brief Symptom Inventory) a median of 2.4 months before donation, and 3 and 12 months after donation. Indicators of the medical process were severity of donor complications (none; light; severe) and number of recipient re-hospitalizations at 3 and 12 months after the operation. Multilevel regression analyses were used to examine whether these indicators were related to donors' mental health over time. We found that more severe donor complications and more recipient re-hospitalizations were both related to a greater number of donors' psychological symptoms over time, e.g. depressive symptoms. However, indicators of the medical process were not related to donors' wellbeing, e.g. life satisfaction. We conclude that clinicians should be aware that donors who experience complications themselves and/or recipient re-hospitalizations are at greater risk for poorer psychological outcomes after donation and should evaluate their need for support. In such cases when needed, psychological support should be offered that focus on preventing psychological symptoms rather than on increasing wellbeing.

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