Background: Although many living organ donors experience no adverse psychosocial consequences of donation, others develop enduring somatic symptoms, psychological distress, and interpersonal difficulties. There are no evidence-based interventions to prevent such outcomes. We conducted a single-site randomized controlled trial to examine the feasibility and impact of a new preventive intervention. The intervention utilized motivational interviewing (MI) to target a major risk factor for poor psychosocial outcomes, residual ambivalence about donating (i.e., lingering hesitation and uncertainty that coexist with the intention to donate).
Methods: Of 184 prospective kidney or liver donors, 131 screened positive for residual ambivalence; 113 were randomized to (a) the 2-session telephone-based MI intervention, (b) an active comparison condition (2 telephone education sessions on healthy lifestyle habits), or (c) standard care only before donation. Ambivalence was reassessed post-intervention (before any donation surgery). Psychosocial outcomes in somatic, psychological, and familial interpersonal relationship domains were assessed at 6 weeks and 3 months postdonation.
Results: In terms of feasibility, all interventions were able to be completed before any donation surgery. Postdonation, there was no attrition in any study group; subjects successfully completed all assessments. In terms of outcomes, MI subjects showed the greatest decline in ambivalence about donation from pre- to post-intervention (p=.050). By the 3 months postdonation assessment, in the somatic outcomes domain MI subjects reported fewer physical symptoms related to donation (p=.038), lower rates of fatigue (p=.021) and pain (p=.016), shorter recovery times (p=.041), and fewer unexpected medical problems (p=.023). Among psychological and interpersonal outcomes, MI subjects had a lower rate of anxiety symptoms (p=.046) and fewer unexpected family-related problems (p=.045). MI subjects did not differ from other subjects on depression, feelings about donation, or family relationship quality.
Conclusions: The MI intervention is feasible to offer to prospective donors, and appears to reduce residual ambivalence and prevent poor postdonation outcomes. The findings suggest that the intervention merits testing in a larger, multisite trial.
To cite this abstract in AMA style:Dew M, DiMartini A, Dabbs ADeVito, Zuckoff A, Tan H, McNulty M, Switzer G, Fox K, Greenhouse J, Humar A. Prevention of Poor Psychosocial Outcomes in Living Kidney and Liver Donors: Feasibility and Efficacy in a Randomized Controlled Trial [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/prevention-of-poor-psychosocial-outcomes-in-living-kidney-and-liver-donors-feasibility-and-efficacy-in-a-randomized-controlled-trial/. Accessed November 13, 2019.
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