Journal Article Annotations
2019, 4th Quarter
Annotations by Andrea DiMartini
Also of interest:
In this descriptive work authors at the University Health Network in Toronto provide the first report on the physical and psychological outcomes of anonymous live liver donor (A-LLD- no biological connection or prior relationship) using a mixed methods approach. During the period of study January 2005 to December 2017, 50 A-LLDs donated (representing 6.7% of their LLD donors). Twenty six of 41 A-LLDs (63%) who were >3 months post-donation agreed to participate. Validated self-reported questionnaires assessed personality traits, relationship style, and psychological growth. Qualitative interviews after donation examined motivation and experiences. Surveys showed A-LLDs endorsed personality traits of agreeableness, conscientiousness with low neuroticism and 50% endorsed a secure attachment style. Donors also reported significant post-donation growth in areas of relating to others, personal strength, and appreciation of life. Themes arising from the qualitative interviews included the concept of a good deed, random act of kindness without the expectation of reciprocity, moral obligation to help someone in need, and anonymity helped to preserve the value of doing a good deed.Social, financial, healthcare, and legal support in Canada were identified as facilitators of A-LLD donation.
Weaknesses and limitations:
This is a single center report on a small-sized cohort. There is no control group. Bias may have occurred if A-LLD non-responders had poorer outcomes.
This is the first report on an A-LLD cohort to examine psychological outcomes. The use of qualitative interviewing is especially relevant to understanding motives and decision making in donors.
Type of study
(http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401): cross sectional cohort study
The authors sought to determine the availability of mental health (MH) and chemical dependency (CD) services in US transplant programs using databases from three sources: the 2017-2018 American Hospital Association Annual Survey (>6400 American hospitals), 2017-2018 Area Health Resource file (dataset provided by US Dept of Health and Human Services Health Resources and Services Administration) and Centers for Medicare & Medicaid Services Hospital Compare. All non-federal US transplant programs were included. MH service could include inpatient, consultation-liaison or outpatient services while CD services could include inpatient or outpatient alcoholism-chemical dependency services. Investigators used descriptive data to qualify the availability of services and generalized linear mixed models examine associations of hospital and health services area-level characteristics with the odds of offering MH and CD services. Of the 345 centers offering transplants in the US, investigators found that while 85% offered MH services only 37% offered CD services; 36% offered both MH and CD services. Hospitals were more likely to offer MH services if they were larger and had a lower percentage of uninsured patients in the health services area and were more likely to offer CD services if they were larger or were members of a system. The authors believe this suggests the costs and reimbursement levels for MH and CD services are major factors in a centers’ decision whether to offer these services. They conclude that all transplant centers should ideally provide MH services to comply with the letter and spirit of CMS and UNOS requirements as well as to meet the complex psychosocial and mental health needs of the patients they serve.
Weaknesses and limitations:
The study could not show whether transplant patients could access MH or CD services if available at the transplant program, whether these services were adequate or whether they had alternative access to MH or CD care in the community.
US transplant programs require comprehensive psychosocial evaluations of transplant candidates. Without available MH and CD services within the transplant hospital system transplant candidates and recipients may only be able to receive such care in the community which may not be aware of the unique needs of transplant patients, be capable of assisting in the complex evaluation process or providing the type of expert coordinated MH and CD care required of transplant patients.