Rodrigue J R, Pavlakis M, Danovitch G M, Johnson S R, Karp S J, Khwaja K, Hanto D W, Mandelbrot D A
Department of Psychiatry, the Transplant Center, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Am J Transplant. 2007 Oct;7(10):2326-32. doi: 10.1111/j.1600-6143.2007.01921.x.
We conducted a survey of 132 US kidney transplant programs to examine how they evaluate and select potential living kidney donors, focusing on donor-recipient relationships, psychosocial criteria, and consent processes. There is heterogeneity in donor-recipient relationships that are considered acceptable, although most programs (70%) will not consider publicly solicited donors. Most programs (75%) require a psychosocial evaluation for all potential living donors. Most programs agree that knowledge of financial reward (90%), active substance abuse (86%), and active mental health problems (76%) are absolute contraindications to donation. However, there is greater variability in how other psychosocial issues are considered in the selection process. Consent processes are highly variable across programs: donor and recipient consent for the donor evaluation is presumed in 57% and 76% of programs, respectively. The use of 13 different informed consent elements varied from 65% (alternative donation procedures) to 86% (description of evaluation, surgery and recuperative period) of programs. Forty-three percent use a 'cooling off' period. Findings demonstrate high variability in current practice regarding acceptable donor-recipient relationships, psychosocial criteria, and consent processes. Whether greater consensus should be reached on these donor evaluation practices, especially in the context of more expansive use of living donor kidney transplantation, is discussed.
我们对美国132个肾脏移植项目进行了一项调查，以研究它们如何评估和选择潜在的活体肾脏捐赠者，重点关注捐赠者与受赠者的关系、社会心理标准和同意程序。尽管大多数项目（70%）不会考虑公开招募的捐赠者，但在被认为可接受的捐赠者与受赠者关系方面存在异质性。大多数项目（75%）要求对所有潜在的活体捐赠者进行社会心理评估。大多数项目一致认为，了解经济回报（90%）、当前药物滥用（86%）和当前心理健康问题（76%）是捐赠的绝对禁忌证。然而，在选择过程中如何考虑其他社会心理问题方面存在更大的差异。各项目的同意程序差异很大：分别有57%和76%的项目假定捐赠者和受赠者同意进行捐赠者评估。13种不同知情同意要素的使用情况在各项目中的比例从65%（替代捐赠程序）到86%（评估、手术和恢复期描述）不等。43%的项目设置了“冷静期”。研究结果表明，目前在可接受的捐赠者与受赠者关系、社会心理标准和同意程序方面的实践存在很大差异。文中讨论了是否应就这些捐赠者评估实践达成更大的共识，尤其是在更广泛地使用活体捐赠者肾脏移植的背景下。
