活体肾供体心理社会评估中各中心之间的差异不影响结果：一项观察性多中心研究的结果
Differences Between Centers in Psychosocial Evaluations for Living Kidney Donors Do Not Influence Outcome: Results From an Observational Multicenter Study.
作者信息
Ludwig Gundula, Geiger Irene, Götzmann Lutz, Jordan Katja-Daniela, Döbbel Susanne, Klaghofer Richard, Salathé Michelle, Stillhard Urs, Meinlschmidt Gunther, Kiss Alexander, Venetz Jean-Pierre, Steiger Jürg, Hirt-Minkowski Patricia
机构信息
Psychiatric Liaison Service, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland.
Department of Psychosomatic Medicine, University Hospital and University of Basel, Basel, Switzerland.
出版信息
Transplant Direct. 2022 Nov 4;8(12):e1400. doi: 10.1097/TXD.0000000000001400. eCollection 2022 Dec.
UNLABELLED
Rather little is known about how psychosocial evaluations for living kidney donation (LKD) are performed. We aimed to explore whether Swiss transplant centers (STCs) vary regarding the rate of living kidney donors refused for psychosocial reasons, the psychosocial evaluation process, and the characteristics of the donors.
METHODS
We investigated 310 consecutive candidates for LKD in 4 of 6 existing STC during mandatory psychosocial evaluations. We registered (i) sociodemographic data, (ii) the type of the decision-making process regarding LKD (ie, snap decision, postponed, deliberate, other), (iii) the evaluator's perception of the donor's emotional bonding and his/her conflicts with the recipient, (iv) the donor's prognosis from a psychosocial perspective, (v) time taken for the psychosocial evaluation, and (vi) its result (eligible, eligible with additional requirements, not eligible).
RESULTS
Centers had comparable proportions of noneligible donors (2.9%-6.0%) but differed significantly in the percentage of donors accepted with additional requirements (3.4%-66%, < 0.001). Significant differences emerged between centers regarding the time needed for evaluation (75-160 min [interquartile range (IQR) 75-180 min] per single exploration, < 0.001), the perception of the donor's emotional bonding (visual analogue scale [VAS] 8-9 [IQR 6-10], < 0.001), his/her conflicts with the recipient (VAS 1.5-2 [IQR 0-3], = 0.006), the donor's psychosocial prognosis (VAS 8-9 [IQR 7-10], < 0.001), and the type of decision concerning LKD (59%-82% with snap decision "yes," = 0.008). However, despite differences in the psychosocial evaluation process, the rates of patients accepted for transplantation (eligible and eligible with additional requirements versus noneligible) were comparable across STC ( = 0.72).
CONCLUSIONS
Our results emphasize that it is more important to establish clear guidelines to identify potential psychosocial risks than to stringently standardize the procedure for psychosocial evaluation of living kidney donors.
未标注
关于活体肾移植（LKD）的社会心理评估是如何进行的，我们了解得相当少。我们旨在探讨瑞士各移植中心（STC）在因社会心理原因被拒绝的活体肾供者比例、社会心理评估过程以及供者特征方面是否存在差异。
方法
在强制性社会心理评估期间，我们调查了6个现有STC中4个中心的310名连续的LKD候选者。我们记录了（i）社会人口统计学数据，（ii）关于LKD的决策过程类型（即快速决定、推迟、深思熟虑、其他），（iii）评估者对供者情感联系及其与受者冲突的认知，（iv）从社会心理角度看供者的预后，（v）社会心理评估所需时间以及（vi）评估结果（合格、有附加要求合格、不合格）。
结果
各中心不合格供者的比例相当（2.9%-6.0%），但在有附加要求而被接受的供者比例上有显著差异（3.4%-66%，P<0.001）。各中心在评估所需时间（每次单次评估75-160分钟[四分位间距（IQR）75-180分钟]，P<0.001）、对供者情感联系的认知（视觉模拟量表[VAS]8-9[IQR 6-10]，P<0.001）、其与受者的冲突（VAS 1.5-2[IQR 0-3]，P=0.006）、供者的社会心理预后（VAS 8-9[IQR 7-10]，P<0.001）以及关于LKD的决策类型（59%-82%快速决定为“是”，P=0.008）方面存在显著差异。然而，尽管社会心理评估过程存在差异，但各STC接受移植的患者比例（合格和有附加要求合格与不合格）相当（P=0.72）。
结论
我们的结果强调，制定明确的指南以识别潜在的社会心理风险比严格规范活体肾供者社会心理评估程序更为重要。
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