NDT Advance Access originally published online on July 3, 2008
Nephrology Dialysis Transplantation 2008 23(10):3316-3324; doi:10.1093/ndt/gfn295
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Living kidney donor informed consent practices vary between US and non-US centers
1 Department of Medicine, Yale University, New Haven and Veterans Affairs Medical Center, West Haven, CT 2 Alden March Bioethics Institute, Albany Medical College, NY 3 Department of Medicine, Washington University, St Louis, MO 4 Department of Surgery, Yale University, New Haven, CT 5 Department of Medicine and Epidemiology, London Health Sciences Centre, London, UK
Chirag Parikh, Section of Nephrology, Yale University and VAMC, 950 Campbell Avenue, Mail Code 151B, Bldg 35 A, Room 219, West Haven, CT 06516, USA. Tel: +1-203-932-5711 Ext. 4300; Fax: +1-203-937-4932; E-mail: chirag.parikh{at}yale.edu
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Abstract |
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Background. Living kidney donation rates are increasing in the United States and internationally. Major consensus statements on the care of living kidney donors recommend communicating all potential health and psychosocial risks to donors. We evaluated the degree of international variation in the process of informed consent of potential donors during their evaluation.
Methods. Transplant professionals attending the 2006 World Transplant Congress responded to a survey assessing their process of informed consent, evaluation and communication of living donor risk. US-based respondents were compared to non-US respondents.
Results. There were 221 respondents from 177 transplant centers and 40 countries (48% US respondents). Across US and non-US transplant centers, potential donors were most likely to receive written material about living donor risk by mail prior to evaluation, receive risk information in person during evaluation, have a psychosocial evaluation, which usually lasted longer than 30 min and sign an official donation consent form presented to them by a surgeon or nephrologist. Although over 75% of respondents stated that donors received information about medical risks such as hypertension, chronic kidney disease and potential need for dialysis, there was less consistency regarding whether or not respondents conveyed an increased risk of these medical complications to donors. Additionally, the financial and psychosocial costs associated with being a living donor were inconsistently communicated to donors during the informed consent process. Compared to non-US respondents, US respondents were more likely to use written material and visual aids to convey risks to donors, have mandatory psychosocial evaluations and provide access to donor support groups. US transplant centers were also more likely to discuss the possibility of the donors needing dialysis or a transplant if their remaining kidney fails in the future, possible travel expenses and loss of work income due to donation recovery. Conversely, the US respondents were less likely to offer long-term follow-up and to utilize nephrologists to obtain written donor consent for donation.
Conclusions. As dependence on living organ donation increases best practices for informed consent, donor evaluation and uniform risk conveyance need to be established. This may be accomplished by using a model informed consent template to ensure that informed consent from donors is consistently obtained.
Keywords: informed consent; kidney transplant; living donation
Received for publication: 25. 1.08
Accepted in revised form: 30. 4.08