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There are many different components involved in a living donor transplant evaluation. One of the most crucial components to ensure optimal outcomes for living donors is the living donor psychosocial assessment. The living donor psychosocial assessment aims to examine a multitude of factors surrounding the living donor’s life. It is important to understand how a living donor operates within their own environment, including social structures, and how this may affect their day-to-day functioning before and after donation surgery. A complete psychosocial history, utilizing the components identified below, can be used to better predict patient outcomes following donation. Additionally, some of the considerations listed below may negatively impact the donor’s ability to donate. If so, this will need to be discussed thoroughly among the living donor team as well as in the living donor candidate selection meeting to assess for potential risks and the candidate’s suitability for donation.

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SOCIAL WORK PSYCHOSOCIAL ASSESSMENT: COMPONENTS OF A LIVING DONOR PSYCHOSOCIAL ASSESSMENT
  • Psychosocial History (demographic information, race/ethnicity/culture, religious beliefs and practices, language, education, comprehension level, occupation, etc.)

Considerations: citizenship status, health literacy, developmental delays and/or learning problems, maturity level

  • Motivation for Donation (duration and type of relationship with transplant recipient, understanding of recipient’s medical condition, request from recipient or family, consistent with donor’s values and beliefs)

Considerations: pressure, coercion, financial incentive, ambivalence, hoping to repair relationship or expectation for change in their relationship

  • Social Support (intact support from family/friends, family/friends are supportive of donation)

Considerations: lacking social support system or caregiver, family/friends are against donation, out-of-town donors

  • Financial Situation (employment and ability to receive paid time off [PTO] or disability during recovery period, assistance from family and friends, insurance status, eligibility for financial assistance programs)

Considerations – inability to get PTO, potential to lose their job if complications occur, eligibility for financial assistance programs, financial assistance from recipient, future medical insurability, health/life insurance cancellations and/or premiums, out-of-town donors

  • Family History (medical, social, psychiatric)

Considerations: medical history relating to kidney disease, hypertension, diabetes

  • Medical History (significant prior medical history, functional status, established primary care doctor, advanced directives, surgical history, adherence to medical recommendations)

Considerations: compliance with medical follow-up and medications

  • Psychiatric History (mental health history and diagnosis, current and/or former behavioral health treatment and/or hospitalizations, psychiatric medications, suicidal/homicidal ideation or attempts, trauma history)

Considerations: psychiatric referrals for transplant clearance for acute issues, complicated psychiatric histories, and altruistic donors

  • Social Health Behaviors (smoking, alcohol use, illicit drug use—current or former, legal history, high-risk behaviors)

Considerations: current/former substance misuse treatment, current alcohol or illicit substance consumption, prior incarcerations—parole/probation)

  • Coping Strategies and Ability to Handle Stress (stress management techniques, hobbies, impact of religion)

Considerations: poor coping skills and stress management, unwilling to reach out to others for help

  • Postoperative Recovery Plan (including housing, caregiver, transportation, and any potential barriers)

Considerations: unable to identify a caregiver, caregiver is unwilling/unable to assist, difficulty with transportation

  • Understanding of ...

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