Both authors contributed equally to this article.
Psychiatric and psychological outcomes of Japanese living donors following liver transplantation
Article first published online: 15 JUN 2009
© 2009 The Authors. Journal compilation © 2009 Japanese Society of Psychiatry and Neurology
Psychiatry and Clinical Neurosciences
Volume 63, Issue 4, pages 583–585, August 2009
How to Cite
Shibata, N., Shimazaki, H., Sano, N., Kawasaki, S. and Arai, H. (2009), Psychiatric and psychological outcomes of Japanese living donors following liver transplantation. Psychiatry and Clinical Neurosciences, 63: 583–585. doi: 10.1111/j.1440-1819.2009.01992.x
- Issue published online: 16 JUL 2009
- Article first published online: 15 JUN 2009
- Received 28 April 2008; revised 17 March 2009; accepted 11 April 2009.
- living donor liver transplantation;
- psychological assessment;
- Profile of Mood States;
- State–Trait Anxiety Inventory
This study indexed the mental status in six living donor liver transplantations (LDLT) performed at the Juntendo University Hospital between 2005 and 2007. The donors' preoperative and postoperative psychiatric and psychological status was assessed using the Profile of Mood States (POMS) and the State–Trait Anxiety Inventory (STAI). The present study found that the donors' POMS anger/hostile score decreased significantly following transplantation. In addition, the STAI score suggested that donors had little anxiety or depression following the operation. Although the present study was limited due to the small number of donors, the findings suggest that a successful operation stabilizes donor mentality. The studied donors will be reassessed for their mental and physical condition in the future.
THE NUMBER OF living donor liver transplantations (LDLT) has recently increased in Japan. More than 3000 LDLT have been performed in Japan until 2005, and 20 were carried out at the Juntendo University Hospital. Donors were evaluated for their preoperative and postoperative psychiatric and psychological status. Because healthy LDLT donors feel anxiety about the operation and their postoperative recovery, they often have conflicts with other family members.
Studies on the preoperative psychological status of donors using psychological tests have been reported.1 Although most donors are highly motivated to donate, some have a high level of anxiety (with an increased State–Trait Anxiety Inventory [STAI] score) and depression.2 There are few studies that have evaluated both the preoperative and postoperative psychological status of Japanese donors. In the present study we assessed the postoperative psychological status of donors and discuss how clinical treatment by psychiatrists could be improved.
The psychosocial suitability and mental status of potential living donors was assessed by the authors at the Juntendo University Hospital. Between 2005 and 2007, six hepatectomies and transplantations were performed with living donors. Two of the six donors were female and both were aged 32 years. The average age of the four male donors was 34.5 years. One donor was the son of the recipient, one the husband, one the brother-in-law, one the father and two the mothers.
A semi-structured interview was performed by a psychiatrist in order to make a comprehensive evaluation of the mental status of the donors before transplantation. Psychological tests, including the Profile of Mood States (POMS) and STAI in Japanese (STAI-JYZ) were performed on all donors to confirm that none had any symptoms of psychiatric disorders. All six donors had no history of psychiatric illness and did not conform to any ICD-10 criteria. The postoperative psychometric data were collected between 10 days and 4 weeks after each operation and once the recovery of the recipients was verified. We also confirmed that all donors were physically stable prior to the re-test. Donor moods were measured with the POMS, which consists of 65 questions, and rates six moods. To assess donor anxiety and the tendency to be anxious the STAI, which consists of 40 questions, was utilized. Because Trait Anxiety (T-A) indicates the tendency toward anxiety and does not depend on time, only the State Anxiety (S-A) was re-tested. The purpose and significance of this study was explained in detail to each donor and all subjects provided their informed consent. The study protocol was approved by the Ethics committee of the Juntendo University School of Medicine.
Preoperative and postoperative status was compared using Wilcoxon's signed rank test. Statistical significance was set at P < 0.05 (two-tailed). Statistical analysis was performed using SPSS version 14.0 (SPSS, Chicago, IL, USA).
According to the standard T-scores from a healthy population, a score >60 is suggestive of a clinical disturbance for all moods. Table 1 shows the mean preoperative T-scores for each mood. All mean preoperative scores were within the standard range for healthy individuals. A comparison of the postoperative scores with the preoperative scores showed that there was a statistically significant decrease in the anger/hostile score. No other moods showed any significant difference between the preoperative and postoperative states. Among the donors, two presented with negative scores for all moods prior to the operation and two presented with negative scores for all moods following operation.
|Before operation (Mean score)||After operation (Mean score)||P|
State–Trait Anxiety Inventory
The mean preoperative T-A and S-A scores for the donors was 44.7 ± 10.5 and 46.0 ± 8.3, respectively. These scores are not different from that of a normal population. The mean postoperative S-A score was 39.5 ± 9.8. Although the postoperative S-A score was found to be lower than that of the preoperative state, it did not reach statistical significance.
The present results showed a significant decrease in the POMS anger/hostile score. To the best of our knowledge, this study is the first to use POMS to evaluate LDLT donors. Although some previous studies have suggested that donors suffer from severe psychiatric complications,3,4 others indicate that donors feel a sense of satisfaction through the course of the procedure.5
We re-tested the psychological parameters almost 1 month after the transplantation. We found that LDLT donors displayed feelings of sacrifice and agitation prior to the operation and of achievement following the operation. These changes decreased the mean anger/hostile score. Fortunately, because all six donors were physically stable, they were not troubled about their physical condition. As with personal operations, donor S-A scores increase before transplantation and decrease after. The increase in donor anxiety prior to transplantation could possibly be reduced through the support of family members and medical staff. If additional donors were included in the study, the preoperative POMS anger/hostile score and STAI score might exceed the normal range.
The present results suggest that reducing donor anxiety and agitation during the operation procedure by reviewing psychometric data is crucial. The authors willingly support donors and are available for consultation when requested. Additionally, clinical psychologists (HS) regularly counsel donors. Support is also provided to assist donors to maintain healthy relationships with other family members. The present study was limited due to the small number of the donors studied and the short follow-up time span. Therefore, more LDLT donors should be evaluated in the future. It was reported that the physical and mental status of donors return to their previous levels in 3–12 months6,7 and that some donors have negative moods after LDLT.8 We plan to re-assess these six donors for their mental status and psychosocial situations in the future. As the families return to their original situations, conflict, anger and anxiety sometimes re-appear, but these may be moderated by receiving psychiatric and psychological care. It would be important to conduct extended follow-up studies of Japanese LDLT donors.
This work was partly funded by the Institute for Psychological Research, Meijigakuin University.