Psychological Outcomes of Living Liver Donors from a Multi-Center, Prospective Study: Results from the Adult to Adult Living Donor Liver Transplantation Cohort Study (A2ALL)

While single-center and cross-sectional studies have suggested modest impact of liver donation on donor psychological well-being, few studies have assessed these outcomes prospectively among a large cohort. We conducted one of the largest, prospective, multi-center studies of psychological outcomes in living liver donors within the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL-2) Consortium. 271 (91%) of 297 eligible donors were interviewed at least once at pre-donation, 3-, 6-, 12- and 24-months post-donation using validated measures. We found that living liver donors reported low rates of major depressive (0–3%), alcohol abuse (2–5%), and anxiety syndromes (2–3%) at any given assessment in their first two years after donation. Between 4.7–9.6% of donors reported impaired mental well-being at various time points. We identified significant predictors for donors’ perceptions of being better people and experiencing psychological growth following donation, including age, gender, relationship to recipient, ambivalence and motivation regarding donation, and feeling that donation will make life more worthwhile. Our results highlight the need for close psychosocial monitoring for those donors whose recipients died (n=27), some of whom experienced guilt and concerns of responsibility. Careful screening and targeted, data-driven follow-up holds promise for optimizing psychological outcomes following this procedure for potentially vulnerable donors.