Living liver donors have QoL advantage

Living liver donors have a better quality of life (QoL) than the general population, show the results of a Japanese study.

However, donors who experience ongoing complications and a need for medical care can endure significant deterioration to their QoL, sometimes over long periods of time.

"We may need to make an effort to identify such donors and recommend them for psychiatric counseling," say Yasutsugu Takada (Ehime University, Toon, Japan) and colleagues.

"It is also important for transplant team doctors and coordinators to be concerned about donor comorbidities emerging after donation and, if it is necessary, to help donors to receive appropriate therapy."

Living donor liver transplant is the main treatment for end-stage live disease in Japan, and Kyoto University Hospital, where the study took place is one of the country's main centers for the procedure.

In all, 578 of the 1000 donors who underwent the procedure between 1990 and 2004 completed the Short Form 36 survey. Their results were compared with the Japanese population whose scores were normalized to a mean of 50.

The results showed that, regardless of what year the donation took place, donors had significantly higher health-related QoL scores than the Japanese population norm.

However, the authors noted that while the occurrence and severity of postoperative complications did not seem to be related to long-term QoL, prolonged medical complications were.

Multivariate analysis revealed that having two or more comorbidities increased the odds of a physical component score of less than 40 by 8.9-fold, and was also significantly associated with an increased odds of low mental and social component scores.

Additionally, age, recovery time, number of hospital visits, and time needed away from work in the previous month were associated with decreased HRQoL scores.

It has previously been found that living liver transplant donors have a higher QoL than the general population before donation, but the authors say their findings show that this can persist for many years after surgery.

In an accompanying editorial, Leona Kim-Schluger and Sander Florman, from Mount Sinai Medical Center in New York, USA say that the mental wellbeing of donors must be a major priority.

"We must strive to study and comprehend the motivations leading to donation and the financial and economic impact of donation and learn to alleviate the fears before and after donation with the single goal of safely getting liver donors through the donor process medically, surgically, and psychologically."

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