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Consensus Doc: Evaluation of the Living Kidney Donor, part II

[Note: Sorry for the delay, I’ve been up to my ears in IRS nonprofit exemption paperwork. ugh]

Where were we? Oh right, we were highlighting how after almost sixty years of harvesting kidneys from living people, the transplant industry still has no clinical evidence to support how they evaluate prospective LDs for adequate health….

Page 12, the psychosocial evaluation:

This evaluation must be performed by a psychiatrist, psychologist or social worker with experience in transplantation.

Here’s the thing: psychiatrists are medical doctors, psychologists are PhDs. A social worker could be nothing but an undergraduate Bachelor’s degree with a state license. Yet every state has licensed COUNSELORS, which are Master’s level practitioners. Why aren’t they mentioned here?

And exactly what does “experience in transplantation” mean? Knowledge of the recipient’s side of the equation? Employment at a transplant center? Neither of these things makes one qualified to know the living donor experience or how to properly protect a prospective living donor from their own emotions or from a system whose overall message is “Donate! Donate!”

The document spends a page and a half outlining what should be included in the psycho-social evaluation. But most living donors report spending exactly ONE forty-five to sixty minute session with a social worker (if they’re lucky, a psychologist) as the totality of their psych eval. Exactly how in the hell is a proper analysis supposed to result from that, especially when part of the time is spent by the social worker explaining about insurance issues and living wills and such?

This includes a realistic plan for donation and recovery, with social, emotional and financial support available as recommended;

This, in itself, would require more than one session!

In fact, under “Relative Exclusion Criteria”:

Lack of or insufficient family, caregiver, social, and/or economic support

This isn’t a Mental Status Exam (MSE) where the purpose is to determine if an individual is mentally incapacitated, and where the protocols and boundaries are well established. Living donation is usually rife with convoluted motivations, relationships, responsibilities, and emotions. As someone trained in mental health, I can say with certainty that the answers to the queries posed in determining the suitability of someone as a living donor cannot be satisfied in such a small window.

(And btw, 1 1/2 pages for the psycosocial evaluation, but 5 pages on the medical eval.)

On page 17 under “Absolute Exclusion Criteria” is this little nugget:

Active malignancy, or incompletely treated malignancy

And under “Relative Exclusion Criteria”:

History of cancer, including metastatic.

In lieu of my usual snark, let me instead refer back to Loyola’s recent press barrage, celebrating their decision to perform a double mastectomy on a woman – then take her kidney anyway. This was so worth bragging that it showed up in every major media outlet in the country. Really?

Remember: ASTS is seeking comments on this document.

Permanent link to this article: http://livingdonorsarepeopletoo.com/consensus-doc-evaluation-of-the-living-kidney-donor-part-ii/

1 comment

  1. SUGAR AIN'T SWEET

    Fascinating stuff, cristy!!! My husband is a licensed counselor in our state – I'm sure that he would not be pleased to know that he isn't considered worthy of being a counselor in the donor process, especially with TWO family members who have Alport's Syndrome in the immediate family! Oh sure, he doesn't know SQUAT about kidney disease . . .he only lives with its results EVERY DAY.

    I learn SO MUCH from your posts – thank you for all your hard work, and my condolences on losing your "Dragon." Our furbabies are so very special to us, aren't they?

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