Living donor outcomes improved by motivational interviewing

Image: PD 

1. Two motivational interviews, each under one hour in duration, are associated with significantly improved psychosocial outcomes for living donors. 

2. The efficacy of this brief and relatively inexpensive preoperative intervention in preventing residual ambivalence merits assessment in a larger randomized controlled trial. 

Evidence Rating Level: 1 (Excellent)       

Study Rundown: Living donors are treated with great attentiveness and care. Their postoperative health is carefully monitored to ensure positive physical and emotional outcomes. This study is a phase II trial that tested a motivational interviewing intervention aimed to resolve pre-operative donor ambivalence toward the transplant – a risk factor for poor post-procedural psychosocial outcomes. The small size of this study, it’s restriction to a single institution, short follow-up time and lack of preoperative baseline in each psychosocial domain limit this study’s generalizability. However, significant results in each of the somatic, psychological and family relationship domain merit a larger Phase III trial to evaluate the effectiveness of this intervention on a large sample of patients.

Click to read the study in American Journal of Transplantation

Relevant Reading: Psychosocial Health of Living Kidney Donors: A Systematic Review

In-Depth [phase II randomized controlled trial]: This study enrolled 113 live donors who demonstrated ambivalence about the procedure prior to transplantation. Residual donor ambivalence has been previously associated with worse psychosocial outcomes. To prevent this, authors created a motivational interviewing protocol targeted at identifying and resolving pre-translant ambivalence. Participants were randomized to receive a postoperative intervention consisting of two motivational interviews(MI), a time-matched educational talk as a control or standard post-transplant treatment. Those who underwent pre-transplantation MI had significantly fewer depression symptoms at 6 weeks although this difference was not maintained by three months.  Conversely, patient anxiety showed no differences at 6 weeks but was significantly reduced at 3 months. Donors also acknowledged a smaller number of donation-associated family issues at 3 months. In addition to shorter recovery time, the MI cohort reported experiencing much less fatigue, pain and unexpected medical problems. Importantly, the only patients to change their mind about donating (total of three) were in the MI group, likely indicating that this intervention was able to assist possible donors in making this important decision.

By Asya Ofshteyn and Chaz Carrier

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