Magazine article Clinical Psychiatry News

Evaluate Comprehension in Living Organ Donors. (Few Absolute Contraindications)

Magazine article Clinical Psychiatry News

Evaluate Comprehension in Living Organ Donors. (Few Absolute Contraindications)

Article excerpt

SAN ANTONIO -- With the increasing prevalence of living organ donation, psychiatrists are often called upon to evaluate potential donors, Dr. Steven A. Epstein said at the annual meeting of the Academy of Psychosomatic Medicine.

While there are few absolute psychiatric contraindications to donation, those performing the evaluation must be sure that the donor knows what he or she is getting into, and must be vigilant for subtle signs of coercion, he said. (See related guest editorial on p. 22.)

"When you meet with the [potential donor] you have to explain that the psychiatric evaluation is a required component of the transplant evaluation," said Dr. Epstein, interim chair in the department of psychiatry at Georgetown University Hospital in Washington. "It helps people relax in the beginning." Potential donors should also be told that the results of the evaluation will be shared with the transplant team, but not with the potential recipient.

It's important that the potential donor be seen alone. If an interpreter is necessary, this person should be especially skilled and should be instructed not to edit the potential donor's responses. A family member would not be acceptable as an interpreter, since part of the psychiatrist's job is to determine whether the individual is being coerced by his or her family to donate.

Psychiatrists should be vigilant for subsyndromal problems, such as anxiety or depression, since potential donors typically do not come from a psychiatric population. But even when donors do have psychiatric histories this usually does not bar them from donating as long as there is no coercion, they can provide fully informed consent, and their illness does not impair their judgment.

Dr. Epstein discussed one case in which a potential donor was rejected because of his psychiatric history. This person, who was manic, met the potential recipient's family in the hospital elevator. He overheard them talking about how disappointed they were that one family member was not going to be a suitable partial liver donor, and on the spot he volunteered to be a donor himself. Although he turned out to be a suitable donor from a medical perspective, "we believed that his mania per se was so likely to be inhibiting his judgment that we didn't let him go through with it. …

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