Donor Self-Esteem Before and After Living Kidney Donation.

RATIONALE &

OBJECTIVE

Most living kidney donors report normal to high self-esteem before donation. Less is known about the longer-term effects of donation on self-esteem, whether certain predonation characteristics are associated with lower self-esteem after donation, or how changes in self-esteem are associated with changes in symptoms of depression and anxiety.

STUDY

DESIGN

Prospective cohort study.

SETTING &

PARTICIPANTS

Living kidney donors (n = 941) were enrolled before donation from 12 Canadian and 5 Australian transplant centers between 2009 and 2014.

EXPOSURE: Living kidney donation.

OUTCOME: Self-reported self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES) before donation, 3 months after donation, and then annually for 5 years or until the last follow-up visit (possible scores range from 0 to 30, with higher scores indicating higher self-esteem). Donors also completed the Beck Depression and Anxiety Inventories at these time points.

ANALYTICAL APPROACH: Linear and modified Poisson regression models were used to examine whether predonation characteristics were associated with lower self-esteem after donation and if changes in self-esteem were associated with changes in symptoms of depression and anxiety.

RESULTS

Nearly all donors (98.6%) reported normal to high self-esteem before donating (928 of 941), and only 2% to 4% had low self-esteem in follow-up evaluation (RSES score < 15). On average, the donors had a <1-point decrement in average self-esteem between the predonation and follow-up measurements; although these changes were statistically significant, they were not clinically meaningful (all mean changes < 5). Donors with RSES scores ≤ 20 before donation had an approximate 2-point increase in self-esteem in follow-up (P < 0.001). More symptoms of depression before donation were associated with lower self-esteem scores 3 months after donation (P = 0.006). An increase in self-esteem scores after donation was associated with concurrent reductions in symptoms of depression and anxiety (P < 0.001).

LIMITATIONS: We did not examine the association of early recipient allograft failure or death with donor self-esteem.

CONCLUSIONS

In this multicenter study of living kidney donors, nearly all donors reported normal to high self-esteem before donation and during 5 years of follow-up evaluation. On average, donors with lower self-esteem before donation had a modest increase in self-esteem after donation. Increases in self-esteem after donation were accompanied by modest reductions in symptoms of depression and anxiety.

PLAIN-LANGUAGE SUMMARY: Living kidney donation is considered a safe procedure for carefully selected candidates although donors may experience complex feelings and emotions before and after the donation process. We studied 941 living kidney donors and assessed self-esteem before donation and for 5 years after donation or until the last follow-up visit. Nearly all donors (99%) reported normal to high self-esteem before donating, and fewer than 5% developed low self-esteem after donating. Reassuringly, donors with lower self-esteem before donation had a modest increase in self-esteem on average after donation. An increase in self-esteem after donation was accompanied by reduced symptoms of depression and anxiety.