VANCOUVER, B.C.—Individuals who wish to donate a kidney anonymously are motivated by altruism rather than psychopathology, according to new studies.
A case series presented by a Vancouver team at the Canadian Psychiatric Association’s 2011 annual meeting indicated that six out of 10 people who stepped forward to be anonymous donors (ADs) were motivated only by the desire to help someone else. This corroborates the results of a study published earlier this year that showed carefully screened ADs are individuals acting out of positive motivations (Transplantation 2011;91:772-778).
“Most donors were middle-aged, well psychologically and physically, and motivated primarily by altruism,” said Maria Corral, MD, who headed the Vancouver team. “In our sample, because they were all anonymous donations, the issues of pressures for donation or financial exchange were not present. This also eliminated any issues of a need for recognition as a motive, as the donors cannot publicize their donation.”
The term AD is somewhat broader in the United States than in Canada. In the United States, it includes not only people who are giving an anonymous, non-directed donation, but also those giving directed donations to a stranger.
James Rodrigue, PhD, Associate Professor of Psychiatry at Harvard Medical School and a psychologist at the Transplant Institute of Beth Israel Deaconess Medical Center in Boston, is the lead investigator of the other study that involved 39 ADs and 52 non-anonymous or traditional donors (TDs) from two transplant programs in the United States. His team found that members of both groups had positive donation motivations and relatively few had donation-related psychological problems such as anxiety, depression or marital or financial difficulties.
“Our ADs are not much different from more traditional donors in terms of the reasons for exclusion,” Dr. Rodrigue told Renal & Urology News. “That is, our data suggest that the rate of psychological disturbance is not significantly higher than we see in other donor candidates.”
Dr. Corral, Clinical Professor of Psychiatry at the University of British Columbia, and Interim Head of the Department of Psychiatry at St. Paul’s Hospital, and other members of the Consultation Liaison Psychiatry Team at St. Paul’s Hospital first began psychological evaluation of potential ADs in 2008. In the subsequent two years they assessed 10 patients.
The potential ADs ranged in age from 21-62 years; seven were women and three were men. Three were rejected because they were found to have psychopathology: one suffered from antisocial personality disorder; another had a major depressive disorder and avoidant personality disorder; and third had a cognitive disorder not otherwise specified. A fourth person who was not accepted as a donor was motivated by a need for recognition and was found to have incomplete individuation.
The remaining six all had a clean bill of psychological and motivational health—including one with major depressive disorder in remission—and had indeed stepped forward primarily due to the desire to help others, the team reported in a poster. For example, one potential donor had not been a good match for a family member with kidney disease so decided to continue the process as an anonymous donor. Another had watched a distant relative die of kidney disease and wanted to ‘do something to help,’ the investigators noted.
The study by Dr. Rodrigue and his colleagues uncovered similar results. The team found both ADs and TDs were both primarily motivated by altruism and were psychologically healthy. However, TDs were more likely to except something in return for the donation, such as financial assistance or preferential treatment from the recipient, or better health care. Overall, 85% of the ADs and 94% of the TDs felt “very” or “extremely” satisfied with the donation experience.
Dr. Rodrigue and his colleagues recently received a grant from the National Institutes of Health for a study of surgical, medical, and psychological outcomes over the first two years after either traditional or anonymous kidney donation. When completed, it should be the most comprehensive study of ADs, Dr. Rodrigue said.