Abstract: Dialysis in chronic renal failure ensures survival but simultaneously leads to reduced quality of life and to a series of psychological problems such as anxieties and depressions. In clinical practice the occurrence of depression is often underappreciated. A consequence of the additional depressive disorder may be the reduction of lifetime. An investigation in Dresden of 127 patients showed that life satisfaction is reduced and 28.6% reported noticeable psychological problems. 24% of the…patients had anxieties and 22.4% had relevant depressive symptoms. Duration of dialysis had no influence on the level of these mental disorders. As a consequence of these results psychodiagnostic possibilities for the assessment of psychological health should be improved in clinical practice and models for improvement of psychological health should be tested.
Keywords: Psychonephrology, kidney failure, end stage renal disease (ESRD), depression, psychological problems, quality of life
Abstract: Renal transplantation is the oldest established organ transplantation technique and internationally the most widely used transplantation treatment. Renal transplantation not only replaces the insufficient renal excretory function and enables independence from chronic dialysis treatment but also reestablishes all other renal functions. Successful renal transplantation thus leads to a remarkable improvement in general health and quality of life. The lack of suitable donor organs has led to an increase in the numbers of…living donor renal transplantations; however, for the majority of recipients cadaveric donation remains the standard treatment. Therapeutic immunosuppression remains a lifelong necessity for transplant recipients and this leads to inevitable problems with side-effects and patient compliance.
Keywords: Renal transplantation, immunosuppression, organ procurement, live donor transplantation
Abstract: Over the last decade quality of life and patient survival have improved in patients with end stage renal disease (ESRD). We present a complicated case demonstrating important somatic and psychological issues. A 31 year old woman was delivered of healthy siblings in 2002. Following acute renal failure she remained in ESRD. Nephrectomy of the right kidney had to be performed because of post-biopsy bleeding. Due to the flood in Dresden in 2002 she had…to be evacuated to an outside hospital while her family stayed in Dresden. Chronic hemodialysis was performed from that time on. She suffered from being separated from her children during dialysis. In April of 2004 she received a kidney transplant from her husband. This resulted in excellent graft function. Nevertheless her self-assessed psychological situation was far from satisfactory. She suffered from feelings of failure especially concerning hermotherhood. Psychotherapy including here husband was started. Within 6 months here situation improved markedly. Treatment of chronic renal disease should focus on somatic as well as psychological aspects. Health care professionals should work together to further improve the quality of life of these patients.
Abstract: Background: Psychological counselling and evaluation of transplantation patients and their living donors is dealt with very differently at the different transplantation centres. At Heidelberg University Hospital, counselling provided by the Medical Psychology department in collaboration with the transplantation center started in 1997 and has developed constantly until 2005, when this counselling became an internal task of the transplantation center. This article summarizes the ongoing development of our counselling approach during this period,…triggered by continuous research from 2001 on. Methods: From June 2001 to February 2002, we carried out a first evaluation of our counselling interviews with 33 donor-recipient pairs. Since June 2002 we carry out continuous follow-ups one year after living donor kidney transplantation. Results: In many cases participants were sceptical to indifferent about preparatory medical-psychological counselling. The need for either drastic or extremely sensitive information varied and frequently acquired a new meaning in retrospect depending on the outcome of the transplantation. During the hospital stay, many patients experienced short-term, severe distress they usually coped with on their own but would have liked the offer of psychological relief. A long time after the operation there was only a small number of recipients or donors who did express a wish for psychological support. Conclusions: Based on the results, we were able to draw up further proposals for an optimum care concept for kidney transplantation patients from living donors. Our medical-psychological counselling spectrum as of 2005 covers the preoperative, in-patient and postoperative phase and is currently accompanied by a one-year follow-up. However, readiness to engage in intensive pre-operative psychological reflexion may decrease, as living donor kidney tranplantation is becoming a routine operation to be delivered in great numbers.
Keywords: Psychological counselling, living donor, kidney transplantation
Abstract: Objectives: The study was conducted to assess the health-related quality of life of kidney donors one year or longer after donation. Methods: Kidney donors were asked to answer a set of questionnaires measuring sociodemographic data as well as psychological distress (BSI), health-related quality of life (SF-36), and several questions regarding donation (modified EUROTOLD questionnaire), one year or longer after donation. Results: 47 out of 65 patients answered. All donations were successful to the day of…investigation. Time between donation and participation in the survey was on average 31 months (standard deviation 14 months, range 12–72 months). 16 donors (34%) were male and 31 (66%) female. The majority was married (37, 79%), only a few widowed (2, 4%) and divorced or living separately (8, 17%). The majority donated the kidney to his/her son (15, 32%) or daughter (7, 15%), the wife (7, 15%) or husband (5, 11%), donations to sister or brother (6, 13%), parents (4, 8%), nephew, foster-daughter or stepson (each 1) were less frequent. On average, there was no measurable psychological distress in the group of 47 donors; only 6 (13%) donors demonstrated remarkable psychological distress. Health-related quality of life in terms of physical capacity and emotional role functioning was lower compared with normative data; and higher regarding general health perception, vitality, and psychological well-being (p < 0.001). Conclusion: Two or three years after successful kidney donation donors report better health-related quality of life than normative samples regarding general health perception, vitality and psychological well-being; only very few donors were markedly psychologically distressed. These results could be the effect of a specific selection before kidney donation (rejection of potentially donors suffering from severe psychological or physical illness). On the other hand, the successful donation and the positive consequences for family life (termination of dialysis etc.) could enrich one&'s life. Living kidney donation seems to restrict physical capacity and emotional role function; future studies should differentially investigate these contradictory results.
Abstract: Quality of life is becoming an increasingly important concept in the evaluation of different therapeutic interventions. In this study, 76 kidney transplanted patients were compared with 65 patients with end-stage renal disease awaiting transplantation. The results clearly show a higher quality of life in patients with a functioning graft. The low rate of return to work among transplanted patients may be explained by both their physical impairment and the currently high levels of unemployment.
Abstract: Germany is reported to suffer from a significant shortage of organs ready to be transplanted. Law or legal intervention is often considered to be a proper method to diminish shortage. But discussing several instruments of legal intervention presumes that first the real situation and second the general structure of legal intervention is described juridically. Then focus has to be turned on the existing rules concerning death and live donation and the problems connected to them. At…last decisions can be taken whether a special problem needs new legal intervention. Here this is to be approved for the duty of notification of brain-dead donors only.
Keywords: Shortage of organs, legal intervention, brain death, contradiction versus consent, duty of notification, live donation, trading organs, anonymous donation, cross-over situations