Psychiatric issues in living liver donors: Safeguarding the rescuers

Purpose of the review: In view of the emerging medical literature on psychiatric and surgical outcomes of adult living liver donors, the authors reviewed the topic to determine what guidelines may be helpful in safeguarding the donors. Data on a sample of donors from one of the authors was used to guide the discussion of what psychiatric issues may arise in consideration of living liver donors. Recent findings: The paper outlines current controversies in living organ donation, and discusses application of ethical principles in living liver donation. Recent data on safety concerns are reviewed, so that donor advocates may be better able to inform prospective donors of the risks involved in donating a lobe of the liver. In one sample of donors a high percentage had a history of alcohol or substance abuse, affective disorders and obesity, which raised issues for consideration. Some centers have had to contend with issues of faith that may impact living donor liver transplantation. Psychological contraindications to living donor liver transplantation and risk factors for negative psychological outcomes are discussed. Summary: Various psychological dynamics may motivate donors for living donor liver transplantation. Psychiatric contraindications are discussed, and guidelines for safeguarding the interests of donors are proposed.