Table 3.

Psychosocial outcomes studies of donors assessed in the long term after living liver donation¹

First author, year, country, reference	Donor cohort sample size and graft types	Study design2,3	Response rate	Years since donation	Outcome measures	Donor-reported outcomes in four domains
						Overall views about donation	Physical symptoms and health concerns	Emotional well-being	Interpersonal and socioeconomic concerns
Castedal, 2010, Sweden (10)	34 (23 LLS; 11 RL)	Single group, cross-sectional	94% of all donors; 97% of those contacted	Median, 6.0 years Range, 1–12 years	Items created by the authors	General view of experience Regret Willingness to donate again	Symptoms Medical problems	Depression related to donation	Return to work status Incurred unreimbursed lost income
Noma, 2011, Japan (30)	30 (graft type not reported; all adult to adult)	Single group, follow-up	55%	Mean, 4.3 years, SD, 0.5 Range, 3–5 years	Validated scales: State-Trait Anxiety Inventory Beck Depression Inventory			Symptoms of depression and anxiety
Sotiropoulos, 2011, Germany (31)	83 (all RL)	Single group, cross-sectional	75% of those alive; 99% of those able to be contacted	Median, 5.7 years Range, 3.8–10.7 years	Items created by the authors	Overall satisfaction Willingness to donate again	Symptoms Medical problems	Symptoms of depression Self-esteem	Impact on ability to obtain/keep life insurance
Imamura, 2013, Japan (32)	47 (29 RL, 18 extended LL)	Single group, cross-sectional	53%	Mean, 7.2 years Range, 2.9–14.0 years	Items created by the authors		Pain, numbness, discomfort of surgical scar		Discomfort or embarrassment with appearance of scar
Fournier, 2013, France (33)	26 (graft type not reported; 24 adult to pediatric, 2 adult to adult)	Single group, cross-sectional	71%	Mean, 2.0 years Range, 1.2–4.7 years	Open-ended qualitative items created by the authors	General view of experience Overall satisfaction Regret	Health-related concerns	General distress	Impact on career Impact on finances
Fukuda, 2014, Japan (34)	81 (≈68% LLS; 29% hyper-reduced LLS; ≈2% RL; ≈11% LL; exact n’s and/or %s not reported)	Single group, cross-sectional	81%	Mean 3.8 years for larger group of 100 in study Range, 2.2–6.0 years	Items created by the authors	Regret	Symptoms Overall health status Recovery status		Return to work status
Kroencke, 2014, Germany (35)	40 (31 with final assessment) (19 LLS, 19 RL; 2 LL)	Donor and nondonor groups, prospective	78–100% (postdonation; varies by measure)	All were 2 years at final postdonation assessment	Items created by the authors Validated scale: Hospital Anxiety and Depression Scale		Symptoms Activity limitations	Symptoms of depression and anxiety General symptoms related to donation
Dew, 2016, USA (36)	517 (all adult to adult; all RL or LL; exact n’s and/or %s not reported)	Single group, cross-sectional	66% of eligible donors, 71% of those located	Mean 5.8 years SD 1.9 years Range 3–10 years	Items from previous studies: Simmons’ health worries items and items on views about donation; Holtzman’s items on socio-economic concerns Validated scales: Checklist of Donation-Related Physical Symptoms; Better Person Scale; Post-traumatic Growth Inventory-Short Form	Overall feelings about donation Willingness to donate again	Symptoms Medical problems Activity limitations Health-related worries	Feelings of being a better person Post-traumatic growth from donation experience	Incurred financial costs; had financial burden Impact on job/income Impact on ability to obtain/keep health, life insurance
DiMartini, 2016, USA (37)	271 (139 with final assessment) (228 RL, 43 LLS or LL, exact n’s and/or %s not reported)	Single group, prospective	91% of eligible donors	All were 2 years at final postdonation assessment	Items from previous studies: Simmons’ items about interpersonal relationships; Holtzman’s and Smith’s items about socioeconomic concerns				Impact on relationship with family, recipient Incurred financial costs Financial burden Impact on job/income Impact on ability to obtain/keep health, life insurance
Humphreville, 2016, USA (38)	107 (≈85% RL; remainder were LLS; exact n’s and/or %s not reported)	Single group, cross-sectional	84%	Median 6.9-years mean 7.7-years, SD 3.4-years Range 2–15.7	Items created by the authors	Overall satisfaction Willingness to donate again	Symptoms Overall health status	Symptoms of depression Self-esteem	Return to work status
Murad, 2016, USA (26)	68 (all RL or LL; exact n’s and/or %s not reported)	Single group, cross-sectional	70% of eligible donors	Median 5.5 years Range, 1.5–10.9 years	Items created by the authors	Comfort with decision to donate Willingness to donate again Would encourage others to donate	Postoperative pain	Feelings of personal benefit from donation	Body image Impact on relationship with recipient Return to work status Financial burden Impact on ability to obtain/keep health, life insurance

LLS, left lateral segment; RL, right lobe; LL, left lobe.

¹Some studies also assessed generic health-related quality of life; these findings are summarized in Figure 1.

²All studies were single-site except Dew et al (36) and DiMartini et al (37), which each included nine sites. Both reports describe data from the Adult to Adult Living Donor Transplantation Cohort study but assess independent cohorts.

³Only Kroencke et al (35) included a comparison group in their analyses, consisting of 37 individuals approved as donors but who did not donate. Fournier et al (33) also included individuals who did not donate but did not perform formal comparisons with donors. Imamura et al (32) included additional donors but they were not all beyond 1 year postdonation and have thus been excluded.