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      Predictors of decision ambivalence and the differences between actual living liver donors and potential living liver donors

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          Abstract

          Background

          The decision to become a living liver donor is a stressful event. Ambivalence in decision making may result in psychological distress. Thus, the purpose of this study was to provide a description of the ambivalence of potential living liver donors, to examine the predictors of ambivalence, and to compare the ambivalence of potential living liver donors with that of actual living liver donors.

          Methods

          This descriptive and correlational study was conducted in a medical center from August 2013 to December 2015. Self-reported questionnaires were used to collect data. A total of 263 potential living liver donors who were assessed for donation to their parents were included in this study.

          Results

          The mean age of the total sample was 30.7 years (SD = 6.39, range = 20–47), and males comprised 53.6% of the sample. The majority of the potential donors had a college education (70.8%) and were single (63.5%). Of the total sample, the mean score for ambivalence was 4.27 (SD = 1.87, range = 0–7). Multivariate analysis revealed that the Mental Component Summary (MCS) of quality of life ( β = -0.24, p < 0.01), family support ( β = -0.17, p = 0.007), and intimacy ( β = -0.13, p = 0.04) were significant protective predictors of ambivalence. Actual living liver donors had significantly lower ambivalence (3.82 versus 4.60), higher intimacy with recipients (3.55 versus 3.34), higher MCS (45.26 versus 42.80), and higher family support (34.39 versus 29.79) than did the remaining potential living liver donors.

          Conclusion

          Ambivalence is common in potential living liver donors. The MCS of quality of life, family support, and intimacy were protective predictors in terms of ambivalence. Future research should explore other factors and design interventions targeted toward reducing ambivalence, promoting family support, and enhancing the mental dimensions of quality of life in potential living liver donors.

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          Most cited references42

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          Multivariate Data Analysis

          Joseph F. Hair (1998)
          For graduate courses in Marketing Research, Research Design and Data Analysis. For the non-statistician, this applications-oriented introduction to multivariate analysis reduces the amount of statistical notation and terminology used while focusing on the fundamental concepts that affect the use of specific techniques.
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            A complete treatment of adult living donor liver transplantation: a review of surgical technique and current challenges to expand indication of patients.

            A Lee (2015)
            The growing disparity between the number of liver transplant candidates and the supply of deceased donor organs has motivated the development of living donor liver transplantation (LDLT). Over the last two decades, the operation has been markedly improved by innovations rendering modern results comparable with those of deceased donor liver transplantation (DDLT). However, there remains room for further innovation, particularly in adult living donor liver transplantation (ALDLT). Unlike whole-size DDLT and pediatric LDLT, size-mismatching between ALDLT graft and recipient body weight and changing dynamics of posttransplant allograft regeneration have remained major challenges. A better understanding of the complex surgical anatomy and physiologic differences of ALDLT helps avoid small-for-size graft syndrome, graft congestion from outflow obstruction and graft hypoperfusion from portal flow steal. ALDLT for high-urgency patients (Model for End-Stage Liver Disease score >30) can achieve results comparable to DDLT in high volume centers. Size limitations of partial grafts and donor safety issues can be overcome with dual grafts and modified right-lobe grafts that preserve the donor's middle hepatic vein trunk. Extended application of LDLT for unresectable hepatocellular carcinoma above Milan criteria is an optional strategy at the cost of slightly compromised survival. ABO-blood group incompatibility obstacles have been broken down by introducing a paired donor exchange program and refined peri-operative management of ABO-incompatible ALDLT. This review focuses on recent innovations of surgical techniques, safe donor selection, current strategies to expand ALDLT with broadened patient selection criteria and important aspects of teamwork required for success.
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              Quality of life after liver transplantation. A systematic review.

              Martin Wells, Shehta Said, Santiago Tomé … (2008)
              Although many studies have reported significant improvements in quality of life (QOL) after liver transplantation (LT), consistent data on areas of improvement are lacking. To perform a systematic review on medical literature of QOL after LT paying particular attention to studies that utilized the most commonly adopted study instrument, Short Form-36 (SF-36). To collect studies focused on QOL in adult LT recipients, from 1963 to 2007, cited in Pub Med, Embase or Cochrane databases. From an initial identification of 613 articles, we selected 44 longitudinal studies with pre- and post-LT data that we assessed using a sign test, and 19 used SF-36, which we analyzed separately. Longitudinal data showed remarkable improvement of common domains of QOL comparing pre- and post-transplant items. However, analysis of 16 SF-36 cross-sectional studies comparing post-LT patient domains with control population showed significantly higher ratings for controls in six while no differences were found in two. This review suggests that whereas general QOL improves after LT, when compared with healthy controls, LT recipients have significant deficits in QOL. Consequently, the previously reported QOL benefits after LT may have been overstated.
              Article 0 comments Cited 26 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Stanislaw Stepkowski: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 17 May 2017
                Publication date Collection: 2017
                Volume: 12
                Issue: 5
                Electronic Location Identifier: e0175672
                Affiliations
                [1 ]School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan
                [2 ]Department of General Surgery, Chang Gung Medical Foundation-Linkuo, Taoyuan, Taiwan
                [3 ]Department of Long-Term Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
                [4 ]Department of Psychiatry, Chang Gung Medical Foundation-Linkuo, Taoyuan, Taiwan
                University of Toledo, UNITED STATES
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: LCW HLH HHT WCL.

                • Data curation: LCW HLH.

                • Formal analysis: LCW HLH HHT.

                • Funding acquisition: LCW.

                • Investigation: LCW WCL.

                • Methodology: LCW HLH.

                • Project administration: LCW WCL.

                • Resources: WCL.

                • Software: LCW.

                • Supervision: WCL.

                • Validation: HLH HHT.

                • Visualization: LCW.

                • Writing – original draft: LCW HLH HHT.

                • Writing – review & editing: LCW HLH.

                Author information
                http://orcid.org/0000-0002-6926-988X
                Article
                Publisher ID: PONE-D-17-00945
                DOI: 10.1371/journal.pone.0175672
                PMC ID: 5435180
                PubMed ID: 28520727
                SO-VID: db69db6a-6255-4a57-ac9b-1927aa98c91b
                Copyright © © 2017 Weng et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 8 January 2017
                Date accepted : 29 March 2017
                Page count
                Figures: 0, Tables: 6, Pages: 13
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100007225, Ministry of Science and Technology;
                Award ID: NMRPD1C1113
                Award Recipient :
                ORCID: http://orcid.org/0000-0002-6926-988X
                This study received a fund from the Ministry of Science and Technology of Taiwan. The funder had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Health Care
                Subject: Quality of Life
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Digestive System Procedures
                Subject: Liver Transplantation
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Transplantation
                Subject: Organ Transplantation
                Subject: Liver Transplantation
                Subject: Social Sciences
                Subject: Anthropology
                Subject: Cultural Anthropology
                Subject: Religion
                Subject: Social Sciences
                Subject: Sociology
                Subject: Religion
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Science
                Subject: Cognitive Psychology
                Subject: Decision Making
                Subject: Biology and Life Sciences
                Subject: Psychology
                Subject: Cognitive Psychology
                Subject: Decision Making
                Subject: Social Sciences
                Subject: Psychology
                Subject: Cognitive Psychology
                Subject: Decision Making
                Subject: Biology and Life Sciences
                Subject: Neuroscience
                Subject: Cognitive Science
                Subject: Cognition
                Subject: Decision Making
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Digestive System Procedures
                Subject: Liver Transplantation
                Subject: Living-Related Liver Transplantation
                Subject: Medicine and Health Sciences
                Subject: Surgical and Invasive Medical Procedures
                Subject: Transplantation
                Subject: Organ Transplantation
                Subject: Liver Transplantation
                Subject: Living-Related Liver Transplantation
                Subject: Social Sciences
                Subject: Sociology
                Subject: Education
                Subject: Schools
                Subject: Social Sciences
                Subject: Sociology
                Subject: Human Families
                Custom metadata
                Data Availability All relevant data are within the paper and its Supporting Information files.

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