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Review Article
Psychosocial evaluation of a living kidney donor
La evaluación psicosocial de un donante vivo de riñón
Manuel Torres-Gutiérrez
Médico Psiquiatra, Jefe Grupo de Salud Mental, Colombiana de Trasplantes, SAS, Bogotá, Colombia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Today&#44; kidney transplantation is considered the best treatment for end-stage chronic kidney disease&#46; However&#44; a relatively high number of patients remain on dialysis and waiting lists are growing every year&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Needless to say&#44; there are limitations regarding insurers authorising the procedure&#44; but the main limiting factor is organ availability&#46; Organs can come from both a living or deceased donor&#46; The latter appears desirable because it minimises the risks to another human being&#46; However&#44; the demanding conditions of recovery make finding a suitable number difficult&#46; If we compare the constant &#40;and sometimes declining&#41; number of deceased donors to the ever-growing number of patients on waiting lists&#44; it becomes clear that the chance of receiving an organ is proving less and less likely for the majority of patients&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Fortunately&#44; the idea of living organ donation is gaining increasing acceptance&#46; Perhaps the main reason that this idea is on the rise lies in improved medical evaluation criteria for the candidate &#40;which are becoming increasingly clear and more accurate&#41; and improved nephrectomy surgery techniques&#44; which are becoming safer and yielding better results &#40;aesthetics included&#41;&#46; These two elements have given rise to a general perception that there is no injury and a low risk involved&#44; which is gradually radiating from medical professionals to the general public&#46; Moreover&#44; it is not inconceivable that the average citizen&#39;s willingness to participate in this specific form of solidarity has also improved&#46; What is certain is that there are more and more candidates for living donation&#46; Furthermore&#44; most notably&#44; the number of candidates who are not biologically related to the recipient has also &#40;moderately&#41; increased &#40;spouses&#44; same-sex partners&#44; in-laws&#44; friends and even people with unusual motives&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Of course&#44; this shift in attitude should be welcomed as a positive&#46; Nonetheless&#44; it carries with it new psychosocial risks that must be identified&#46; Women generally &#8211; and wives in particular &#8211; tend to be generous towards their partners&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> This generosity may prevent us from detecting the existence of undue pressures exerted by the ill husband&#44; exploiting her frequent financial dependence&#46; The decision to support a homosexual partner may be perfectly legitimate&#44; but it is common for donors to hide their reasons due to censorship fears and this inhibits proper analysis&#46; The emotional bond that sometimes unites in-laws and close friends may be a sufficient and adequate motive&#46; However&#44; it is not uncommon for organs to be sold&#44; concealed behind declarations of friendship which&#44; for the interviewer&#44; are difficult to prove or rule out&#46; Abstract altruism &#40;towards strangers&#44; for example&#41; is an admirable human trait&#44; but let us not be too blind to recognise that behind it there may be deprived citizens subjected to financial pressures or the manipulation of unsuspecting individuals&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">The interview</span><p id="par0025" class="elsevierStylePara elsevierViewall">Almost all transplantation teams include a psychosocial evaluation of their living donor candidates&#46; The World Health Organization &#40;WHO&#41; addresses this requirement in the comments made under Principle 3 of the WHO Guiding Principles on Human Cell&#44; Tissue and Organ Transplantation&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a> The mental health evaluation &#8211; including those carried out by nephrology&#44; the surgeon&#44; the anaesthetist and any other person deemed necessary by the transplant team &#8211; seeks to confirm that the decision to donate justifies the risk assumed by the candidate&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The donation of an organ is a voluntary decision&#46; Candidates have dominion over their bodies and have the right to dispose of them within the scope of the applicable legislation&#46; It is thus usually assumed that they know their reasons for donating &#40;that they are aware of them&#41;&#44; that they have thought at length about their decision and have even sought advice from other people&#46; It is surprising&#44; then&#44; to corroborate that in many cases candidates have only a vague or rather obscure awareness of their reasons and the validity thereof&#46; Sometimes&#44; candidates have made an impulsive decision&#44; driven by their emotions and placing trust in their luck and&#47;or faith&#46; In other cases&#44; they are undecided and under pressure due to various circumstances&#46; The mental health evaluation should help them clarify their reasons&#44; i&#46;e&#46; make them conscious or verbalise them&#46; It should allow candidates to analyse them and to stand by or revoke their decision&#46; In other words&#44; it should be a positive experience that either enriches and develops the decision or disregards it&#46; It should also leave candidates feeling as though they have had help in making the best possible decision to suit their case&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This interview should be the first of many that candidates have to undergo&#46; A well-informed decision is the first prerequisite that allows the rest of the process to flow&#46; The interview should be carried out by a psychiatrist integrated in the transplant team&#46; Integrated means that the psychiatrist should not only understand the phases and requirements of the process&#44; but also have been present and had responsibilities during transplantation&#44; so that he&#47;she knows the pressures&#44; risks&#44; benefits and results thereof both in theory and from experience&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The professional training given to psychiatrists usually gets them used to pursuing and providing strict conditions in which they can properly undertake an interview of this nature&#46; There are five such conditions&#58; time&#44; privacy&#44; intimacy&#44; warmth and sincerity&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">The interview requires time&#46; It is about understanding the donor&#39;s reasons and helping him or her to clarify them&#46; This sometimes constitutes a long and arduous task&#46; Many patients fail to find the words to express themselves&#46; Others believe&#44; given the generosity of their offer&#44; that the medical team is forced to accept with no further questions asked &#40;under the assumption that the decision is one-sided&#41;&#46; Patience and experience are required to convince patients of the need to express their reasons and to direct them towards them&#46; This takes at least an hour&#44; coinciding with the usual length of a psychiatric interview&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">The interview should take place between the psychiatrist and donor alone&#46; This is not only a way of avoiding undue pressures&#46; The candidate may be scared or feel undecided&#44; and should feel able to raise any concerns or doubts in private&#46; Sometimes it may be necessary to reaffirm the confidentiality pledge that is characteristic of psychiatric interviews&#46; If the donor insists&#44; a person in their trust &#40;spouse&#44; child&#44; friend&#41; may attend&#44; but the recipient or any other related person &#40;who would presumably be in favour of a positive decision&#41; must never be present&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Intimacy is an essential requirement of the interview&#46; The interviewer should build trust&#46; Candidates should feel as though they are being listened to and that the depth of their reasons is understood&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Warmth&#44; in other words&#44; friendliness&#44; patience&#44; tolerance and understanding&#46; These are characteristics that a good clinician always offers as the only possible compensation for the attitude expected from the interviewee&#58; sincerity&#46; When this fails &#40;i&#46;e&#46; when we see that the candidate is lying and concealing information&#41;&#44; it is difficult to maintain said warm and respectful attitude&#46; And that is where the clinician&#39;s expertise is best measured&#46;</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">The conditions of the decision</span><p id="par0065" class="elsevierStylePara elsevierViewall">The decision to donate an organ must satisfy several sets of requirements&#46; It should be&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">Legally sound&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">Ethically acceptable&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Psychologically mature&#46;</p></li></ul></p><p id="par0085" class="elsevierStylePara elsevierViewall">The psychosocial evaluation &#40;in particular if it is the first in the process&#41; serves as the ideal opportunity to corroborate the donor&#39;s respect of and compliance with all three sets of requirements &#8211; legal&#44; ethical and psychological &#8211; and the psychiatrist is the most suitable professional to do so&#46;</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Legal requirements</span><p id="par0090" class="elsevierStylePara elsevierViewall">In Colombia&#44; the legal requirements are clearly set out in Law 9 of 1979&#44; Law 73 of 1988 and Law 919 of 2004&#44; as well as in regulatory decrees and resolutions &#40;2363 of 1986&#44; 1546 of 1998 and&#44; in particular&#44; 2493 of August 2004&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> There are three aspects that are directly relevant to the psychiatric assessment of donor candidates&#44; as follows&#58;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">That they are in full possession of their mental faculties&#46; The interview must rule out cognitive limitations &#40;mental retardation&#44; cognitive impairment or dementia&#41;&#44; serious emotional disturbance &#40;depression&#44; anxiety&#41;&#44; other mental illnesses &#40;psychosis&#44; factitious disorder&#41; or serious personality disorders that impede full comprehension of their decision&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">That the decision is altruistic&#46; The interviewer must ensure that the candidate has no other reasons besides the desire to help the recipient and that there is no financial benefit agreement or ulterior motive involved&#46; In Principle 5 of the WHO declaration&#44; it rightly states&#58; &#8220;Payment for cells&#44; tissues and organs is likely to take unfair advantage of the poorest and most vulnerable groups&#44; undermines altruistic donation&#44; and leads to profiteering and human trafficking&#46; Such payment conveys the idea that some persons lack dignity&#44; that they are mere objects to be used by others&#8221;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">That the donor is informed&#46; The legislation of most countries in Latin American requires express informed consent&#44; in writing&#44; with a minimum term lasting from the signature of the document to the extraction of the organ&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a> In Colombia&#44; a sworn statement before a notary public is also required&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">6</span></a> Most teams hold one or several educational meetings that must be attended by the candidate before signing the informed consent&#46; The interviewer must confirm that the candidate has received timely and suitable &#40;comprehensible&#41; information on the risks and implications of their decision regarding their general health&#44; and that the implications pertaining to psychiatric health and later life have also been specified &#40;including possible changes to their life plan&#41;&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Ethical requirements</span><p id="par0110" class="elsevierStylePara elsevierViewall">There are four ethical requirements&#58;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0115" class="elsevierStylePara elsevierViewall">Autonomy&#46; This is &#8220;self-rule that is free from both controlling interference by others and from limitations &#91;&#8230;&#93; that prevent meaningful choice&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a> Bioethics considers that normal&#44; duly informed individuals are capable of making decisions on their health and any medical procedures offered to them&#44; and that this decision should be respected over the physician&#39;s opinion&#46; The Belmont Report<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> named this concept &#8220;Respect for Persons&#8221;&#46; The psychosocial evaluation should&#58; respect &#40;not interfere with or oppose&#41; their decision to become a donor&#44; ensure that they receive suitable information and protect subjects with limited autonomy &#40;mental disturbance&#44; immaturity or circumstances restricting their freedom&#41;&#46; On the specific topic of living donors&#44; it should always be borne in mind that most threats to autonomy do not come from the physician&#59; more often&#44; they stem from the recipient and environment&#46; We are explicitly responsible for confirming that the donor is acting free from coercion &#40;violent imposition&#41;&#44; manipulation &#40;subtle control&#41;&#44; seduction &#40;promises and insinuations&#41; and subordination &#40;related to work&#44; the military and other groups&#58; church&#44; school&#44; etc&#46;&#41;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">Benefits for the donor&#46; The beneficence principle calls for &#8220;maximiz&#91;ing&#93; possible benefits and minimiz&#91;ing&#93; possible harms&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a> In the psychosocial interview&#44; we must corroborate that the donor is benefiting in exchange for the risk&#46; This seems paradoxical&#58; if they are going to lose a healthy organ&#44; what type of benefit could there be&#63; The only possible answer is&#58; a psychological benefit&#46; There must ALWAYS be a benefit and this should be understood in two ways&#58; genuine alleviation of the donor&#39;s suffering &#40;caused by the illness of a loved one&#41; and their psychological satisfaction &#40;due to alleviating said suffering&#41;&#46; This means that the recipient and donor know one another and have a mutual and significant affection&#46; This condition obligates us to act very carefully in certain cases of alleged abstract altruism&#46; It is thus worth highlighting the comment made by the WHO under Guiding Principle 3&#58; &#8220;In general living donors should be genetically&#44; legally or emotionally related to their recipients&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> Experience shows that one only donates an organ to somebody for whom they feel great affection and devotion &#8211; someone who is of special significance in their life&#44; who they cherish&#46; However&#44; donation is not emotionally neutral either&#46; Once it is decided upon&#44; it strengthens the preexisting bond between those two people and gives the donor a sense of satisfaction and accomplishment that can last for many years&#44; positively influencing many of their subsequent decisions&#46; Conversely&#44; when there are flaws&#44; it tends to distance the two people&#44; leaving the donor with an emotional void&#44; regret and the sense of being used&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">Absence of harm In the Belmont Report&#44; the concept of non-maleficence falls under the beneficence principle&#58; &#8220;maximiz&#91;ing&#93; possible benefits and minimiz&#91;ing&#93; possible harms&#8221;&#46; However&#44; most bioethicists now consider this to be a separate principle&#46; The psychosocial evaluation should forecast that there will be no psychological harm&#46; This should be understood not only in terms of the decision not affecting &#40;exacerbating&#44; triggering or aggravating&#41; any previous mental disorders&#44; but should also rule out any expectation of personal sacrifice and avoid future disability&#46; Donation should not be experienced by donors as a voluntarily accepted sacrifice&#44; but as an act of solidarity with a loved one&#44; which is only permissible if it does them no harm&#44; i&#46;e&#46; if their life can continue without limitations or changes to their medium- or long-term plan&#46;</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">Justice&#46; &#8220;An injustice occurs when &#91;&#8230;&#93; some burden is imposed unduly&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> We are responsible for verifying that the donor has not been &#8220;selected simply because of their easy availability&#44; their compromised position&#44; or their manipulability&#8221;&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> In other words&#44; we must rule out all forms of vulnerability&#58; financial &#40;e&#46;g&#46; a poor relative&#41;&#44; psychological &#40;e&#46;g&#46; the individual with the least emotional independence in a family&#41;&#44; social &#40;e&#46;g&#46; a single mother who is the head of the family and has children under 18&#41; or legal &#40;e&#46;g&#46; a relative with mild mental retardation or borderline intellectual functioning&#41;&#46;</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Psychological requirements</span><p id="par0135" class="elsevierStylePara elsevierViewall">There are three psychological requirements&#58;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0140" class="elsevierStylePara elsevierViewall">That the decision is psychologically understandable&#46; This means that the interviewer understands the premises of the decision and how the donor has come to their conclusions&#46; It also signifies that he&#47;she not only understands the content&#44; but that the logical structure thereof has also been shared&#46; Such a perspective is vulnerable to the accusation of subjectivity&#46; However&#44; we must not forget that&#44; in most cases&#44; the donor and interviewer belong to the same culture and share similar feelings&#44; ways of acting&#44; priorities and value scales about what is right and wrong&#46; This &#8220;understandable&#8221; rating also implies that the donor has made an effort &#40;has sought out arguments&#41; to make it comprehensible to us&#46; Few other exercises can provide greater certainty of the reasons&#8217; transparency&#44; the autonomy of the decision and the subjective benefit received by the donor&#46; Of course&#44; any difficulties understanding the decision could hypothetically be due to the psychiatrist&#39;s inability or prejudices&#46; And I believe a responsible clinician should never lose sight of this possibility&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">That it is mature&#46; In essence&#44; that it has been reflected upon and not made impulsively&#46; There is no &#8220;reasonable time period&#8221;&#44; of course&#44; but it is easy to determine what constitutes &#8220;reckless&#8221;&#46; &#8220;Mature&#8221; also means that the decision is composed and not conditioned by emotions&#46; Two immature feelings must be ruled out&#58; guilt &#40;due to alleged or genuine aggressions and psychological debts to the recipient in relation to other points in their shared life&#41; and fear &#40;that the recipient will die&#44; stop loving them or abandon them&#44; etc&#46;&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">That it is stable&#44; i&#46;e&#46;&#44; that it has been upheld in the face of objections and advice to the contrary&#46; This assures us that it has been carefully considered and discussed with other important people in the candidate&#39;s life for some time&#46;</p></li></ul></p><p id="par0155" class="elsevierStylePara elsevierViewall">We usually only have one session to complete this task&#46; It is thus worth following a protocol to make it more efficient&#58;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Interview technique</span><p id="par0160" class="elsevierStylePara elsevierViewall">Like any evaluation&#44; we should begin by getting to know the donor&#46; Clinical histories nowadays tend to be systematised and most programmes provide the patient&#39;s identifying and sociodemographic data in advance&#46; In my opinion&#44; it is useful to begin the interview by checking these data&#46; The previously standard practice of the patient and clinician verbally identifying themselves serves as an introduction&#44; breaks anonymity and respectfully opens the conversation&#46; We should seek to corroborate their name&#44; age&#44; background&#44; marital status&#44; employment and the name of the recipient&#46; Moreover&#44; it would appear necessary to acquire clear and extensive knowledge on the donor&#39;s family&#46; To do so&#44; we ask the candidate to help us draw a detailed genogram&#46; Together&#44; we can construct a genealogical diagram of their parents&#44; siblings&#44; spouse and children&#46; The genogram is produced from the patient&#39;s point of view&#44; using standard conventions &#40;differentiating between men and women&#44; adding their names&#44; ages and blood or civil relationships&#44; drawing these with a straight line when they are still applicable and cutting through them when they have broken down&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> It is useful to outline groups on the diagram &#40;who lives with who&#41; and to record the city and neighbourhood &#40;or municipality and village&#41; in which they live&#46; When the recipient is not part of the same family&#44; we ask the donor to help us draw their respective genogram&#46; Doing so alongside the donor makes the relationship between both individuals visible from the outset&#46; Encircling the home of each person not only shows relationships of consanguinity and&#47;or affinity&#44; but neighbourhood relationships too&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">The second part consists of a longitudinal review of the candidate&#39;s life&#46; This is directed at establishing their legal and mental capacity&#58; Childhood&#44; adolescence&#44; education and academic level attained&#44; adult life&#44; work undertaken&#44; marriage&#40;s&#41;&#44; children&#44; etc&#46; Clear evidence of their maturity should be sought&#44; such as signs of their emotional and economic independence&#46; Next&#44; try to identify their main personality traits &#40;insofar as possible in a single interview&#41;&#46; This section always includes a full&#44; cross-sectional mental examination&#44; corroborating the statements made by the donor about their life history&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">The third part examines the formal ties between the candidate and recipient &#40;siblings&#44; married couple&#44; friends&#44; etc&#46;&#41;&#46; We then clarify the emotional ties between them &#40;they grew up together&#44; they have been happily married for many years&#44; etc&#46;&#41; and explicitly note any evidence of this bond&#46; Experience reveals that suitable donors can perfectly describe the daily life of the recipient&#44; as well as their family environment&#44; finances&#44; underlying disease and any treatment they are receiving&#46; Collecting anecdotes about their life together is useful&#46; If the donor and recipient are siblings&#44; corroborate their joint upbringing&#44; shared education and stories from their childhood&#59; if they are married&#44; confirm their day-to-day involvement&#44; responsibilities regarding any children they have together and that they have matching life plans&#46; If they are friends&#44; verify their shared upbringing&#44; education&#44; work&#44; neighbourhood and social life&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">We must also specifically analyse the financial relationship between the donor and recipient&#44; clarifying the sources of income of both&#46; This allows us to establish any financial dependence&#44; subordination or hierarchal dependence with relative certainty&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">In the fourth part&#44; the donor&#39;s decision-making is analysed&#46; It is necessary to ask the date on which the decision was made&#44; to clearly establish who proposed the initiative&#44; how the donor told the recipient &#40;or how the latter expressed his&#47;her request&#41; and the donor&#39;s reasons for making it &#40;why this person as opposed to another family member&#63;&#41;&#46; The goal is for the donor to express his&#47;her reasons in terms of his&#47;her own feelings and personal interest&#44; and to dismiss vague and generic phrases about the virtue of altruism as insignificant&#44; and those regarding the benefit to the recipient as obvious&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">As part of this section&#44; we must find out whether there is any opposition to the donation within the family&#44; especially when married women or young people who have recently come of age are concerned&#46; After all&#44; while these two groups do not legally require authorisation&#44; they often depend emotionally and financially on their husband or parents&#46; The candidate&#39;s attitude towards any such opposition should also be explored &#40;how important is it in his&#47;her life&#44; how will he&#47;she manage said opposition&#41; and he&#47;she should be clearly and formally asked about the existence of undue pressures from the recipient or the relatives thereof&#44; as well as whether they are receiving money in exchange for the donation&#46; Negation is relatively insignificant&#44; since it is normal for donors &#40;all of them&#41; to vehemently deny this&#46; We should note&#44; however&#44; if any evidence of undue pressure or monetary compensation is observed during the interview&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">The fifth section assesses the candidate&#39;s knowledge of the two surgical procedures &#40;their nephrectomy and the transplant&#41;&#46; It is necessary to ascertain their level of knowledge regarding the recipient&#39;s disease&#58; cause&#44; treatments&#44; type of dialysis&#44; compliance&#44; complications&#46; This usually reveals what the donor thinks about the prognosis of the procedure &#40;will the recipient be able to take care of the graft&#63;&#41; and dismisses the common belief &#8211; which is almost always false &#8211; that the recipient will die without the donation&#46; Among the topics of knowledge concerning the surgery&#44; it is always necessary to include a question about the donor&#39;s support mechanism &#40;carer and postoperative accommodation&#41;&#46; The donor&#39;s independence with respect to the recipient&#39;s support network is usually reassuring as regards his&#47;her autonomy&#46; In our working group&#44; it is common for the donor to have attended the educational meeting held for the recipient and his&#47;her family&#44; so knowledge is usually adequate&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">The interview ends by gathering background information to exclude a history of mental illness and illustrate the donor&#39;s tendency to adopt either healthy and&#47;or high-risk behaviours&#58; use of tobacco&#44; alcohol and other substances&#44; hospital admissions&#44; surgeries and previous medical consultations&#44; accidents&#44; extreme sports&#44; previous psychiatric care&#46; The use of alcohol&#44; tobacco or other substances is not a formal contraindication for donation&#46; However&#44; any such habits require special analysis&#46; Substance abusers tend to have little regard for their health and often carry other risks &#40;e&#46;g&#46; accidents&#41; which may discourage donation&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">At this point&#44; it is very rare for an expert interviewer to not have a clear sense of the donor&#39;s suitability&#46; In our group&#44; we use a checklist to ensure compliance with the aforementioned requirements and we decide between two different ratings&#58; suitable and unsuitable&#46; When the candidate is deemed suitable&#44; we inform them of our decision and refer them immediately to the nurse to receive laboratory orders and appointments for other assessments &#40;nephrology&#44; surgery&#44; anaesthesia&#41;&#46; If the evaluation is positive&#44; we advise donors that they will undergo many other examinations and interviews to&#58;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Establish their risk level for the nephrectomy&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Establish the capacity of their remaining kidney&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Ensure that they will not be forced to implement any lifestyle change &#40;diet&#44; medication&#44; physical limitation&#44; job change&#44; etc&#46;&#41;&#46;</p></li></ul></p><p id="par0220" class="elsevierStylePara elsevierViewall">Colombian legislation<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> requires the donor to have been previously informed that it is impossible to be sure of all of the risks that might materialise during the procedure&#44; due to the occurrence of unforeseeable circumstances&#46; We also feel it is advisable to add that we cannot predict future events such as an accident involving lumbar spine trauma or an abdominal injury&#44; which may affect the only remaining kidney&#46; Donors are also clearly informed that they may withdraw from the donation procedure at any time&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">As regards patients deemed unsuitable&#44; we explain the reasons behind our decision and suspend the process initiated&#46; Occasionally&#44; candidates come to the interview with serious doubts about their decision&#44; changing their mind part-way through&#46; Voluntary withdrawal tends to make donors feel guilty for getting the recipient &#8220;excited&#8221; and they are often scared and ashamed to tell them&#46; In such cases&#44; we make it clear to the donor that the interview is totally confidential and that we will not inform the recipient or his&#47;her representative of any such reasons&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflicts of interest</span><p id="par0230" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The decision to become a living kidney donor is full of conflicts&#46; It is generally believed that the candidates are aware of their reasons&#44; that they have thought long about it&#44; and have even asked questions about it&#46; Thus it is surprising that&#44; in many cases&#44; they are only vaguely aware of their reasons and their validity&#46; Sometimes&#44; it is an impulsive decision guided by their emotions and entrusted to their luck or faith&#46; Sometimes&#44; they are undecided and put under pressure due to various circumstances&#46; The mental health assessment should help to clarify their reasons&#44; and to put them into words&#46; It should be a positive experience&#44; enriching their decision&#46; It should give the candidate the inner feeling of having received help for taking the best decision&#46;</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The psychosocial evaluation should be the first of multiple assessment ratings that the living kidney donor must face&#46; A well-taken decision is a requirement to start the process properly&#46; The author reviews the conditions in which that interview should be developed&#44; the requirements to be met by the decision&#44; and the proper techniques to obtain accurate information&#46;</p></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La decisi&#243;n de convertirse en donante vivo de ri&#241;&#243;n suele ser conflictiva&#46; Generalmente se cree que el candidato conoce sus motivos&#44; que es consciente de ellos&#44; que ha pensado largamente su decisi&#243;n y hasta ha consultado sobre ella&#46; Sorprende corroborar que &#8211; en muchos casos &#8211; solo tiene una conciencia vaga&#44; m&#225;s bien oscura&#44; de sus razones y de la validez de ellas&#46; Otras veces ha tomado una decisi&#243;n impulsiva&#44; guiado por sus afectos&#44; y se ha confiado a su suerte y&#47;o a su fe&#46; Y&#44; otras m&#225;s&#44; viene indeciso&#44; presionado por diversas circunstancias&#46; La evaluaci&#243;n de salud mental debe ayudarle a poner sus motivos en claro&#44; es decir&#44; a hacerlos conscientes&#44; a verbalizarlos&#46; Debe permitirle analizarlos y afirmarse en su decisi&#243;n o arrepentirse de ella&#46; Es decir&#44; debe ser una experiencia positiva&#44; que enriquezca la decisi&#243;n&#44; la madure o la descarte&#46; Y debe dejar al candidato la sensaci&#243;n interior de haber recibido ayuda para tomar la mejor decisi&#243;n posible en su caso&#46;</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La evaluaci&#243;n psicosocial deber&#237;a ser la primera de varias valoraciones a las que debe someterse un candidato&#44; porque una decisi&#243;n bien tomada es requisito para realizar un proceso adecuado&#46; El autor revisa las condiciones en que debe desarrollarse la entrevista&#44; los requisitos que debe cumplir la decisi&#243;n y las t&#233;cnicas apropiadas para obtener la informaci&#243;n indispensable&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Torres-Guti&#233;rrez M&#46; La evaluaci&#243;n psicosocial de un donante vivo de ri&#241;&#243;n&#46; Rev Colomb Psiquiat&#46; 2018&#59;47&#58;252&#8211;257&#46;</p>"
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                  "comentario" => "Available from&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0010" href="http://www.ins.gov.co/lineas-de-accion/Red-Nacional-Laboratorios/Paginas/marco-Legal-documentos-tecnicos-y-estadisticas.aspx">http&#58;&#47;&#47;www&#46;ins&#46;gov&#46;co&#47;lineas-de-accion&#47;Red-Nacional-Laboratorios&#47;Paginas&#47;marco-Legal-documentos-tecnicos-y-estadisticas&#46;aspx</a>"
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Informes Anuales Red de Donaci&#243;n y Trasplantes a&#241;os 2011&#44; 2012&#44; 2013&#44; 2014&#44; 2015"
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                        0 => array:2 [
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              "etiqueta" => "2"
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                    0 => array:2 [
                      "titulo" => "Observaciones sobre la evaluaci&#243;n del candidato a donante vivo de ri&#241;&#243;n"
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                          "autores" => array:1 [
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                        "fecha" => "2011"
                        "editorial" => "Congreso latinoamericano y del Caribe de Trasplante"
                        "editorialLocalizacion" => "Cartagena&#44; marzo"
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                  "referenciaCompleta" => "OMS&#46; Principios Rectores sobre Trasplante de C&#233;lulas&#44; Tejidos y &#211;rganos Humanos&#46; Available from&#58; <a id="intr0015" class="elsevierStyleInterRef" href="http://www.who.int/transplantation/Guiding_PrinciplesTransplantation_WHA63.22sp.pdf">http&#58;&#47;&#47;www&#46;who&#46;int&#47;transplantation&#47;Guiding&#95;PrinciplesTransplantation&#95;WHA63&#46;22sp&#46;pdf</a>&#46;"
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                  "referenciaCompleta" => "Legislaci&#243;n colombiana sobre trasplantes&#46; Available from&#58; <a id="intr0020" class="elsevierStyleInterRef" href="http://www.ins.gov.co/lineas-de-accion/Red-Nacional-Laboratorios/Paginas/marco-Legal-documentos-tecnicos-y-estadisticas.aspx">http&#58;&#47;&#47;www&#46;ins&#46;gov&#46;co&#47;lineas-de-accion&#47;Red-Nacional-Laboratorios&#47;Paginas&#47;marco-Legal-documentos-tecnicos-y-estadisticas&#46;aspx</a>&#46;"
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                      "titulo" => "Legislaci&#243;n sobre donaci&#243;n y trasplante de &#243;rganos&#44; tejidos y c&#233;lulas&#58; Compilaci&#243;n y an&#225;lisis comparado"
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                  "comentario" => "Available from&#58; <a class="elsevierStyleInterRef" target="_blank" id="intr0030" href="http://www.ms.gba.gov.ar/sitios/ccis/files/2012/08/INFORMEBELMONT.pdf">http&#58;&#47;&#47;www&#46;ms&#46;gba&#46;gov&#46;ar&#47;sitios&#47;ccis&#47;files&#47;2012&#47;08&#47;INFORMEBELMONT&#46;pdf</a>"
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ISSN: 25303120
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