Live Kidney Donation: Informed consent related aspects

Background
Living kidney donors are a unique group of “patients”, undergoing surgery for the benefit of someone else. There is, to date, no consensus on how the informed consent procedure for the live donor nephrectomy should be arranged, and great differences exist between centers. Moreover, some donors report, in retrospect, not to have been well enough informed about, or prepared for the operation.
Methods
In this thesis, the informed consent procedure was analyzed with regard to current practice, contents, and the surgeon’s and the donor’s perspective. This has been done by means of literature reviews, a meta-analysis, a survey study, and two prospective cohort studies.
Results
A literature review demonstrated great differences between countries, hospitals, and individual professionals. The need for a standardized informed consent procedure was underlined by many authors. A number of complications that are mandatory to disclose have been identified (i.e. bleeding, wound infection, mortality), and a number of additional complications (e.g. testicular pain, neuropathy) have been suggested to be included as well. Surgeons were found to vary in their information disclosure, and important complications were not always discussed with donors. Donor knowledge of the procedure and postoperative period was demonstrated to be low. Donors were most knowledgeable about the duration of hospital admission and convalescence, and least about long-term complications. Donor satisfaction with the informed consent procedure was relatively high, although some negative experiences were encountered.
Conclusion
Great differences are present in informed consent procedures for the live donor nephrectomy, and a standardized format is highly desirable. Complication rates are low for the current techniques, but some still occur, and these are not always disclosed to potential donors. Donor knowledge is low, but satisfaction with the informed consent procedure is relatively high.