Predicting post-donation family dysfunction in living kidney donors

Psychosocial assessment of living related-kidney donors is important, yet limited prospective data exist on donor-perceived family functioning after transplantation. Identifying donors at high risk for deterioration in family functioning prior to transplantation is crucial for management. This study aimed to identify preoperative psychosocial predictors of post-donation family dysfunction to facilitate early targeted intervention, and to identify clinical predictors of functional change. A total of 106 Japanese LRKT donors were included in the analysis. Family functioning was assessed using the Family Assessment Device (FAD) before and 1 year after LRKT. Based on the General Functioning subscale, participants were classified into maintenance family function or deterioration groups. Binomial logistic regression was used to identify factors independently associated with deterioration in family functioning. Although most donors maintained stable family functioning, 17.2% (n = 15/87) of donors with good preoperative functioning experienced significant deterioration 1 year after LRKT. Multivariable analysis identified two independent predictors of deterioration: higher pre-LRKT FAD Affective Involvement scores (odds ratio [OR], 9.28; 95% confidence interval [CI], 1.60-53.88; p = .013) and a perception that life satisfaction after LRKT was worse than anticipated (OR, 2.25; 95% CI, 1.10-4.59; p = .026).These findings underscore the critical need for healthcare professionals to evaluate family dynamics before LRKT. Notably, inappropriate emotional connections (higher Affective Involvement) and unmet expectations regarding life after donation are potent predictors of donor-perceived family dysfunction. Therefore, comprehensive care that addresses potential changes in family roles and the realities of postoperative life is essential for identifying and supporting high-risk LRKT donors.