Donor Self-Esteem Before and After Living Kidney Donation

Most living kidney donors report normal to high self-esteem before donation. Less is known about the longer-term effects of donation on self-esteem, whether certain predonation characteristics are associated with lower self-esteem after donation, or how changes in self-esteem are associated with changes in symptoms of depression and anxiety.

Prospective cohort study.

Living kidney donors (n = 941) were enrolled before donation from 12 Canadian and 5 Australian transplant centers between 2009 and 2014.

Living kidney donation.

Self-reported self-esteem was measured using the Rosenberg Self-Esteem Scale (RSES) before donation, 3 months after donation, and then annually for 5 years or until the last follow-up visit (possible scores range from 0 to 30, with higher scores indicating higher self-esteem). Donors also completed the Beck Depression and Anxiety Inventories at these time points.

Linear and modified Poisson regression models were used to examine whether predonation characteristics were associated with lower self-esteem after donation and if changes in self-esteem were associated with changes in symptoms of depression and anxiety.

Nearly all donors (98.6%) reported normal to high self-esteem before donating (928 of 941), and only 2% to 4% had low self-esteem in follow-up evaluation (RSES score < 15). On average, the donors had a <1-point decrement in average self-esteem between the predonation and follow-up measurements; although these changes were statistically significant, they were not clinically meaningful (all mean changes < 5). Donors with RSES scores ≤ 20 before donation had an approximate 2-point increase in self-esteem in follow-up (P < 0.001). More symptoms of depression before donation were associated with lower self-esteem scores 3 months after donation (P = 0.006). An increase in self-esteem scores after donation was associated with concurrent reductions in symptoms of depression and anxiety (P < 0.001).

We did not examine the association of early recipient allograft failure or death with donor self-esteem.

In this multicenter study of living kidney donors, nearly all donors reported normal to high self-esteem before donation and during 5 years of follow-up evaluation. On average, donors with lower self-esteem before donation had a modest increase in self-esteem after donation. Increases in self-esteem after donation were accompanied by modest reductions in symptoms of depression and anxiety.

Living kidney donation is considered a safe procedure for carefully selected candidates although donors may experience complex feelings and emotions before and after the donation process. We studied 941 living kidney donors and assessed self-esteem before donation and for 5 years after donation or until the last follow-up visit. Nearly all donors (99%) reported normal to high self-esteem before donating, and fewer than 5% developed low self-esteem after donating. Reassuringly, donors with lower self-esteem before donation had a modest increase in self-esteem on average after donation. An increase in self-esteem after donation was accompanied by reduced symptoms of depression and anxiety.