M. Ayşın NOYAN, Özen SERTÖZ ÖNEN, HAYRİYE ELBİ, Özgül ÇETİN

Canlıdan organ naklinde ruhsal değerlendirme

Canlıdan organ nakli immünosupresan ilaçlar ve cerrahi yöntemlerdeki gelişmelerle alıcıların yaşam sürelerinde belirgin uzamaya yol açmasına karşın, canlı vericilere ilişkin uzun dönem ruhsal ve fiziksel veriler henüz yoktur. Bu alandaki en önemli konu vericinin sağlığının güvenliği olmasına karşın, vericilerin değerlendirilmesinde iki ana noktada eksiklikler bulunmaktadır. Birincisi, nakil öncesi verici seçiminde tüm merkezlerce ortak olarak kabul edilmiş, üzerinde anlaşılmış hiçbir standart ölçüt olmamasıdır. İkincisi, vericileri nakil sonrası düzenli olarak izleyen herhangi bir merkezin ve güvenilir bir veri tabanının olmamasıdır. Bu yazıda canlıdan organ nakli uygulamasındaki sorunlara ve canlı vericilerin ruhsal değerlendirilmelerinde dikkat edilmesi gereken noktalara değinilecektir. Canlı verici değerlendirilmesinde kapı ölçütleri öncelikle vericinin ruhsal açıdan sağlıklı ve medeni haklarını kullanabilir olması ile vericinin gönüllüğüdür.

Psychiatric assesment in living donation

Although the success of living organ donation continues to grow with improved survival, immuno-supression and surgical technical advancement, the long-term physical and psychological consequences are not established for living donors. Living donors are confronted with major operation without any potential health benefit in liver transplantation. Despite the importance of donor safety, neither the international pre-transplant guidelines, standards about the living liver donor selection, nor post-transplant donor database are not available. We have tried to recommend a donor selection criteria in liver transplantation. These were firstly to ensure donor’s psychological healthy and competence and to ensure voluntarism.

PDF

___

1. Sutherland DER. Presidental address to The Transplantation Society: Accomplishments, ethics, and scientific perspectives. Transplantation 2005; 79:1000-1007.
2. Organ ve Doku Nakli Hizmetleri Yönetmeliği. http://www.saglik.gov.tr
3. Daar AS. Strangers, intimates, and altruism in organ donation. Transplantation 2002; 74:424-426.
4. Kranenburg LW, Visak T, Weimar W, Zuidema W, de Klerk M, Hilhorst M, et al. Starting a crossover kidney transplantation program in the Netherlands: Ethical and psychological considerations. Transplantation 2004;78:194-197.
5. Simmons RG, Anderson CR. Related donors and recipients: Five to nine years post-transplant. Transplant Proc 1982; 14:9-12.
6. Sharma VK, Enoch MD. Psychological sequel of kidney donation: a 5-10 years follow-up study. Acta Psychiatr Scand 1987; 75:264-267.
7. Schrover L, Streem S, Boparai N, Duwiak K, Noeick AC. The psychosocial impact of donating a kidney: long-term follow-up from urology based centre. J Urol 1997;157:1596-1601.
8. Johnson EM, Anderson JK, Jacobs C, Suh G, Humar A, Suhr BD, et al. Long-term follow-up of living kidney donors: quality of life after donation. Transplantation 1999; 67:717-721.
9. Papachristou C, Walter M, Dietrich K, Danzer G, Klupp J, Klapp BF, et al. Motivation for living-donor liver transplantation from donor’s perspective: An in-depth qualitative research study. Transplantation 2004; 78:1506-1514.
10. Miyagi S, Kawagishi N, Fujimori K, Sekiguchi S, Fukumori T, Akamatsu Y, et al. Risk of donation and quality of donors’life after living donor liver transplantation. Transplant Int 2004; 18:47-51.
11. Lee SH, Jeong JS, Ha HS, No MJ, Hong JJ, Kwon JS, et al. Decision-related factors and attitudes toward donation in living related liver transplantation: Ten-year experience. Transplantation Proc 2005; 37:1081-1084.
12. Cronin DC, Siegler M. Ethical issues in living donor transplantation. Transplantation Proc 2003; 35:904-905.
13. Neuberger J, Price D. Role of living liver donation in United Kingdom. BMJ 2003; 327:676-679.
14. Abougergi MS, Rai R, Cohen CK, Montgomery R, Solga SF. Trends in adulth-to-adulth living donor liver transplant organ donation: the Johns Hopkins experience. Prog Transplant 2006; 16:28-32.
15. Walter M, Papachristou C, Pascher A, Danzer G, Neuhaus P, Klapp BF, et al. Impaired psychosocial outcome of donors after living donor transplantation: A qualitative case study. Clin Transplant 2006; 20:410-415.
16. Trotter JF, Hill-Callahan MM, Gillespie BW, Nielsen CA, Saab S, Shrestha R, et al. Severe psychiatric problems in right hepatic lobe donors for living donor liver transplantation. Transplantation 2007; 83:1506-1508.
17. Miller CM. Ethical dimensions of living donation: experience with living liver donation. Transplant Rev 2008;22:206-209.
18. Beresford TP. Living donor grafts in liver transplantation: where are psychiatric issues? Curr Opin Organ Transplant 2004; 9:437-440.
19. Erim Y, Malago M, Valentin-Gamazo C, Senf W, Broelsch CE. Guidelines for the psychosomatic evaluation of living liver donors: Analysis of donor exclusion. Transpl Proceeding 2003; 35:909-910.
20. The Authors for Live Organ Donation Concensus Group. Consensus statement on the live organ donor. JAMA 2000; 284:2919-2926.
21. Jowsey SG, Schneekloth TD. Psychosocial factors in living organ donation: clinical and ethical challenges. Transplant Rev 2008; 22:192-195.
22. Knibbe M, Verkerk M. Making sense of risk. Donor risk communication in families considering living liver donation to a child. Med Health Care Philos 2010;13:149-156.
23. Noyan MA. Donor kararında psikiyatrik değerlendirme. Turkiye Klinikleri J Int Med Sci Gastroenterohepatoloji 2006; 2(51)(Supp):32-37.
24. Fujita M, Slingsby BT, Akabayashi A. Three patterns of voluntary consent in the case of adult-to-adult living related liver transplantation in Japan. Transplant Proc 2004; 36:1425-1428.
25. Walter W, Papachristou C, Danzer G, Kalpp BF, Frommer J. Willingness to donate: an interview study before liver transplantation. J Med Ethics 2004; 30:544-550.
26. Huyse FJ, Touw DJ, van Schijdel RS, de Lange JJ, Slaets JP. Psychotropic drugs and the perioperative period: a proposal for a guideline in elective surgery. Psychosomatics 2006; 47:8-22.
27. Shrestha R. Psychosocial assessment of adult living liver donors. Liver Transpl 2003; 9(10 Suppl): S8-S11.
28. Dew MA, Jacobs CL, Jowsey SG, Hanto R, Miller C, Delmonico FL. Guidelines for the psychosocial evaluation of living unrelated kidney donors in the United States. Am J Transplant 2007; 7:1047-1054
29. Dew MA, DiMartini AF, De Vito Dabbs A, Myaskovsky L, Steel J, Unruh M, et al. Rates and risk factors for nonadherence to the medical regimen after adult solid organ transplantation. Transplantation 2007; 83:858-873.
30. Sercan M. Yurttaşlık hukukunda (medeni hukuk) adli psikiyatri. M Sercan (Ed.), Adli Psikiyatri Uygulama Kılavuzu. TPD Yayınları, Bilimsel Çalışma Birimleri Dizisi No:5, Ankara, 2007, s.80-88.
31. McCashland TM. Controversies in liver transplantation. Liver Transpl 2005; 11:S1.
32. Noyan A, Sertöz ÖÖ. Kalp pili, ICD ve transplantasyon yapılan hastalarda psikiyatrik sorunlar ve tedavisi. Türk Kardioloji Seminerleri 2009; 9:94-103.