Donor Self-Esteem Before and After Living Kidney Donation

RATIONALE & OBJECTIVE: 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 pre-donation 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. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: Living kidney donors (n=941) were enrolled before donation from 12 Canadian and 5 Australian transplant centers between 2009 and 2014. EXPOSURE: Living kidney donation. OUTCOMES: 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 0-30, with higher scores indicating higher self-esteem). Donors also completed the Beck Depression and Anxiety Inventories at these timepoints. ANALYTICAL APPROACH: Linear and modified Poisson regression models were used to examine whether pre-donation 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. RESULTS: Nearly all donors (98.6%) reported normal-to-high self-esteem before donating (928/941), and only 2-4% had low self-esteem in follow-up (RSES scores <15). On average, donors had a less than 1-point decrement in average self-esteem between pre-donation and follow-up measurements; while 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). LIMITATIONS: We did not examine the association of early recipient allograft failure or death with donor self-esteem. CONCLUSIONS: In this multicenter study of living kidney donors, nearly all donors reported normal-to-high self-esteem before donation and during five years of follow-up. 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.