**4. Correlates**

Relatedly, studies show that donors rate their physical health as fair to poor or worse following donation [77, 95, 101, 105]. More specifically, it was shown that quality of life was worse at 2-year than 5-year follow-up [106]. Donors also suffer from debilitating symptoms including pain around the scar, fatigue and poor body image [84, 87–89, 94–96, 105, 107]. In particular, difficulties in quality of life are related to financial difficulties, negative changes in employ-

As in the case with recipients of transplant, reviews [15] show that donors who report poor

More qualitative research has been undertaken to examine the experience of donors than that

A number of qualitative studies have explored the donors' views on becoming a donor. Accordingly, donors perceive the process of becoming a donor as an automatic response and as an opportunity to help the loved one [67, 108, 109]. The donors felt that they had no choice and decided to be a donor by prioritizing the recipient's life, viewing transplantation as the last chance for the recipient and her family and feeling obligated to save the recipient [110]. More specifically, this study showed that donors decided on becoming a donor by going through five stages [110]. The first stage, recognition, involves learning of liver transplantation from recipients, family, doctors or media; the second stage, digestion, involves realizing the seriousness of liver transplantation and wanting to save recipients from suffering and avoiding the guilt; the third stage consists of making a decision; the fourth stage, reinforcement, involves the donors reinforcing themselves psychologically; the final stage, resolution, involves preparedness and acceptance of donation. Relatedly, it was also reported that donors give three types of consent [111]. 'Unconditional consent' is a voluntary consent to save family members' life; 'pressured consent' is a consent whereby the donor feels pressurized to become a donor but he/she feels frightened.

'Ulterior-motivated consent' refers to the situation when the donor has a hidden motive.

Relatedly, other studies have shown that donors consider donation to cope with guilt regarding their own health and to reduce the responsibility for the ESLF of the recipient [112]. In the same study, donors recounted that they would only donate to certain family members or close friends [88]. By contrast, in another study donors recounted that they would donate to people who were related by blood as well as to anybody whom they felt close to regardless of

Only one study explored donors' beliefs of the ESLF of the recipients, their transplantation and their own organ donation surgery [113]. This study found that donors' beliefs could be viewed in a number of groups including beliefs about recipients ESLF, beliefs about being a donor, beliefs about surgery for organ donation and beliefs about organ donation. Beliefs about recipients' ESLF included diverse explanations for ESLF (such as spontaneous failure of the liver, worry, stress, senseless drug use, blaming oneself and physicians) and physical symptoms (such as cramps, itching, weakness, developmental slowing down). Beliefs about being a donor consisted of reasons for donating (such as being related by blood, saving a life, doing the right thing, being healed), barriers to being a donor (such as pregnancy, obesity, other people being senseless and selfish), ways of managing these barriers (such as getting

ment status or social relationships as indicated by reviews [15].

quality of life also report psychological problems.

whether or not they were related by blood [113].

**3.2. Qualitative research**

226 Liver Research and Clinical Management

of recipients.

A small number of quantitative studies have examined the effect, of a number of factors on outcomes among recipients of a liver transplant and their donors. For example, it was found that that 51–58% of the variance in quality of life was explained by a number of factors [60]. After transplantation among recipients, employment, age, and depression predicted physical aspects, whereas anxiety and depression predicted mental dimensions of quality of life. Transplantrelated factors such as rejection of the transplant, the number and length of hospital stays, effectiveness of the medication and complications did not predict anxiety symptoms. However, more patients suffering from anxiety and/or depression went through re-transplantation.

transplant and their donors. One explanation for this evidence is that high levels of these problems impair quality of life directly or as a mediator by, for example, maintaining the sick role [60]. Another explanation is that anxiety and depression may reduce compliance with

Psychosocial Aspects of Liver Transplantation and Liver Donation

http://dx.doi.org/10.5772/intechopen.74551

229

Despite numerous studies on the extent of psychological problems and quality of life, attempts to predict these outcomes have fallen short. There is little evidence to conclude from quantitative studies that particular factors predict outcome. Therefore, more research is needed. The construct of beliefs could guide future attempts to explain these outcomes. A review on adjustment in end-stage renal failure (ESRF) [118] shows that although the variance explained in outcomes by beliefs is small, beliefs have been more consistent in predicting these outcomes than other variables such as social support. One exception for these small effects is the beliefs postulated by the self-regulatory model of illness [119, 120] which is developed on the basis of interviews with patients suffering from different types of chronic physical illnesses. This model includes beliefs about identity, cause, consequences, timeline and cure or controllability of a particular chronic physical illness. Future research may examine the ways in

An alternative approach to better understand these outcomes is to be guided by qualitative studies. In terms of beliefs, only one qualitative study [113] examined donors' beliefs about ESLF, transplantation and organ donation surgery. More qualitative research is needed, in

Overall, qualitative findings suggest that candidates or recipients of a liver transplant and their donors experience ESLF and/or transplantation surgery or organ donation surgery and the process of organ donation in ways that are not identified by quantitative research. God's will, blaming oneself, blaming physicians as causes for recipients' ESLFl, doing the right thing, being healed as reasons for being a donor, the views that others are frightened of getting infected by ESLF and insensitive, experience of positive emotions, ways of improving, worsening aspects of character and close relationships are among findings which extend quantitative findings. These findings can be used not only to develop ESLF-specific quality of life or emotional well-being questionnaires but also patient- or donor-derived interventions

treatment, and this in turn reduces quality of life [61].

which these beliefs predict these outcomes.

to improve poor outcomes.

**Conflict of interest**

**Author details**

Margörit Rita Krespi

There is no conflict of interest.

Kadir Has University, Istanbul, Turkey

particular about recipients' beliefs about ESLF and transplantation.

Address all correspondence to: margorit.boothby@khas.edu.tr

Studies have shown that the experience of feelings including ambivalence about donation, hesitation and uncertainty are important predictors of poor adjustment and quality of life at post-donation period among donors [76, 86]. Moreover, it was also shown that donors who were concerned about their own health, finances and close relationships at pre-donation period had a history of psychiatric illness or present psychiatric illness and held a graduate degree reported poorer quality of life, although donors' medical complications were unrelated to their quality of life [86].
