Psychosocial evaluation of living liver Donors- State of current practices in the US.

We surveyed living donor liver transplant (LDLT) programs in the United States to describe practices in the psychosocial evaluation of living donors focused on 1) composition of psychosocial team, 2) domains, workflow, and tools of the psychosocial assessment, 3) absolute and relative mental-health related contraindications to donation, and 4) post-donation psychosocial follow-up. We received 52 unique responses, representing 33 of 50 (66%) of active LDLT programs. Thirty-one (93.9%) provider teams included social workers, 22 (66.7%) psychiatrists, and 14 (42.4%) psychologists. Validated tools were rarely utilized but domains assessed were consistent. Respondents rated active alcohol (93.8%), cocaine (96.8%), and opioid (96.8%) use disorder, as absolute contraindications to donation. Active suicidality (97%), self-injurious behavior (90.9%), eating disorders (87.9%), psychosis (84.8%), non-adherence (71.9%), and inability to cooperate with the evaluation team (78.1%) were absolute contraindications to donation. There were no statistically significant differences in absolute psychosocial contraindications to liver donation between geographical areas or between large and small programs. Programs conduct post-donation psychosocial follow up (57.6%) or screening (39.4%) but routine follow-up of declined donors is rarely conducted (15.8%). Psychosocial evaluation of donor candidates is a multidisciplinary process. The structure of the psychosocial evaluation of donor is not uniform among programs though domains assessed are consistent. Psycho-social contraindications to living liver donation vary amongst the transplant programs. Mental health follow-up of donor candidates is not standardized.