SAN FRANCISCO – Postoperative psychiatric complications in a small percentage of liver donors included three completed or attempted suicides, Dr. James F. Trotter reported in a poster at the annual meeting of the American Association for the Study of Liver Diseases.
Data on the right hepatic lobe donors came from the Adult-to-Adult Living Donor Liver Transplant Cohort Study (A2ALL), which followed donors and recipients at nine U.S. transplant centers for at least 5 days and up to nearly 6 years after the surgery.
“Suicide and severe psychiatric complications are of concern in right hepatic lobe donors. We suggest psychiatric assessment and monitoring of liver donors may be helpful to understand and prevent such tragic events,” wrote Dr. Trotter of the University of Colorado Health Sciences Center, Denver, and his associates.
More studies are needed to determine if the psychiatric complications are related to stress from the surgery or to the types of people who choose to donate, or both, he said.
The postoperative psychiatric complications, which occurred in 3% of 390 liver donors, included two completed suicides and one attempted suicide in addition to depression in two donors, substance abuse in two, and the development of worsening obsessive-compulsive disorder, insomnia, or bipolar disorder in one donor each. Detailed questionnaires were used to profile the three suicide events. The recipients of the right hepatic lobe donations in these three cases were alive and well at the time of the suicide attempts.
A 50-year-old man who donated to his niece was treated with clonazepam for bipolar disorder before and after the donation. He developed physical postoperative complications, including a middle hepatic vein thrombosis, abdominal discomfort, and fatigue. He used a shotgun to the head to kill himself 22 months after the donation.
A 35-year-old man who donated to his brother developed a pleural effusion, ileus, and mild urinary retention after the surgery. Prior to donation, he had been in counseling related to a divorce but had no psychiatric history. A fatal, self-induced drug overdose 23 months after donation was recorded as suicide by the transplant center.
A 23-year-old man who donated to his father had no physical complications. Nine months later he was hospitalized twice in a 2-month period for slashing his wrists in attempted suicides after a breakup with his significant other. He is alive and doing well today, Dr. Trotter wrote.
Besides the two donors who committed suicide, two other donors died–one from postdonation surgical complications and one in a train accident.