Beyond the gift: unveiling the impact of donor-recipient relationship on donors' quality of life and mental health - results of a european bi-center study.
Papachristou C, Papoulaki N, et al. • Transplant international : official journal of the European Society for Organ Transplantation • 2026
Caregiving burden and perceived responsibility for the recipient's health emerged as key predictors of psychological distress in living kidney donors, while most donors demonstrate good psychosocial outcomes but at-risk subgroups warrant appropriate attention prior and after donation.
Key Findings
Results
Relationship type was not associated with physical wellbeing but was linked to lower mental wellbeing in spouse donors compared to child-to-parent and other genetically related donors.
Sample included 713 living kidney donors from two major European transplant centers
Analysis adjusted for gender, age, center, and time since donation
Spouse donors showed lower mental wellbeing compared to child-to-parent donors and other genetically related donors
The effect of relationship type on wellbeing was described as 'inconclusive' overall
Results
Caregiver role among living kidney donors was associated with lower mental wellbeing and increased anxiety.
Caregiver role was assessed as part of the caregiving dimensions examined alongside donor-recipient relationship types
The association with lower mental wellbeing and increased anxiety persisted after adjusting for gender, age, center, and time since donation
Caregiving dimensions were identified as under-explored factors in long-term psychosocial donor outcomes
Results
Caregiving burden was associated with higher somatization in living kidney donors.
Somatization was one of the psychological outcomes assessed alongside anxiety, depression, and quality of life
Caregiving burden was measured as a distinct dimension from caregiver role
Caregiving burden emerged as one of the key predictors of psychological distress
Results
Perceived responsibility for the recipient's health was associated with higher depression in living kidney donors.
Perceived responsibility for recipient's health was assessed as a separate caregiving dimension
It emerged alongside caregiving burden as a key predictor of psychological distress
Depression was measured as part of a battery of psychological outcomes including anxiety and somatization
Results
Differences in mental health outcomes between the two European transplant centers were identified, likely reflecting cultural and organizational characteristics.
The study was conducted at two major European transplant centers (bi-center design)
Center was included as a covariate in adjusted analyses
Differences were attributed to 'cultural and organisational characteristics' rather than donor or clinical factors
Results
Differences in wellbeing linked to older age and time since donation were observed and interpreted within ageing processes.
Both age and time since donation were included as adjustment variables in the analyses
The authors interpret these differences as 'eventually understood within ageing processes'
These factors were assessed alongside relationship type and caregiving dimensions as predictors of outcomes
Conclusions
Most living kidney donors demonstrated good psychosocial outcomes, but at-risk subgroups were identified.
713 living kidney donors were included in the study
QoL, anxiety, depression, and somatization were all assessed
At-risk subgroups identified include spouse donors, those with caregiver roles, high caregiving burden, and high perceived responsibility for recipient's health
Authors conclude these subgroups 'warrant appropriate attention prior and after donation'
What This Means
This research examined the psychological wellbeing and quality of life of 713 people who donated a kidney to someone they knew, recruited from two large European transplant centers. The study looked at how the type of relationship between the donor and recipient (such as spouse, parent, or other relative), as well as whether donors took on caregiving roles for recipients after the transplant, affected donors' mental and physical health over time.
The study found that most donors fared well psychologically, but certain groups were more vulnerable. Spouses who donated to their partners reported lower mental wellbeing compared to parents who donated to their children or other blood relatives. Donors who continued to care for their recipients after the transplant experienced more anxiety and poorer mental wellbeing. Those who felt a heavy burden from caregiving reported more physical complaints (somatization), and donors who felt personally responsible for their recipient's health were more likely to experience depression. Notably, there were also differences in mental health outcomes between the two transplant centers involved, which the researchers attribute to differences in cultural context and how the programs are organized.
This research suggests that the psychological risks of living kidney donation extend beyond the surgery itself and are shaped by the ongoing relationship between donor and recipient. Donors who take on caregiving responsibilities or feel responsible for how well their recipient does may be at higher risk for mental health difficulties. These findings highlight the importance of screening and supporting not just physical recovery in living donors, but also their emotional wellbeing—especially for spouses and those in active caregiving roles—both before and after donation.
Papachristou C, Papoulaki N, Kondi E, Budde K, Torres X, Babel N, et al.. (2026). Beyond the gift: unveiling the impact of donor-recipient relationship on donors' quality of life and mental health - results of a european bi-center study.. Transplant international : official journal of the European Society for Organ Transplantation. https://doi.org/10.3389/ti.2026.16536