Live Donor Assessment Tool (LDAT)
©LDAT: Recanati/Miller Transplantation Institute at Mount Sinai and the Zweig Family Center for Living Donation, 1425 Madison Ave, New York, NY, 10029
The Live Donor Assessment Tool (LDAT) is to be used as part of the live donor psychosocial evaluation to provide a quantitative indicator of the psychosocial risk
level of potential live organ donors. It was created to standardize the process by which donor candidates are evaluated across institutions. Please rate the
following items during or after the psychosocial evaluation interview.
1.
0
1
2
3
No internal desire to donate and/or has not thought about donation previously (Donation motivation is for external benefit; spouse
donating to spouse to help him/her get back to work, family life will improve)
Little internal desire to donate and/or wish to be last option (I will do this if I am the only option)
Moderate internal desire to donate (“I would like to help”)
Significant internal desire to donate (“I am the donor”; expresses strong interest in donating, other donors have come forward but wants
to be the donor, altruistic donors)
2.
0
1
2
3
Appropriateness of Motives (Choose all that apply)
Correct the past
Lack of flexibility
To improve own quality of life
Obligation
Religion
Other (list)
4.
0
1
2
3
Motivation to Donate: External Motivation (Motivated by influences outside individual; external gain, relief of
burden)
Expresses no external benefit or influence to donate (Outcome has no impact on donor’s life/altruistic or non-directed donor)
Expressed little external benefit or influence to donate (Patient’s life will not significantly improve as a result of donating, minor impact)
Expresses moderate external benefit or influence to donate (Spouse donating to spouse so that he/she can get back to work and donation
will make their life easier in some way)
Expresses significant external benefit to donate (Outcome has a strong impact on donor’s life)
Exchange for money: AUTOMATIC RULE-OUT
3.
-1
-1
0
0
1
Motivation to Donate: Internal Motivation (Motivated by task of donation itself; personal desire to help someone)
1
1
1
1
1
Previous knowledge/experiences with living donation
To save recipient’s life
Altruism to community
Altruism to family
To improve recipient’s quality of life
Knowledge of Process
Little to no knowledge/comprehension of donation process (Not able to remediate, unable to comprehend donation process)
Minimal knowledge/comprehension of donation process (Intervention needed to improve knowledge)
Fair to moderate knowledge/comprehension of donation process (Can describe general components of donation process)
Extensive knowledge/comprehension of donation process (Can describe general components as well as details of donation process)
5.
Knowledge of Recipient’s Diagnosis and Prognosis (Non-Directed Donors: Assess Understanding of Diagnosis and
Prognosis of Donation)
0 Little to no knowledge of the recipient’s diagnosis and prognosis (For non-directed donors: “I am donating my kidney because he is going
to die without it”)
1 Minimal knowledge of the recipient’s diagnosis and prognosis (Understands the basics; the patients kidneys/liver doesn’t function and a
transplant will make this better)
2 Moderate knowledge of the recipient’s diagnosis and prognosis (Has some understanding of the cause of organ failure and has some
understanding of the implications of life with a transplant)
3 Extensive knowledge of the recipient’s diagnosis and prognosis (Understands thoroughly the etiology of end organ disease, co-morbidities
and has a realistic expectation of prognosis; For non-directed donors: “I am donating my kidney to help improve someone’s quality of life
and help someone get off dialysis)
June 15, 2015
6.
0
1
2
3
Does not know recipient (Non-directed, altruistically directed such as community/social networks/media, no direct relationship with
recipient)
Minimal/distant relationship with recipient (Distant relative, connected through another person, limited contact)
Fairly close relationship with recipient (Contact with recipient on regular basis; significant relationship)
Close relationship with recipient/primary role in donor’s life (Parent, child, sibling, spouse/significant other)
7.
0
1
2
3
Available Support from Caregiver
No identifiable caregiver plan
Caregiver can provide minimal support (“I’ll pick you up but I won’t be able to take care of you at home”)
Caregiver can provide some support (“Even though I will be at work, I will leave you meals and come to check on you”)
Solid caregiver support plan
9.
0
1
2
3
Significant Other/Family Agreeable to Decision
Significant other/family does not agree with decision and does not accept/no significant other, family or friends (Significant other
believes donation is a mistake, donation will alter relationship with significant other or are unaware of plan to donate)
Significant other/family/friends expressed concern, hesitant to accept decision and not supportive
Significant other/family/friends may have concerns but is ultimately supportive/neutral about decision
Significant other/family/friends in full support and/or is actively participating in donation process
8.
0
1
2
3
Closeness to Recipient
Coercion
External threats posed if patient does not donate/persistent external pressure to donate (Patient feels forced to donate)
Moderate external pressure to donate (Signs of pressure to donate/emotional blackmail)
Some external encouragement to donate (Patient asked/encouraged to get tested for donation)
No external pressure to donate
10. Anxiety/Fear
0
0
1
3
Expression or demonstration of anxiety/fear is a predominating factor (Patient cannot successfully manage anxiety/fear about donation)
Denial of any anxiety/fear
Moderate expression or appearance of anxiety/fear (Focused on concerns about donation)
Realistic expression or appearance of anxiety/fear (Anxiety/fear about donation is managed by knowledge, faith in process, support from
loved ones, etc.)
11. Indecision Behavior
0
1
2
3
Responses indicate significant inconsistency with interest/motivation to donate (Patient did not complete evaluation)
Adequate thought and time spent toward donation (Patient has rescheduled appointments or has not shown up to appointments)
Few inconsistencies in actions/attitude toward donation (Patient is late to appointments, not due to scheduling issues; passive)
Responses indicate consistent interest/motivation to donate (Patient arrives to appointments on time; proactive)
12. Impulsivity
0
1
2
Impulsive (Patient has not thought whole process through, made a quick decision, did not research)
Adequate thought and time spent toward donation (Spent moderate time considering donation and/or researched donation)
Extensive thought and time spent toward donation (Spent extensive time considering donation and/or researched donation)
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13. Ambivalence
0
1
2
3
Expressed significant struggle with mixed feelings/contradictory ideas about donation (Patient is unable to resolve conflicted feelings
about donation)
Expressed moderate level of mixed feelings about donation (Patient is somewhat troubled about proceeding with donation/not certain if
they want to donate)
Patient’s mixed feelings or conflicting thoughts about donation are minimal (Patient acknowledges risks of donation but decides to
proceed, patient experiences some mixed feelings – crying and tearful, but is certain about wanting to proceed)
Expressed no mixed feelings or conflicting thoughts about donation
14. Post-Donation Expectations: Physical
0
2
No, physical expectations are not consistent with materials
Yes, physical expectations are consistent with materials, balanced
If expectations are not consistent with materials, please specify (Circle all that apply):
Exaggerates positives
Exaggerates negatives
Anxious
Denial
Passive
15. Post-Donation Expectations: Psychosocial
0
2
No, psychosocial expectations are not consistent with materials
Yes, psychosocial expectations are consistent with materials
If expectations are not consistent with materials, please specify (Circle all that apply):
Exaggerates positives
Exaggerates negatives
Anxious
Denial
Passive
16. Post-Transplant Expectations for Recipient
0
2
No, post-transplant expectations for recipient are not consistent with materials
Yes, post-transplant expectations for recipient are consistent with materials
If expectations are not consistent with materials, please specify (Circle all that apply):
Exaggerates positives
Exaggerates negatives
Anxious
Denial
Passive
17. Early Life
0
2
Unstable (PTSD, rape, divorce with traumatic response)
Stable
18. Current Relationship Stability
0
2
Unstable
Stable
19. Current Employment
0
2
Inconsistent employment/unemployed
Consistent employment/student
20. Current External Life Stressors within the Last Year (Family, finance, divorce, death, abuse, other; excluding
substance abuse or mental illness)
0
1
2
3
Severe, active or current
Moderate
Minimal
Absent
Please specify:
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21. Current Sleep
0
2
Less than 6 hours, or greater than 10 hours
6-9 hours
22. Pain Tolerance
0
2
2
3
Low
N/A (Never had experience with pain)
Medium
High
23. Presence of Psychopathology
0
1
2
3
Extreme/severe psychopathology (Patient is in need of acute psychiatric intervention before proceeding; severe acute symptoms
currently; noncompliance with psychiatric medication regimens; multiple psychiatric hospitalizations; current SI/SA
Moderate psychopathology (moderate acute symptoms currently; responsive to treatment in the past; good compliance with psychiatric
medication regimens; history of SI/SA but not current)
Mild psychopathology ( mild, self-limiting symptoms without significant impact on functioning; no treatment needed)
None (No history of psychiatric problems or treatment)
24. Influence of Personality Traits vs. Disorder
0
1
2
3
Severe (Extreme character pathology or history of severe personality disorder present in response to illness, medical treatment or
psychosocial stressors; patient is in need of acute psychiatric intervention before proceeding or has needed multiple psychiatric
hospitalizations in the past)
Moderate (History of moderate personality traits or psychopathology in response to illness, medical treatment or psychosocial stressors;
treatment, if needed, has been effective; patient with good compliance, no characterological interference with treatment; no history of
SI/SA)
Mild (History of mild personality traits or psychopathology in response to illness, medical treatment or psychosocial stressors)
None (No history of significant personality disorder or traits of disorder)
25. Effect of Truthfulness vs. Deceptive Behavior in Presentation
0
2
3
There is clear evidence of deceptive behavior as evidenced by records, collateral information or testing/patient has not been fully
forthcoming with negative information; information obtained only from external sources
Patient has not been fully forthcoming with negative information, but provides to confrontation
Patient has not volunteered some negative information, but truthfully answered direct questioning/no evidence of deceptive behavior
by history or at present
26. Alcohol Use/Abuse/Dependence/Severe Use (Reflect Audit C-SDS)
0
1
2
3
History of SEVERE use or current SEVERE use (Patient qualifies for current or past alcohol abuse/dependence diagnoses, OR required
treatment or intervention)
Current MODERATE alcohol use (Evidenced by excessive drinking, heavy social alcohol use)
Past MODERATE alcohol use (Evidenced by excessive drinking, heavy social alcohol use)
Past or current MINIMAL use, OR no use history (History of minimal alcohol use which has caused no social or medical problems (i.e. no
abuse); if requested by the team the patient promptly discontinued all use; mild social use and agrees to stop for donation; or no history of
alcohol use)
Current alcohol dependence/abuse/severe use: AUTOMATIC RULE-OUT
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27. Substance Use/Abuse/Dependence/Severe Use (Excluding Marijuana and Alcohol)
0
1
2
3
History of SEVERE use or current SEVERE use (Patient qualifies for current or past drug abuse/dependence diagnoses, OR required
treatment or intervention)
Current MODERATE substance use (Evidenced by excessive substance use, heavy social use, etc.)
Past MODERATE substance use (Evidenced by excessive substance use, heavy social use, etc.)
Past or current MINIMAL use, OR no use history (History of minimal drug use which caused no social or medical problems (i.e. no abuse);
if requested by the team the patient promptly discontinued all use; mild social use and agrees to stop for donation; or no history of drug
use)
Current dependence/abuse/severe use: AUTOMATIC RULE-OUT
28. Marijuana Use/Abuse/Dependence/Severe Use
0
1
2
3
History of SEVERE use or current SEVERE use (Patient qualifies for current or past abuse/dependence diagnoses, OR required treatment or
intervention)
Current MODERATE substance use (Evidenced by excessive marijuana use, heavy social use, etc.)
Past MODERATE substance use (Evidenced by excessive marijuana use, heavy social use, etc.)
Past or current MINIMAL use, OR no use history (History of minimal use which caused no social or medical problems (i.e. no abuse); if
requested by the team the patient promptly discontinued all use; mild social use and agrees to stop for donation; or no history of drug use)
29. Nicotine Use/Abuse/Dependence/Severe Use
0
1
3
Still currently smoking
Former smoker (Stopped greater than 6 months ago)
None (No history of nicotine use)
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The LDAT tool comprises 29 items across 9 domains (motivation, knowledge about donation, relationship with the recipient, support available to the donor,
feelings about donation, post-donation expectations, stability in life, psychiatric issues, and alcohol and substance use). The total score (0-82) is calculated as the
sum of the individual item scores. Higher scores indicate more desirable pre-donation psychosocial characteristics or lower psychosocial risk, and lower scores
indicate less desirable characteristics or increased risk for donation.
Patient Identifier:
Relationship to Recipient:
Assessment Completed By:
Date:
Scoring
1.
2.
3.
Motivation
Questions: 1, 2, 3
Maximum score: 12
Domain Total:
Knowledge about Donation
Questions: 4, 5
Maximum Score: 6
Domain Total:
Relationship with the Recipient
Question: 6
Maximum Score: 3
Domain Total:
4.
Support Available to the Donor
Questions: 7, 8
Maximum Score: 6
Domain Total:
5.
Feelings about Donation
Questions: 9, 10, 11, 12, 13
Maximum Score: 14
Domain Total:
6.
Post-Donation Expectations
Questions: 14, 15, 16
Maximum Score: 6
Domain Total:
7.
Stability in Life
Questions: 17, 18, 19, 20, 21, 22
Maximum Score: 14
Domain Total:
8.
Psychiatric Issues
Questions: 23, 24, 25
Maximum Score: 9
Domain Total:
9.
Alcohol and Substance Use
Questions: 26, 27, 28, 29
Maximum Score: 12
Domain Total:
TOTAL SCORE (maximum score 82): _____
X-X
X-X
X-X
Low Psychosocial Risk Candidate
Moderate Psychosocial Risk Candidate
High Psychosocial Risk Candidate
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