Abstract Altruistic donation is currently a common source of organs for kidney transplantation in the United States. In clinical practice, prospective donors typically undergo psychosocial evaluations to determine their suitability for donation. However, the current guidelines for such assessments contain limited recommendations in regard to specific psychiatric disorders. Here we discuss the case of a patient with dissociative identity disorder (DID) who presented for altruistic kidney donation, the challenges involved in her evaluation, and available evidence pertaining to risk assessment in this patient population. Stable baseline functioning, fewer suicidal behaviors, higher integration of personality states and engagement in long term specialized treatment may predict a better general psychiatric prognosis for DID patients, and thus may be useful parameters to consider when assessing risk for live organ donation. We recommend a multi-pronged approach to the psychosocial evaluation for DID patients for altruistic kidney donation. Such an approach should include taking an extensive history of psychiatric illness including suicidal and self-injurious behavior, any prior experiences or adverse responses to medical and surgical procedures, and assessment of baseline functioning and level of integration of personality states. Performing a careful capacity assessment for informed consent should include a focus on the patient’s personalities’ opinions about donation while evaluating for any discrepancies between them. Collateral history is also crucial for determining risk as both the patient’s psychiatric narrative and consistency amongst personality states must be corroborated. Finally, we recommend consulting DID experts and including their recommendations in the final risk assessment.

中文翻译：

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分离性身份障碍患者的利他性肾脏捐赠：病例报告

摘要 无私捐赠是目前美国肾移植器官的常见来源。在临床实践中，潜在捐赠者通常会接受社会心理评估，以确定他们是否适合捐赠。然而，目前针对此类评估的指南对特定精神疾病的建议有限。在这里，我们讨论了一名接受无私肾脏捐赠的分离性身份障碍 (DID) 患者的案例、她的评估所涉及的挑战以及与该患者群体的风险评估有关的现有证据。稳定的基线功能、更少的自杀行为、更高的人格状态整合和长期专业治疗的参与可能预示着 DID 患者更好的一般精神病预后，因此，在评估活体器官捐赠的风险时，可能是需要考虑的有用参数。我们建议对无私肾脏捐赠的 DID 患者进行多管齐下的社会心理评估。这种方法应该包括广泛的精神疾病史，包括自杀和自伤行为、任何先前的经历或对医疗和外科手术的不良反应，以及评估基线功能和人格状态的整合水平。对知情同意进行仔细的能力评估应包括关注患者个性对捐赠的看法，同时评估他们之间的任何差异。附带病史对于确定风险也至关重要，因为必须证实患者的精神病学叙述和人格状态之间的一致性。最后，我们建议咨询 DID 专家，并将他们的建议纳入最终风险评估中。