3663 results in Surgery
7 - Frequency and rate
- Paul Glasziou, University of Oxford, Les Irwig, University of Sydney, Chris Bain, University of Queensland, Graham Colditz, Harvard School of Public Health
-
- Book:
- Systematic Reviews in Health Care
- Published online:
- 01 September 2009
- Print publication:
- 08 November 2001, pp 67-73
-
- Chapter
- Export citation
-
Summary
The question
Questions of frequency (or prevalence) arise commonly in health care. For example:
What is the frequency of hearing problems in infants?
What is the prevalence of Alzheimer's disease in the over-70s?
What is the frequency of BrCa1 gene for breast cancer in women?
If the proportion changes over time, then a time period is incorporated into the definition to give a rate (or incidence). Thus, a possible question may be:
What is the rate of incidence of influenza in different seasons and years?
Traditionally, for diseases, prevalence is distinguished from incidence and the following quantities have been defined (Rothman and Greenland, 1998):
prevalence – the proportion of people who have the condition at a specific point in time (frequency of current cases);
incidence – the instantaneous rate of development of new cases (also known as the incidence rate or simply the rate); and
incidence proportion – the proportion of people who develop the condition within a fixed time period (also called cumulative incidence, with a specific example being the lifetime risk).
Incidence and prevalence are linked by the duration of illness, so that in a steady-state population:
Prevalence= incidence × duration
In this book, the terms ‘frequency’ and ‘rate’ are preferred to ‘prevalence’ and ‘incidence’ because not all questions refer to diseases, but may refer to risk factors such as diet, or false-positive rates (for diagnostic questions), and so on. The definition and calculation of frequencies and rates involve a number of subtleties, which are described by Rothman and Greenland (1998).
The apparent frequency may be greatly influenced by the case definition.
10 - Prediction: prognosis and risk
- Paul Glasziou, University of Oxford, Les Irwig, University of Sydney, Chris Bain, University of Queensland, Graham Colditz, Harvard School of Public Health
-
- Book:
- Systematic Reviews in Health Care
- Published online:
- 01 September 2009
- Print publication:
- 08 November 2001, pp 102-106
-
- Chapter
- Export citation
-
Summary
The question
Prognostic questions generally contain two parts:
the definition of the patient population of interest, e.g. recent-onset diabetes, newly detected colorectal cancer; and
the outcomes of interest, such as morbidity and mortality.
The implicit third part of the usual three-part question is the set of risk factors that have been used for the prediction of prognosis. Chapter 9 looked at a single risk factor, with a particular focus on whether that risk factor was causally associated with the outcome. In this chapter this idea is extended but with a focus on prediction or prognosis for individuals. This chapter should therefore be read in conjunction with Chapter 9 on risk factors but differs in two ways.
Firstly, the principal aim is prediction of outcomes, whether or not the factors are causal. For example, an earlobe crease might be considered a valid marker of cardiovascular disease risk and form a useful part of a risk prediction model, though clearly it is a marker rather than being causal.
Secondly, the combination of multiple factors for prediction will often give better prediction than the single factors considered in Chapter 9 (e.g. Framingham cohort study risk equations for heart disease).
Why should we be interested in prediction?
There are two principal reasons for investigating questions about prediction. Firstly, patients are intrinsically interested in their prognosis, so that they can adapt and plan for their future. Secondly, separation of individuals with the same disease into those at high and low risk may be extremely valuable in appropriately targeting therapy. Generally, those with high risk have more to gain, and hence benefits are more likely to outweigh disadvantages, and also to be more cost-effective.
Index
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 305-311
-
- Chapter
- Export citation
The Transplant Patient
- Biological, Psychiatric and Ethical Issues in Organ Transplantation
- Edited by Paula T. Trzepacz, Andrea F. DiMartini
-
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000
-
Organ transplantation is an essential element of treatment for a wide range of diseases, but despite increasing surgical success rates there remain many other issues affecting selection of patients and clinical outcome with which clinicians and patients themselves must be familiar. Originally published in 2000, this book reviews psychosocial, psychiatric and ethical aspects of organ transplantation in a uniquely authoritative way. Drawing heavily on the pioneering work of the Pittsburgh transplant team, it surveys the essentials of transplantation biology before engaging with a range of topics fundamental to the success of the procedure and the quality of life of recipients and donors alike. The interdisciplinary approach and the authority of the contributors will make this book of value to anyone with an interest in organ transplantation procedures.
8 - Alcoholism and organ transplantation
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 214-238
-
- Chapter
- Export citation
-
Summary
Epidemiology
The frequency of alcohol–related end stage organ disease is surprisingly low given the prevalence of alcoholism (nearly 9% of US adults) (Grant 1994) and the toxic effects of ethanol on the liver and heart. There is not a direct concordance between alcohol use, alcohol abuse or dependence and either the development of alcoholic cirrhosis (Simko 1983; Arria, Tarter, and Van Thiel 1991) or alcoholic cardiomyopathy (Hosenspud 1994). Evidence from the natural history of alcoholic liver disease suggests that the risk of alcoholic liver disease increases with habitual alcohol intake of 20 g ethanol/day for women and 80g ethanol/day for men (Diehl 1997) (there are approximately 10g of ethanol per standard drink). But, despite the amount of heavy drinking, the lifetime incidence of alcoholic cirrhosis only approaches 50% of people who drink excessively (i.e., consumption of 227g pure ethanol or nearly one–fifth of a gallon of hard liquor per day) for over two decades (Lelbach 1975). Inconsistencies in the risk of cirrhosis by level of alcohol consumption may be due to lack of controlling for body size, gender, and alcohol consumption patterns (frequency and temporal patterns) (Parrish, Higuchi, and Dufour 1991). Nevertheless, alcohol related end stage liver disease results typically from 10 to 20 years of heavy drinking. Though a diagnosis of alcohol-induced liver disease can be supported by medical data (liver biopsy and liver enzyme profiles) in conjunction with a history of heavy alcohol consumption, a patient may not meet the criterion for alcohol abuse or dependence in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV).
9 - Ethics and images in organ transplantation
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 239-254
-
- Chapter
- Export citation
-
Summary
Introduction
The ethical issues associated with organ transplantation encompass some of the most basic features of our moral belief systems about human beings as embodied individuals. Here we find a deeply challenging mixture of images and arguments that concern life, death, and what is essential to being an intact human being. On the face of it, the issues seem clear, one person donating tissue or an organ that they are willing to give or can no longer benefit from to another person who needs that organ to live. But this is only the beginning of the discussion because of the inevitable mixed feelings that arise in relation to body parts from one person being used in another. Consider, for example, the problem of a heart transplant from a beating heart donor: if the heart is still beating and the donor is still breathing, then in what sense is the donor dead? This question has provoked one commentator to argue “that the heartbeat ‘counts for life’” (Evans 1990). It has also led some to a vigorous contemporary debate on strategies for obtaining organs for transplantation (Price 1996). The exact nature of human death and what defines life are among a number of questions that must be addressed in discussing these issues. These questions include:
Are there individuals who should be treated as freely accessible sources for organs and tissues for transplantation, such as fetuses and anencephalic infants?
If you are alive and could give a kidney to save somebody else's life, then you also decide to donate your heart to your child?
[…]
7 - Pharmacologic issues in organ transplantation: psychopharmacology and neuropsychiatric medication side effects
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 187-213
-
- Chapter
- Export citation
-
Summary
Introduction
Organ transplant candidates and recipients pose special pharmacologic problems because of organ–system insufficiency or failure, often multisystem, and the medical need for polypharmacy. The use of immunosuppressant agents post–transplantation complicates psychiatric assessment because of associated neuropsychiatric side effects. Because patients are also at risk for unusual infections that require aggressive treatment, neuropsychiatric syndromes resulting both from the medications and the infections further complicate psychiatric differential diagnosis (Trzepacz et al. 1991). The potential for drug–drug interactions is high, and can result in drug toxicity and delirium.
The psychologic stresses of undergoing organ transplantation are also high. Clinically significant depression or anxiety may be difficult to distinguish from secondary psychiatric symptoms, e.g., due to medications (e.g., ganciclovir, cyclosporine, prednisone) or to medical disorders (e.g., hypoxia, cytomegalovirus infection). Identification and treatment of primary psychiatric disorders in organ transplant patients is covered in detail elsewhere (Trzepacz et al. 1991; Trzepacz, DiMartini, and Tringali 1993b).
General issues in organ insufficiency
Some of the organs that are transplanted also play important roles in drug metabolism and clearance (for a review, see DiMartini and Trzepacz 1999). The liver is the most involved in detoxification and metabolism, with the kidneys responsible for excretion of some drugs (e.g., digoxin, lithium, gabapentin) and many metabolites of hepatically altered drugs. The heart is responsible for movement of blood that transports drugs and oxygen to all tissues. Third spacing of drugs into peritoneum (ascites) or interstitial tissues (edema) in the context of hepatic, cardiac, or renal failure may lower effective levels in the bloodstream, requiring adjustment of doses.
11 - Pediatric transplantation
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 275-286
-
- Chapter
- Export citation
-
Summary
Introduction
Pediatric recipients of organ transplants and their families present a variety of psychological and ethical challenges to transplant teams and the psychologists and psychiatrists who work with them. Some of these are relatively similar to those of adult patients, but others differ in significant ways. For example, a primary difference between adult and pediatric transplants is that the majority of organ transplantation done in children is for congenital disorders such as biliary atresia or cardiac malformations (Fox and Swazey 1992). This means that the recipients are often very young, and require an adult, usually a parent, to act as the decision maker. Congenital illnesses also mean that the child has been chronically ill, often without an experience of normal development, and sometimes with quite delayed development. A third implication of a congenital illness is that it is not acquired by the patient, and thus is not subject to the recrimination about causation or concern for recurrence frequently raised by organ damage secondary to alcohol use, cigarette smoking, or diet, and often seen in the adult population (Craven and Rodin 1992).
These areas of difference between adult and pediatric organ transplantation will be the focus of the first part of this chapter: the unique epidemiology, role of the family, issues of development, and responses of staff for pediatric organ transplant recipients.
Frontmatter
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp i-iv
-
- Chapter
- Export citation
1 - The mystique of transplantation: biologic and psychiatric considerations
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 1-20
-
- Chapter
- Export citation
-
Summary
Most major advances in medicine spring from discoveries in basic science and are therefore predictable, or at least logical. Organ transplantation was the supreme exception to the rule. Although the potential benefit of whole-organ replacement in the absence of an immune barrier was dramatically demonstrated with the identical-twin kidney transplantation performed, in December 1954, by Joseph E. Murray (Nobel Laureate, 1990; Merrill et al. 1956), this achievement only confirmed what already was known to be possible with identical-twin skin grafts (Padgett 1932; Brown 1937). In 1961, two months after receiving the 1960 Nobel Prize for research in immunology, Macfarland Burnet wrote in the New England Journal of Medicine that “much thought has been given to ways by which tissues or organs not genetically and antigenetically identical with the patient might be made to survive and function in the alien environment. On the whole, the present outlook is highly unfavorable to success …” (Burnet 1961).
This grim prospect, only a third of a century ago, faced the pioneer organ recipients whose courage in offering themselves up for human experimentation made it possible to crack the immunologic barrier (Starzl 1992). For three decades after this was done, there was no explanation for what had been accomplished. The resulting mystique of transplantation as well as the unpredictable outcome of these procedures created a fertile emotional soil for psychiatric complications.
12 - Current trends and new developments in transplantation
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 287-304
-
- Chapter
- Export citation
-
Summary
Introduction
In less than 40 years organ transplantation has advanced from the experimental laboratory to clinical reality. As such, transplantation is now viewed as the treatment of choice for most forms of organ failure. The critical shortage of organ donors has resulted in the development of innovative surgical techniques, including reduced size organ partitioning, and a greater emphasis on living donation. Likewise, the public and legislators are being asked to consider novel approaches to organ donation such as Presumed Consent and financial incentives to organ donor families. The 1990s and the century beyond hold even greater promise for significant advances in our scientific knowledge and management of allograft rejection, immune tolerance, and cross-species transplantation. This chapter focuses on recent major advances in organ transplantation in the last decade and a better understanding of immunology introduced in clinical settings with new immunosuppressant agents that now challenge conventional protocols.
In addition, the concept of chimerism has invited new and exciting approaches to tolerance induction using bone marrow and stem cell-derived factors, combined with solid organ transplantation. Cell and intestinal transplants have also been initiated and will soon be included in routine clinical practice. Finally, the previously impossible feat of xenotransplantation has now been successfully carried out by the pivotal experiments in baboon to human liver transplants.
Special recognition for the exciting field of organ transplantation was recently awarded to Drs. Joseph Murray and E. Donnall Thomas, who received the 1990 Nobel Prize in Medicine for their visionary contributions to the fields of renal and bone marrow transplantation, respectively.
5 - Quality of life of geriatric patients following transplantation: short- and long-term outcomes
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 146-163
-
- Chapter
- Export citation
-
Summary
Introduction
In recent years there has been a considerable increase in the size of the elderly population (i.e., those over 64 years of age) in the USA, with this trend expected to continue into the twenty–first century (Anand et al. 1990). From 1900 to 1990, the number of elderly American citizens increased 10-fold, rising from 3.1 million to 31.4 million, and their proportion of the total population has tripled, rising from 4.1% to 12.6%. By 1996, 20% of the US population was older than 65 years of age (Latos 1996), while in developed countries overall those aged 65 or older make up 14% of the population (Gelbard, Haub, and Kent 1999). US men who survive to age 65 can expect to live another 16 years on average; US women who are age 65 can expect to live another 19 years (Gelbard et al. 1999).
The aging of the population will play an important and controversial role in the distribution and provision of health resources. On the one hand, the existing discrepancy between the percentage of elderly in the population and the high proportion of health care resources that they consume (Rowe, Grossman, and Bond 1987) will contribute to an increase in health care spending (Chelluri et al. 1993). On the other hand, the lack of information about the influence of age on outcomes suggests the need to readdress using age as a criterion for efficient distribution of health care resources (Callahan 1987; Veatch 1988; Hunt 1993).
Preface
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp ix-xii
-
- Chapter
- Export citation
-
Summary
The transplant patient faces extraordinary challenges in their emotional and social lives as they undergo the physical transformations associated with the transplantation process. The need for an organ transplant may occur acutely or as a consequence of chronic organ insufficiency, each with its own set of biopsychosocial consequences. The interrelationships between physiology and psychological health are important for bodily health. Even immunological functions show links between brain and other body areas that may bridge emotional and physical states in complex and heretofore poorly understood ways. Pharmacological interventions often cross the bloodbrain barrier, causing psychiatric side effects – for example, during uremia or hypocholesterolemia combined with cyclosporine treatment.
Our book opens with a chapter, “The mystique of transplantation: biologic and psychiatric considerations”, by Thomas Starzl, the distinguished pioneer of liver transplantation from the laboratory to the human situation. Starzl traces the history of immunological barriers that were overcome in order to allow orthotopic organ transplantation, including engraftments of kidney, liver, lung, heart, pancreas, intestine and multiple abdominal viscera. He describes bidirectional immunologic confrontation between graft and host and the important discovery of donor leukocyte chimerism in solid organ transplantation, contrasting it with bone marrow transplantation, where host cells are deliberately cytoablated.
The closing chapter, by Maureen Martin, “Current trends and new developments in transplantation”, addresses new approaches to clinical immunosuppression, based on the concept of chimerism, which use bone marrow and stem cell-derived factors combined with solid organ transplantation.
6 - Cognitive assessment in organ transplantation
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 164-186
-
- Chapter
- Export citation
-
Summary
Introduction
Deficits on neuropsychologic tests have been reported in patients with acute and chronic pulmonary (Incalzi et al. 1993), hepatic (Tarter et al. 1991), renal (Hart and Kreutzer 1988), cardiac (Bornstein et al. 1995) and pancreatic (Ryan 1988) diseases. At first glance, it would appear that injury or disease to a vital organ directly causes an encephalopathy that is manifest in part as a cognitive impairment. Upon more careful inspection, however, it is evident that biologic, psychologic, and social contextual factors synergistically determine the pattern and severity of cognitive deficit. Specifically, a cognitive impairment is not invariably due to an encephalopathy caused by organ–system disease. Numerous factors must be taken into consideration, resulting in a variety of etiologic pathways, in determining the extent to which a cognitive deficit is causally related to the medical illness.
Integrity of brain functioning is entirely dependent on the metabolic efficiency of the other vital organs. Because the brain's metabolic reserve capacity is very limited, satisfying its high oxygen, energy, and nutritional needs depends on efficient functioning of other vital organs. Consequently, even slight perturbation, or a small reduction of metabolic efficiency, can disrupt brain functioning to the degree that an encephalopathy is manifest. Impaired cognitive functioning is typically a salient facet of the neuropsychiatric disorder.
This chapter examines the cognitive sequelae of medical disorders in which organ transplantation is a recommended treatment. There is justification for determining the cognitive capacity and efficiency of patients undergoing organ transplantation.
2 - Psychosocial screening and selection of candidates for organ transplantation
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 21-41
-
- Chapter
- Export citation
-
Summary
Overview
Since the earliest days of organ transplantation, psychiatrists and other mental health professionals have been involved in the screening and selection of candidates to receive these surgeries. Postoperative psychiatric disorders were common among the first disorders noted in patients undergoing transplant surgery, and these outcomes, while less common and more manageable today, still influence selection of patients, since pretransplant psychopathology is a predictor for post-transplant psychopathology. As a result of the growing shortage of organ donors relative to the number of persons in need of transplant surgery, there is increased pressure to select the patients most likely to benefit from the surgery, from medical and psychosocial perspectives. Concerns include the patient's ability to cope with the stresses of surgery, postoperative complications and a rigorous medical regimen, capacity to comply with lifestyle changes necessary to minimize morbidity and mortality, and attainment of a satisfactory rehabilitation and quality of life following transplant. In this chapter on psychosocial screening of transplant candidates, we discuss in turn relevant medical issues, the rationale behind screening, characteristics of screening processes (evaluation process, criteria, outcome) instruments and psychological tests used, and clinical issues related to disability law in the USA.
Patient selection – medical issues
Over the past decade, consensus within the transplant community has developed regarding some criteria for organ candidate selection and position on waiting lists. In general, the sickest patients with the least life expectancy and most limited functional capacity move to the top of the list, while patients with fewer lifestyle restrictions and with the ability to wait longer are given lower priority.
4 - Quality of life in organ transplantation: effects on adult recipients and their families
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 67-145
-
- Chapter
- Export citation
-
Summary
Introduction
Over the past 25 to 30 years, the call to examine quality of life (QOL) as it is affected by transplantation has become stronger and more urgent. This has occurred because transplantation technology and immunosuppression have improved, leading transplants of many types to become more prevalent. The increasing prevalence of transplantation demands that we consider the full range of costs and benefits of these therapies to the individual recipient, his or her family, and society at large.
It is customary to begin articles focused on QOL in transplantation with the statement that QOL has seldom been investigated and/or that little is known about QOL in transplantation. In this review, we suggest that the first point is no longer true for the established types of transplantation in adults and, as regards the second, that more is known about QOL in transplantation than has been previously recognized. There are certainly gaps in what is known, and studies vary widely in their ability to contribute to this knowledge base depending on their design, the number of subjects and the types of comparison groups included. Nevertheless, as we have argued previously (Dew and Simmons 1990; Dew 1998), just as psychometric principles show that multi-item measures of any given domain increase the reliability of our overall assessment of the domain, so too do multiple studies of QOL – each with its own strengths and weaknesses – yield a more complete and accurate understanding of QOL in transplantation than that contained in any single investigation.
List of contributors
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp vii-viii
-
- Chapter
- Export citation
10 - Psychoneuroimmunology and organ transplantation: theory and practice
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 255-274
-
- Chapter
- Export citation
-
Summary
Introduction
Psychoneuroimmunology (PNI) is the science of nervous, endocrine, and immune interactions in health and disease. Unfortunately, the field of PNI has been largely neglected by transplant biologists, who traditionally have been inclined to view the immune system as an autonomous network of host defense. However, the last decade has witnessed considerable progress in our understanding of the structural and functional pathways of neuroimmune interaction. In light of these advances, the role of PNI in organ transplantation warrants increased attention.
Transplantation is a viable clinical option for patients with a variety of end stage organ disorders. However, despite its overall success, this approach poses a variety of clinical challenges. Patients come to organ transplantation after a protracted illness, in which at least one vital organ has failed. As a rule they have previously been subjected to prolonged polypharmaceutical interventions. Anxiety and mood disorders are common, often reflecting either failed coping mechanisms including immunosuppresant mediator or the complications of metabolic encephalopathy. Frequent hospitalizations and invasive procedures also predispose these patients to developing phobias, panic disorder, and post-traumatic stress disorder (PTSD) (Surman 1989).
Successful integration of the transplanted organ is a psychosomatic challenge. From a psychodynamic perspective, the graft can be viewed as a liminal object, one that is foreign, yet also part of self. Castelnuovo-Tedesco (1981) has suggested that the graft is not psychologically inert and that mental factors can affect graft outcome.
Contents
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp v-vi
-
- Chapter
- Export citation
3 - Psychosocial issues in living organ donation
- Edited by Paula T. Trzepacz, Eli Lilly and Company, Indianapolis and university of Mississippi Medical Center, Andrea F. DiMartini, University of Pittsburgh
-
- Book:
- The Transplant Patient
- Published online:
- 14 September 2009
- Print publication:
- 16 March 2000, pp 42-66
-
- Chapter
- Export citation
-
Summary
Introduction
The theme of the gift, of freedom and obligation in the gift, of generosity and self–interest in giving, reappear in our own society like the resurrection of a dominant motif long forgotten. (Marcel Mauss, The Gift, 1954.)
The living donation of organs or bone marrow entails significant sacrifice on the part of the donor and can be legitimately classified as a unique and important form of gift giving. There are, however, features of organ donation that distinguish it from other types of gift giving, including its impersonal context, few if any penalties for refusing to donate (particularly for unrelated donors), no expectation of reciprocal gift giving, and consequences of the gift to prolong life (Titmuss 1972). Volunteer donors undergo significant discomfort, inconvenience, and physical risk to provide such gifts, suggesting uniqueness to the psychological issues surrounding the decision to donate, and factors that impact on donors' postdonation physical and psychological experiences.
Composing a coherent summary of current research and issues involved in living organ donation is a daunting task. First, unlike the case of the organ recipient, whose condition is dire regardless of what type of organ he or she is receiving, the physical risk of organ donation varies greatly across organ types. Bone marrow donation is minimally invasive and involves a regenerating body part, while kidney, liver lobe, and lung lobe donations require major surgery to remove organ or organ portions that do not regenerate (except some liver tissue).