2 results
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.
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).