A Swedish survey of young people's views on organ donation and transplantation

The aim of this study is to explore young people's attitudes, beliefs, and knowledge on organ donation and transplantation. A survey was conducted among 1,447 students aged 15-18 years in four urban areas in Sweden. Although students looked upon organ transplantation favorably, only 50% were willing to donate their own organs, and only 20% the organs of their parents. Concerning organ donation, 75% of the students expressed some discomfort. There were significant gender differences. About 70% of the students indicated that transplantation issues should be included in the school curriculum. It is concluded that teenagers feel irresolution and discomfort regarding organ donation after death, but concurrently see organ transplantation as a highly valued service. One way that this mental conflict can be resolved is through education. Educational programs in school must address this ambivalence and both mediate facts and help students to work through the fear and discomfort associated with organ donation.

Psychological consequences derived during process of human hand allograft

OBJECTIVE

To study the psychology and the treatment during the process of hand allograft.

METHODS

The patients were interviewed to evaluate their states of mind and their abilities to manage stress during the selection of patients. The psychology of the two patients were trained before the operation and managed accordingly afterwards.

RESULTS

One of 12 candidates was found to be unsuitable for the transplantation because of psychiatric problems. One week postoperatively, the two patients were anxious, lacked patience and were afraid of seeing the long-awaited grafted hand. After 1 week, the patients began to accept the new hand, with full acceptance of the hand 1 month later. With the recovery of hand sensation 4 to 5 months after the operation, the patients regarded the hand as their own.

CONCLUSION

Psychological problems exist during preoperative selection of patients and postoperative rehabilitation, requiring psychologists in the hand transplantation team.

Induction of antinociception and increased met-enkephalin plasma levels by cyclosporine and morphine in rats: implications of the combined use of cyclosporine and morphine and acute posttransplant neuropsychosis

BACKGROUND

Cyclosporine A (CsA) and morphine have neurotoxic and psychiatric side effects, respectively. Endogenous opiatelike peptides can elicit a number of behavioral responses that mimic the symptoms of psychiatric illness. The purpose of this study was to quantitiate the changes of Met-enkephalin (ME) and beta-endorphin (BE) after administration of CsA and morphine in surgery and to assess the antinociceptive effect.

PATIENTS AND MATERIALS

Pain sensitivity, an antinociceptive indicator in rats, was determined with the hotplate test. Plasma ME and BE levels were measured with radioimmunoassays.

RESULTS

In normal unoperated rats, CsA induced a profound analgesic effect concomitant with an increased plasma ME level on day 1. Morphine produced an analgesic effect on days 1 and 2, with decreased ME levels on days 2 and 3. Coadministration of CsA and morphine prolonged the analgesia from days 1 to 4 and increased the plasma ME level on day 1. No change in plasma BE level was found. In surgically operated rats, CsA induced an analgesic effect and higher ME levels than those in unoperated rats. Interestingly, the combined use of CsA and morphine prolonged the analgesia and increased plasma ME levels from days 1 to 4, with no significant change in plasma BE levels.

CONCLUSIONS

Our results showed that CsA can induce antinociception and increase plasma ME levels. This induction can be potentiated by the addition of morphine. Acute neuropsychiatric manifestations in the early posttransplant period might, therefore, be due to induction of ME after coadministration of CsA and morphine.

Do genetic relationships create moral obligations in organ transplantation?

In 1999, a case was described on national television in which a woman had enlisted onto an international bone marrow registry with the altruistic desire to offer her bone marrow to some unidentified individual in need of a transplant. The potential donor then was notified that she was a compatible match with someone dying from leukemia and gladly donated her marrow, which cured the recipient of the disease. Years later, though, the recipient developed end-stage renal disease (ESRD), a consequence of the high-dose chemotherapy she received earlier to destroy her stem cells and prepare her for the bone marrow transplant. Finding a suitable donor for a kidney transplant proved extremely difficult. Desperate, she requested that the donor registry personnel help her locate the individual who earlier was determined to be a compatible donor and asked this now-identifiable individual to consider donating one of her two normally functioning kidneys for a kidney transplant.

Tissue donation: what does it mean to families?

CONTEXT

Previous research has described families' responses and experiences with the donation process; however, little attention has been paid to families linked to tissue banks that have no affiliation with hospitals or organ procurement agencies.

OBJECTIVE

To assess the impact of approaches made to families who consented to tissue donation with the Donor Tissue Bank of Victoria, Australia, and to examine how this information could be used to improve the existing service.

DESIGN

An evaluation questionnaire was developed and consisted of 15 questions. The questionnaire was part of a structured follow-up service and was given only to 339 families who consented to donation.

SETTING AND PARTICIPANTS

Families who are approached about tissue donation are contacted within 24 hours of their family member's death. They are coping with the sudden unexpected death of a family member and have little knowledge of tissue donation or the donor tissue bank.

MAIN OUTCOME MEASURES

Fifty-eight percent of participants completed the questionnaire. The data were quantitatively and qualitatively examined.

RESULTS

The skills and procedures utilized by the transplant coordinators are affirmed by the results, and respondents appear to find contact with the donor tissue bank positive at a terrible time in their lives. Approaches to families must be made sensitively and sufficient information must be given to enable decision making.

[Psychosomatic medicine and transplant patients - what is known and what is needed]

Psychosomatic research has resulted in a huge pool of data concerning the psychic state of transplant patients and their relatives during the course of organ transplantation. It has been possible as well to describe important psychosocial prognostic factors, influencing both somatic and psychosocial outcome after transplantation. The following review article gives an overview of the results that are relevant to daily psychosomatic practice in transplantation medicine. It mainly deals with the problems of transplant patients and their relatives. The special issues of living related organ donation cannot be subject of this review. Finally the article tries to show perspectives for the development of psychosomatic interventions in the treatment of organ transplant patients.

Commodified kin: death, mourning, and competing claims on the bodies of organ donors in the United States

A pronounced disjunction characterizes symbolic constructions of the cadaveric donor body in the United States, where procurement professionals and surviving donor kin vie with one another in their desires to honor this unusual category of the dead. Of special concern is the medicalized commodification of donor bodies, a process that shapes both their social worth and emotional value. Among professionals, metaphorical thinking is key: death and body fragmentation are cloaked in ecological imagery that stresses renewal and rebirth. Such objectification also obscures the origins of transplantable organs, renders individual donors anonymous, and silences kin who mourn their dead. In response, donor kin have grown increasingly assertive, generating alternative public mortuary forms that exclude professional mediators. In so doing, they challenge the medical assumption that anonymity is central to transplantation's continued success. Through donor quilts and Web cemeteries, they proclaim the personal identities of donors who, at times, may speak beyond the grave, offering critiques of donation as socio-medical process in the United States.

Psychiatric morbidity in patients undergoing heart, heart and lung, or lung transplantation

OBJECTIVES

To determine the rate of psychiatric disorder in people undergoing heart and/or lung transplantation; to identify the associations of psychiatric disorder in this group.

METHOD

Preoperative assessments were carried out on an 18-month sample of consecutive admissions to a regional unit for heart and lung transplantation in the UK. Assessment included psychiatric morbidity, sexual dysfunction, quality of life, and demographic and clinical characteristics.

RESULTS

Seventy-six of 79 eligible subjects took part in the assessment. Thirty (39%) were suffering from a psychiatric disorder, the most common being major depressive disorder. Forty-four (58%) reported sexual dysfunction. Clinically significant psychiatric morbidity was associated with a history of treatment for mental disorder, unemployment, and length of physical illness. Patients with psychiatric disorder reported poorer quality of life on the SF-36, with lower scores on subscales for general health perception, social functioning, and energy/vitality.

CONCLUSION

There is a substantial rate of psychiatric disorder in people undergoing heart and/or lung transplantation. Risk is higher in people with a history of psychiatric vulnerability and current illness-related factors. Preoperative psychiatric assessment and intervention in some patients may be a valuable part of their clinical care.

Standards for economic and quality of life studies in transplantation

There are unique requirements in conducting and reporting economic and quality of life investigations in medicine as compared with more traditional studies involving clinical outcomes. In addition, there are several unique characteristics of the discipline of transplantation that also bear attention in economic and quality of life studies. To provide guidelines for future research and reporting of future research, a consensus conference of transplant professionals was convened to discuss these issues. Five different areas were addressed: "Conducting an Economic Analysis," "Reporting an Economic Analysis," "Quality of Life Studies in Transplantation," "Ethical and Conflict of Interest Issues Between Sponsors and Investigators," and "Future Directions for Research." A series of recommendations for each of these areas with reference to relevant literature is presented.

Promoting adherence to transplant medication regimens: a review of behavioral analysis

Failure to adhere to complex behavioral regimens has been a significant and long-standing problem in healthcare. Transplant recipients are one patient population that needs to learn and incorporate a multidimensional regimen of behaviors into their lives. The literature indicates that not all transplant recipients adhere to their medication regimens, which can lead to graft loss and possibly death. Behavioral analysis is often used to increase adherence to health-related regimens and has been effective for a variety of health conditions. The use of behavioral analysis as a strategy to promote adherence behaviors has not been reported in the transplant literature. Transplant coordinators and clinicians should learn the principles of behavioral analysis and apply them to the care of transplant recipients to facilitate recipients' lifelong adherence behaviors.

The use of over-the-counter medications by transplant recipients: a guideline

Over-the-counter medications are becoming increasingly available to the general public. One of the issues facing clinicians working with transplant recipients is how to advise patients regarding management of symptoms associated with common ailments. Minimal literature is available to assist the transplant coordinators in this process. This article describes the usual immunosuppressants prescribed for transplant recipients and the over-the-counter medications used to manage these symptoms, and provides recommendations for over-the-counter medications with the least side effects.

Direct contact between donor families and recipients: crisis or consolation?

A dramatic growth has been seen in the number of organ procurement organizations, transplant programs, and new initiatives related to solving the organ shortage, as well as in the development of protocols dealing with the logistics of facilitating organ and tissue recovery. Extensive deliberation on critical issues related to the organ donor shortage is evident in professional meetings, publications, and educational endeavors. Little research has been conducted, however, regarding direct contact between donor families and recipients, a highly controversial subject in transplantation and procurement. Should there be contact between donor families and recipients? What format should such contacts take? Who should decide? These are questions that must be considered in the field. This article will explore an organ procurement organization's 5-year experience regarding direct contact between donor families and recipients.

Renaissance of immunosuppressive therapy in the new millennium

Immunosuppression in the next millennium will be based not merely on the survival of the patient and his graft, but more importantly on regimens that optimize the "Three C's": Co-morbidity, Cost, and Convenience. To meet these goals, the field of transplantation urgently requires new technologies: both new scientific tools of drug design, testing, and implementation, and informational tools including a categorical database and theoretical models to answer specific therapeutic questions. Just as the Renaissance marked a renewed interest in man himself after an age of Medieval spiritualism, so too will transplantation need to address the unique concerns of each patient to achieve an optimal outcome that includes self-reliance and the desired "texture of life." In weaving our tapestry for the 21st century, we must meet these challenges not merely with the 20th century tools at hand but with a strategic vision that searches for, readily adopts, and effectively harnesses unique technology.