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van Daal M, de Kanter AFJ, Jongsma KR, Bredenoord AL, de Graeff N. Embodiment and regenerative implants: a proposal for entanglement. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2024; 27:241-252. [PMID: 38492184 PMCID: PMC11076359 DOI: 10.1007/s11019-024-10199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 03/18/2024]
Abstract
Regenerative Medicine promises to develop treatments to regrow healthy tissues and cure the physical body. One of the emerging developments within this field is regenerative implants, such as jawbone or heart valve implants, that can be broken down by the body and are gradually replaced with living tissue. Yet challenges for embodiment are to be expected, given that the implants are designed to integrate deeply into the tissue of the living body, so that implant and body become one. In this paper, we explore how regenerative implants may affect the embodied experience of implant recipients. To this end, we take a phenomenological approach. First, we explore what insights the existing phenomenological and empirical literature on embodiment offers regarding the experience of illness and of living with regular (non-regenerative) implants and organ transplants. Second, we apply these insights to better understand how future implant recipients might experience living with regenerative implants. Third, we conclude that concepts and considerations from the existing phenomenological literature do not sufficiently address what it might be like to live with an implantable technology that, over time, becomes one with the living body. We argue that the interwovenness and intimate relationship of people living with regenerative implants should be understood in terms of 'entanglement'. Entanglement allows us to explore the complexities of human-technology relations, acknowledging the inseparability of humans and implantable technologies. Our theoretical foundations regarding the role of embodiment may be tested empirically once more people will be living with regenerative implants.
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Affiliation(s)
- Manon van Daal
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Anne-Floor J de Kanter
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Karin R Jongsma
- Department of Bioethics and Health Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Annelien L Bredenoord
- Erasmus School of Philosophy, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Nienke de Graeff
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden University, Leiden, The Netherlands
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2
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Wadden JJ, Hermiston J, Blydt-Hansen TD, Dhaliwal R, Gielen S, Virani A. Exploring the Ethical Considerations of Direct Contact in Pediatric Organ Transplantation: A Qualitative Study. AJOB Empir Bioeth 2022; 14:143-154. [PMID: 36574227 DOI: 10.1080/23294515.2022.2160513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023]
Abstract
BACKGROUND Nonanonymized direct contact between organ recipients and donor families is a topic of international interest in the adult context. However, there is limited discussion about whether direct contact should be extended to pediatric settings due to clinician and researcher concerns of the potential harms to pediatric patients. METHODS We interviewed pediatric organ recipients, their families, and donorfamilies in British Columbia, Canada, to determine their views on direct contact. Interviews were conducted in two stages, with those who were further removed from the transplant process informing the approach to interviews with those who more recently went throughthe transplant process. RESULTS Twenty-nine individuals participated in twenty in-depth interviews. The study included participants from three major organ systems: kidney, heart, and liver. Only five participants expressed that direct contact might cause harm or discomfort, while twenty-three indicated they saw significant potential for benefits. Nearly half focused on the harms to others rather than themselves, and nearly two-thirds focused on the benefits for others rather than themselves. CONCLUSION There appears to be a community desire for direct contact in pediatric organ transplant programs among those living in British Columbia, Canada. These results suggest a need to revisit the medical community's assumptions around protection and paternalism in our practice as clinicians and researchers.
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Affiliation(s)
- Jordan Joseph Wadden
- Ethics Department, Ontario Shores Centre for Mental Health Sciences, Whitby, ON, Canada
- Department of Philosophy, University of British Columbia, Vancouver, BC, Canada
| | - Jordan Hermiston
- Family Services, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Tom D Blydt-Hansen
- Department of Pediatrics (Nephrology), University of British Columbia, Vancouver, BC, Canada
- Multi-Organ Transplant Program, BC Children's Hospital, Vancouver, BC, Canada
| | - Ranjeet Dhaliwal
- Patient and Family Partner, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Shelby Gielen
- Patient and Family Partner, BC Transplant, Provincial Health Services Authority, Vancouver, BC, Canada
| | - Alice Virani
- Ethics Services, Provincial Health Services Authority, Vancouver, BC, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
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3
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Murakami N, Baggett ND, Schwarze ML, Ladin K, Courtwright AM, Goldberg HJ, Nolley EP, Jain N, Landzberg M, Wentlandt K, Lai JC, Shinall MC, Ufere NN, Jones CA, Lakin JR. Top Ten Tips Palliative Care Clinicians Should Know About Solid Organ Transplantation. J Palliat Med 2022; 25:1136-1142. [PMID: 35275707 PMCID: PMC9467633 DOI: 10.1089/jpm.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Solid organ transplantation (SOT) is a life-saving procedure for people with end-stage organ failure. However, patients experience significant symptom burden, complex decision making, morbidity, and mortality during both pre- and post-transplant periods. Palliative care (PC) is well suited and historically underdelivered for the transplant population. This article, written by a team of transplant specialists (surgeons, cardiologists, nephrologists, hepatologists, and pulmonologists), PC clinicians, and an ethics specialist, shares 10 high-yield tips for PC clinicians to consider when caring for SOT patients.
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Affiliation(s)
- Naoka Murakami
- Division of Renal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nathan D Baggett
- Division of Emergency Medicine, Health Partners Institute/Regions Hospital, St. Paul, Minnesota, USA
| | | | - Keren Ladin
- Department of Occupational Therapy, Tufts University, Medford, Massachusetts, USA.,Department of Community Health, Tufts University, Medford, Massachusetts, USA
| | - Andrew M Courtwright
- Department of Pulmonary and Critical Care Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hilary J Goldberg
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Eric P Nolley
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Nelia Jain
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Michael Landzberg
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kirsten Wentlandt
- Division of Palliative Care, University Health Network and University of Toronto, Toronto, Ontario, Canada
| | - Jennifer C Lai
- Department of Medicine, University of California, San Francisco, California, USA
| | - Myrick C Shinall
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Section of Palliative Care, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Joshua R Lakin
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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4
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Laneuville L, Ballesteros F, Affdal A, Malo MF, Brassard L, Gagnon Chainey B, Millot P, Mavrikakis C, Harel S, Fortin MC. Perspectives of Kidney Transplant Recipients, Transplant Candidates, and Living Kidney Donors on the Role of Patients’ Self-Narratives and Experiences of Creative Writing Workshops: A Qualitative Study. Can J Kidney Health Dis 2022; 9:20543581221132742. [PMID: 36353517 PMCID: PMC9638699 DOI: 10.1177/20543581221132742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Kidney transplantation is the best treatment for kidney failure but is
associated with medical, psychological, and existential challenges for
patients. Patients’ experiential knowledge can help other patients facing
these challenges. Patients’ self-narratives and creative writings are ways
to operationalize this experiential knowledge. Creative writing has been
described as a therapeutic tool for patients with chronic disease. Over the
past year, we conducted creative writing workshops with kidney transplant
recipients (KTRs), living kidney donors (LKDs), kidney transplant candidates
(KTCs), and professional writers. During these workshops, patients were
invited to explore different aspects of their experiences of their
transplant or donation journey through narrative-writing, poetry, comic art,
and screenwriting. Objective: The objectives of this study were to gather the perspectives of KTRs, KTCs,
and LKDs on the role of patients’ self-narratives and creative writing, and
to collect patients’ experiences of the creative writing workshops. Design: Focus groups and individual interviews. Setting: The Center hospitalier de l’Université de Montréal (CHUM) kidney transplant
program. Participants: KTRs, LKDs, and KTCs attending the CHUM kidney transplant clinic between
February 2020 and January 2021. Methods: We conducted 2 focus groups and 8 semi-structured individual interviews with
7 KTRs, 8 LKDs, and 5 KTCs from the CHUM between June and November 2020,
before the creative writing workshops. We also conducted 10 semi-structured
interviews with 5 KTRs, 1 KTC, and 4 LKDs in March 2021, after their
participation in the creative writing workshops. The interviews were
recorded and transcribed. Thematic and content analyses were conducted. Results: KTRs, LKDs, and KTCs had multiple significant moments to share from their
transplant/donation journey. These moments were highly emotional and marked
by uncertainty. The creative writing workshops were described as therapeutic
by participants, because they offered a safe space for group-facilitated
reflection, including a discovery and learning process, and normalization,
relativization, and appreciation of the transplant/donation experience. The
creative writing workshops also provided an opportunity to give back to
others (helping other patients, promoting kidney donation and continuing
this process in the future through the web platform). Limitations: Our participants came from a single French-speaking urban transplant center
in Quebec and were highly educated. Conclusion: The study set out to capture the perspectives of KTRs, LKDs, and KTCs through
the sharing of self-narratives and their participation in creative writing
workshops related to their transplant or donation journey. A website was set
up to publish patients’ creative writings (https://recitsdudonetdelavie.lorganon.ca/les-recits/).
Further study is needed to assess the website’s impact on other
patients. Trial registration: Not registered.
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Affiliation(s)
- Laurence Laneuville
- Department of Psychiatry, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | | | - Aliya Affdal
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Marie-Françoise Malo
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
| | - Léonore Brassard
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Benjamin Gagnon Chainey
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
| | - Pascale Millot
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Catherine Mavrikakis
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département des littératures de langues française, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Simon Harel
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Département de littératures et de langues du monde, Faculté des arts et des sciences, Université de Montréal, QC, Canada
| | - Marie-Chantal Fortin
- Centre de recherche du CHUM, Montréal, QC, Canada
- Bioethics Program, École de santé publique de l’Université de Montréal, QC, Canada
- Chaire McConnell-Université de Montréal en recherche-création sur les récits de don et de la vie en contexte de soins, QC, Canada
- Faculté de médecine, Université de Montréal, QC, Canada
- Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada
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Mierzyńska A, Kokoszka A, Jerzak-Wodzyńska G, Sobieszczańska-Małek M, Zieliński T, Piotrowicz R. Involvement in Health Behavior After Heart Transplantation: The Role of Personal Resources and Health Status. Single-Center Observational Study. Front Psychol 2021; 12:710870. [PMID: 35002825 PMCID: PMC8732372 DOI: 10.3389/fpsyg.2021.710870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: Heart transplantation affects all spheres of the patients’ functioning - their physical well-being and coping with everyday situations, as well as their identity and social functioning. Its long-term effects depend on the effective cooperation with the transplant team. Post-transplant patients are expected to be committed to adherence to recommendations. Patients’ subjective characteristics could increase the risk of difficulties during treatment or might have a protective effect. The major aim of the study was to evaluate the level of engagement in health behavior in heart transplant recipients in relation to their personal resources, such as personality traits, and their health status. Material and Method: The observational ex post facto model was proposed. Participants completed a set of psychological questionnaires. In the study, there were used questionnaires regarding health behavior (HBI), personality traits (NEO-FFI), health locus of control (MHLC), self-efficacy (GSES) and health status (GHQ-28). The group included in the analyses consisted of 107 heart transplant patients. They ranged in age from 19 to 75 years; 10.3% of them were women. Results: According to norms, 71% patients reported high level of engagement in health behavior. There were significant differences in the level of dietary habits and other types of health behaviors. The best predictors of overall health behavior were conscientiousness (β = 0.20, p < 0.05) and health locus of control (Powerful Others) (β = 0.25, p < 0.05). The prophylaxis behavior was related significantly to the level of conscientiousness (p < 0.05) and health locus of control (Internal and Powerful Others) (p < 0.05; p < 0.01). The level of positive mental attitude was related significantly to agreeableness (p < 0.05), health locus of control (Powerful Others) (p < 0.01), and self-efficacy (p < 0.01). Everyday healthy practices were related significantly to openness to experience (p < 0.01) and health locus of control (all categories: Internal, Powerful Others and Chance) (p < 0.05; p < 0.01; p < 0.05, respectively). Conclusion: Majority of heart transplant patients is engaged in high level of health behavior. Among the various forms of health-relevant habits, heart transplant patients adhere significantly less frequently to a healthy diet. Among examined resources, the best predictors of caring about health are generalized self-efficacy and age at the time of HTx.
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Affiliation(s)
- Anna Mierzyńska
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland
- Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland
- *Correspondence: Anna Mierzyńska,
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Jerzak-Wodzyńska
- Department of Heart Failure and Transplantology, National Institute of Cardiology, Warsaw, Poland
| | | | - Tomasz Zieliński
- Department of Heart Failure and Transplantology, National Institute of Cardiology, Warsaw, Poland
| | - Ryszard Piotrowicz
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, Warsaw, Poland
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6
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Lafrance M. 'That is the skin of my brother': alterity, hybridity and media representations of facial transplantation. MEDICAL HUMANITIES 2021; 47:438-446. [PMID: 33906952 DOI: 10.1136/medhum-2020-012031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
In this paper, I explore the 2012 face transplant performed on US recipient Richard Norris and how it was represented by the media as a 'makeover story'. Informed by press coverage from the date of the transplant to the present day, I examine a widely viewed and critically acclaimed investigative report that aired on CBS's 60 Minutes entitled 'My Brother's Keeper'. Through a close reading of both its form and content, I claim that the report's makeover story consists of four key themes: heroic medicine and miraculous science; appearance-based stigma and social alienation; appearance-based conformity and social assimilation; and subjective alterity and embodied hybridity. In doing so, I contend that the report's themes contain the widespread ambivalence about facial transplantation by confirming prevailing assumptions about medical science and how it creates normal people who live good lives. That said, I also contend that the report's themes complicate these assumptions by highlighting how facial transplantation invariably involves immediate encounters with otherness and corporeal interconnectedness. I conclude that the report's makeover story-characterised as it is by the constraints of the before-and-after format-must be rethought and, ultimately, reworked if we wish to do justice to face transplant recipients.
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Affiliation(s)
- Marc Lafrance
- Sociology and Anthropology, Concordia University, Montreal, QC H3G 1M8, Canada
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7
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Integration Process With a Donated Heart: A Grounded Theory Study. Dimens Crit Care Nurs 2021; 41:10-17. [PMID: 34817955 DOI: 10.1097/dcc.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In the posttransplant period, recipients face a complex phenomenon called the new heart, which is a symbol of physical and emotional life. They use different methods to get used to the new heart. OBJECTIVE The aim of this study was to explore the integration process with a donated heart in heart transplant patients. METHODS A qualitative study design with a grounded theory approach following Corbin and Strauss was used. Purposive and then theoretical sampling led to the inclusion of 15 heart transplant patients with diverse characteristics. Observations and semistructured interviews were conducted during a 1-year period in 2019 to 2020. Data collection and analysis occurred simultaneously. RESULTS The process of integration with the new heart in the transplant patients or the core category in this study was "rebirth." The process involved thre3 sequential and overlapping phases, which over time led to toleration and management of the situation. Religious issues, emotional chaos, additional worries, and sense of duality in the early stages after transplantation form a cycle, and the person is moving in this cycle. DISCUSSION The results of this study indicated that the patients experienced several emotional and psychological changes after heart transplantation. It was also shown that the participants experienced a change in the emotions and feelings over time. On the basis of the findings of this study, it can be suggested that health care providers need to improve their knowledge about posttransplant changes, recipients' feelings, and adaptation strategies.
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8
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Peer Mentoring as an Avenue to Explore in Kidney Transplantation: Kidney Transplant Recipients' Perspectives on Peer Mentoring. Transplant Direct 2021; 7:e672. [PMID: 34104710 PMCID: PMC8183856 DOI: 10.1097/txd.0000000000001130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/05/2021] [Accepted: 01/12/2021] [Indexed: 12/12/2022] Open
Abstract
Kidney transplant recipients (KTRs) face numerous challenges following transplantation. Given that healthcare professionals do not necessarily have first-hand experience living with or waiting for a transplant, it may be hard for them to communicate with and help patients when it comes to transplant-related issues. KTRs have experiential knowledge, which could enable them to help other patients going through similar situations. Peer mentoring involves pairing mentees with individuals who have had similar experiences, to provide training, information, and emotional support. The aim of this study was to gather KTRs’ perspectives on a potential peer mentoring program.
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9
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Walker MJ. A Heart without Life: Artificial Organs and the Lived Body. Hastings Cent Rep 2021; 51:28-38. [PMID: 33630322 DOI: 10.1002/hast.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The use of artificial organs is likely to increase in the future, given technological advances, increases in chronic diseases, and limited donor organs. This article examines how artificial organs could affect people's experience and conceptualization of bodies and our understanding of the relation of body to self. I focus on artificial heart devices and argue that these have two conflicting potential influences. First, they may influence people to regard the body as machinelike and separable from the self. Second, they may effect changes to subjective experience that can be understood as changes to the self, confirming the self's embodiment. My primary purpose is to increase our understanding of what might change if it becomes more usual to have a body that is partly nonorganic. But I also argue that the analysis points to potential ethical concerns related to strengthening biomedical conceptions of the body and to the devaluing of bodies and body parts.
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10
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Wiltshire G, Clarke NJ, Phoenix C, Bescoby C. Organ Transplant Recipients' Experiences of Physical Activity: Health, Self-Care, and Transliminality. QUALITATIVE HEALTH RESEARCH 2021; 31:385-398. [PMID: 33124516 PMCID: PMC7750649 DOI: 10.1177/1049732320967915] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Physical activity (PA) is an important lifestyle component of long-term health management for organ transplant recipients, yet little is known about recipients' experiences of PA. The purpose of this study was to shed light on this experience and to investigate the possible implications of PA in the context of what is a complex patient journey. Phenomenological analysis was used to examine interviews with 13 organ transplant recipients who had taken part in sporting opportunities posttransplantation. Findings illuminate how participants' experiences of PA were commonly shaped by the transliminal nature of being an organ transplant recipient as well as a sense of duty to enact health, self-care, and donor-directed gratitude. This analysis underlines the potential role of PA in supporting organ transplant recipients' attempts to live well following transplantation and makes novel connections between PA and our existing knowledge about challenges related to identity, survivorship, obligation, and patient empowerment.
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Affiliation(s)
- Gareth Wiltshire
- Loughborough University,
Loughborough, United Kingdom
- Gareth Wiltshire, School of Sport
Exercise and Health Sciences, Loughborough University, John Beckwith
Building, Epinal Way, Loughborough LE11 3TU, UK.
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11
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Almgren M, Lundqvist P, Lennerling A, Forsberg A. Fatigue after heart transplantation - a possible barrier to self-efficacy. Scand J Caring Sci 2020; 35:1301-1308. [PMID: 33369757 PMCID: PMC9291191 DOI: 10.1111/scs.12951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 10/13/2020] [Accepted: 11/29/2020] [Indexed: 11/20/2022]
Abstract
Rationale Recovery after heart transplantation is challenging and many heart recipients struggle with various transplant‐related symptoms, side‐effects of immunosuppressive medications and mental challenges. Fatigue has been reported to be one of the most common and distressing symptoms after heart transplantation and might therefore constitute a barrier to self‐efficacy, which acts as a moderator of self‐management. Aim To explore the prevalence of fatigue and its relationship to self‐efficacy among heart recipients 1–5 years after transplantation. Research method An explorative cross‐sectional design, including 79 heart recipients due for follow‐up 1–5 years after transplantation. Three different self‐assessment instruments were employed; The Multidimensional Fatigue Inventory‐19, Self‐efficacy for managing chronic disease 6‐Item Scale and The Postoperative Recovery Profile. Ethical approval The study was approved by the Regional Ethics Board of Lund (Dnr. 2014/670‐14/10) with supplementary approval from the Swedish Ethical Review Authority (Dnr. 2019‐02769). Results The reported levels of fatigue for the whole group were moderate in all dimensions of the Multidimensional Fatigue Inventory‐19, with highest ratings in the General Fatigue sub‐scale. Those most fatigued were the groups younger than 50 years; pretransplant treatment with Mechanical Circulatory Support; not recovered or had not returned to work. Self‐efficacy was associated with the sub‐dimensions Mental Fatigue (ρ = −0·.649) and Reduced Motivation (ρ = −0·617), which explained 40·1% of the variance when controlled for age and gender. Study limitations The small sample size constitutes a limitation. Conclusions The moderate levels of fatigue reported indicate that it is not a widespread problem. However, for those suffering from severe fatigue it is a troublesome symptom that affects the recovery process and their ability to return to work. Efforts should be made to identify those troubled by fatigue to enable sufficient self‐management support.
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Affiliation(s)
- Matilda Almgren
- Department of Health Sciences at Lund University, Lund, Sweden
| | - Pia Lundqvist
- Department of Health Sciences at Lund University, Lund, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Forsberg
- Department of Health Sciences at Lund University, Lund, Sweden.,Department of Thoracic surgery at, Skåne University Hospital, Lund, Sweden
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12
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McIntyre HF. Pump, person and Parfit: why the constitutive heart matters. MEDICAL HUMANITIES 2020; 46:384-393. [PMID: 33172911 DOI: 10.1136/medhum-2020-011849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
The historical view of the heart as a source and repository of characteristics of individual persons remains prevalent in speech and literature. A more recent scientific view regards the heart as just a replaceable mechanical device, supporting a hydraulic system (the pump-view). To accept the pump-view is to reduce the historical view of the heart, and reference to it, to metaphor. To address whether this conclusion is justified, this paper investigates what constitutes an individual person over time and whether the heart has any role in that constitution. While some physical continuity may be necessary, most philosophers agree that our 'personal identity' is conferred through the persistence of 'psychological' characteristics predominantly through memory. Memory is constituted through the interplay of external and internal sensory experience-to which the heart is a major contributor. On scientific grounds alone this sensory role for the heart makes the pump-view incomplete. If our persistence as a person reflects the totality of experience codified through memory, and the heart is a central source of the internal component of that experience, then the pump-view is also misleading since the heart plays some constitutive role. More widely, if what fundamentally matters for our survival as persons is just psychological continuity, then the pump-view is irrelevant. While a 'supportive heart' may be necessary for continued embodiment, it is on the constitutive role of the heart, as part of a unique internal experience, that our individuation as persons depends.
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13
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Hordern J. The haunted heart and the Holy Ghost: on retrieval, donation and death. MEDICAL HUMANITIES 2020; 46:362-371. [PMID: 32747339 DOI: 10.1136/medhum-2020-011870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
This enquiry examines problems which haunt the 'heart' and its donation. It begins by examining the heart's enduring significance for culturally mediated self-understanding, its vulnerability to misunderstanding and abuse and its relevance to challenging the determination of death by neurological criteria. Despite turns to brain-centred self-conceptions, the heart remains haunted by the hybrid experiences of identity accompanying organ transplant, the relational significance attached to dead hearts witnessed in the Alder Hey scandal and claims that heart transplants commonly constitute the legitimate killing of a person. To explore these phenomena, traditions are retrieved in which the heart-as-organ was construed in terms of a person's core identity. Influential Abrahamic beliefs about 'the heart' are considered in order to explore explanations for why the heart remains culturally pre-eminent, to make intelligible our haunted hearts and to examine possible violations of solidarity in organ donation practice. Jewish and Christian Scriptures are exegeted to illumine the sources of our haunting and address the desire for holistic bodily life. In these sources, the heart is the seat of affections, intelligence and agency but requires healing, conceived via the surgical metaphors of heart transplant and circumcision, if people are to join the insightful, solidary path of pilgrimage. Absent healing, the heart experiences a judgement of the whole person-organ-and-core-at the moment of death. Through such exegesis, the doctrine of the Holy Ghost emerges as a way to make intelligible, though not dispel, the heart's haunting. The doctrine's practical significance concerns the possibility of social unity among hearts, 'intercordiality', which construes people within a covenantal life of pilgrimage which encourages heart donation in certain circumstances, makes intelligible the Alder Hey parents' experience of social misunderstanding and rejects ascribing any legitimacy in medical culture to the consensual killing of patients for the sake of retrieving their organs.
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Affiliation(s)
- Joshua Hordern
- Faculty of Theology and Religion, Harris Manchester College, University of Oxford, Oxford, UK
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14
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The experiences of adult heart, lung, and heart-lung transplantation recipients: A systematic review of qualitative research evidence. PLoS One 2020; 15:e0241570. [PMID: 33175900 PMCID: PMC7657484 DOI: 10.1371/journal.pone.0241570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 10/18/2020] [Indexed: 11/19/2022] Open
Abstract
Aim To review evidence about the experience of being the recipient of a donated heart, lungs, or heart and lungs. Design A systematic review (registered with PROSPERO: CRD42017067218), in accordance with PRISMA guidelines. Data sources Seven databases and Google Scholar were searched in May 2017 and July 2019 for papers reporting English-language research that had used qualitative methods to investigate experiences of adult recipients. Review methods Quality was assessed and results were analysed thematically. Results 24 papers (reporting 20 studies) were eligible and included. Their results were organised into three chronological periods: pre-transplant (encompassing the themes of ‘dynamic psychosocial impact’, ‘resources and support’), transplant (‘The Call’, ‘intensive care unit’), and post-transplant (‘dynamic psychosocial impact’, ‘management’, ‘rejection’). Sub-themes were also identified. It was evident that contemplating and accepting listing for transplantation entailed or amplified realisation of the precipitating illness’s existential threat. The period surrounding transplantation surgery was marked by profound, often surreal, experiences. Thereafter, although life usually improved, it incorporated unforeseen challenges. The transplantation clinic remained important to the recipient. The meaning of the clinic and its staff could be both reassuring (providing care and support) and threatening (representing onerous medical requirements and potential organ rejection). Conclusion This review has implications for the psychosocial care of transplant recipients and indicates the need for further research to gain insight into the experience of receiving a donated heart and/or lung. Impact Medical consequences of heart and lung transplantation are well documented; this is the first systematic review of research using qualitative methods to investigate the experience of heart, lung, and heart-and-lung transplantation. The psychosocial impact of transplantation was found to be dynamic and complex, with notable features evident before, during, and after transplantation. Clinic staff remained significant to recipients. It is clear that recipients need continuing psychosocial as well as medical support.
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Dalvindt M, Nozohoor S, Kisch A, Lennerling A, Forsberg A. Symptom Occurrence and Distress after Heart Transplantation-A Nationwide Cross-Sectional Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17218052. [PMID: 33139609 PMCID: PMC7663327 DOI: 10.3390/ijerph17218052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 10/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022]
Abstract
Experiencing symptoms after heart transplantation may hamper the heart recipient’s self-management which can lead to negative effects. We know little about symptom occurrence and distress after heart transplantation, especially in relation to sociodemographic variables. The aim of the study was to explore self-reported symptom occurrence and distress after heart transplantation and their relationship with self-reported psychological well-being and sociodemographic factors. This multicenter, cross-sectional, cohort study is associated with the Swedish national Self-Management After Thoracic Transplantation study (SMATT). Two questionnaires were distributed at the heart recipients’ yearly follow-up, one to five years post-transplant at three Swedish university hospitals from 2014–2017. In a total 79 heart recipients, 54 men and 25 women, with a mean age 53 years returned the questionnaires. Symptoms occurred differently depending on type and duration of follow-up. The most common symptoms, trembling hands, and decreased libido were also the most distressing. Heart recipients most burdened by symptoms were those younger than 50 years, not working, with poor psychological well-being or living alone. Fatigue explained more than 60% of the variation in transplant specific well-being. In conclusion this study points at the target groups within the heart transplant population that needs person centered symptom management support where the focus should be on side-effects of the medication i.e., trembling hands as well as the patients’ sexual health.
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Affiliation(s)
- Marita Dalvindt
- Department of Cardiothoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden; (S.N.); (A.F.)
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
- Correspondence:
| | - Shahab Nozohoor
- Department of Cardiothoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden; (S.N.); (A.F.)
| | - Annika Kisch
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
- Department of Haematology, Skåne University, 222 42 Lund, Sweden
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden;
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Anna Forsberg
- Department of Cardiothoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden; (S.N.); (A.F.)
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
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16
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Lindberg C, Almgren M, Lennerling A, Forsberg A. The Meaning of Surviving Three Years after a Heart Transplant-A Transition from Uncertainty to Acceptance through Adaptation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155434. [PMID: 32731539 PMCID: PMC7432631 DOI: 10.3390/ijerph17155434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/25/2020] [Accepted: 07/26/2020] [Indexed: 01/10/2023]
Abstract
The rationale was to longitudinally follow-up interviews performed with heart recipients at their one-year examination in order to deepen the understanding of the meaning of surviving a heart transplant. The aim was to explore the meaning of surviving three years after a heart transplant compared to one year and to identify what constitutes the change process. A phenomenological–hermeneutic method was used. This multicenter study was carried out at the two hospitals in Sweden where heart transplants are performed. A total of 13 heart recipients who survived three years after a heart transplant were invited to participate in this three-year follow-up study and 12 accepted, 3 women and 9 men, with a mean age of 51.25 years. The naïve understanding revealed that the heart recipients strongly accepted their life situation and that time had enabled this acceptance of limitations through adaptation. The thematic structural analyses cover six themes illustrating the meaning of acceptance and adaptation, i.e., accepting life as it is, adapting to post-transplant limitations, adapting to a changed body, social adaptation, showing gratitude and trusting oneself and others. In conclusion, achieving acceptance and a solid sense of self-efficacy after heart transplantation is a time-consuming process that involves courage to face and accept the reality and adapt in every life dimension.
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Affiliation(s)
- Catharina Lindberg
- Department of Health Sciences, Blekinge Institute of Technology, 374 35 Karlskrona, Sweden;
| | - Matilda Almgren
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden;
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 405 30 Gothenburg, Sweden
| | - Anna Forsberg
- Care in High Tech Environments, Institute of Health Sciences at Lund University, 221 00 Lund, Sweden;
- Department of Thoracic Surgery, Skåne University Hospital, 222 42 Lund, Sweden
- Correspondence:
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17
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Jones J, Damery S, Allen K, Nicholas J, Baharani J, Combes G. 'You have got a foreign body in there': renal transplantation, unexpected mild-to-moderate distress and patients' support needs: a qualitative study. BMJ Open 2020; 10:e035627. [PMID: 32234745 PMCID: PMC7170619 DOI: 10.1136/bmjopen-2019-035627] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To explore why transplant patients experience unexpected mild-to-moderate distress and what support they may need. DESIGN Qualitative study using individual in-depth interviews. SETTING Four National Health Service (NHS) Trusts in the Midlands, UK. PARTICIPANTS Fifteen renal transplant patients meeting the criteria for mild-to-moderate distress from their responses to emotion thermometers. MAIN OUTCOME MEASURES Identification of the reasons for distress and support options acceptable to renal transplant patients. RESULTS Three themes were interpreted from the data: 'I am living with a "foreign body" inside me', 'why am I distressed?' and 'different patients want different support'. Following their transplant, participants felt that they should be happy and content, but this was often not the case. They described a range of feelings about their transplant, such as uncertainty about the lifespan of their new kidney, fear of transplant failure or fear of the donor having health conditions that may transfer to them. A few experienced survivors' guilt when others they had met at the dialysis unit had not received a transplant or because someone had died to enable them to receive the transplant. No longer having regular contact with the renal unit made participants feel isolated. Some participants did not initially attribute the source of their distress to their transplant. Participants' preferred support for their distress and their preferences about who should deliver it varied from peer support to seeing a psychologist. CONCLUSIONS Raising the issue of post-transplant mild-to-moderate distress with patients and encouraging them to think about and plan coping strategies pretransplant may prove beneficial for the patient and healthcare provider. Patients should be able to choose from a variety of support options.
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Affiliation(s)
- Janet Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sarah Damery
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kerry Allen
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Johann Nicholas
- Renal Unit, Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, Shropshire, UK
| | - Jyoti Baharani
- Renal Unit, Birmingham Heartlands Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gill Combes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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18
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Lape EC, Hudak P, Davis AM, Katz JN. Body-Self Unity With a New Hip or Knee: Understanding Total Joint Replacement Within an Embodiment Framework. ACR Open Rheumatol 2019; 1:90-96. [PMID: 31777785 PMCID: PMC6857960 DOI: 10.1002/acr2.1014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Medical research increasingly makes use of embodiment concepts to understand how illness disrupts unity of body and self. However, few have applied embodiment concepts in total joint replacement (TJR), an effective treatment for end‐stage arthritis. In considering why a troubling proportion of TJR recipients have continued pain and functional limitation, we ask: what role might be played by the embodied experience of living with an implant? Relevant theoretical models and prior research on embodiment in musculoskeletal health and transplantation are reviewed. Our findings suggest a research agenda with implications for addressing suboptimal outcomes in TJR.
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Affiliation(s)
- Emma C Lape
- Brigham and Women's Hospital Boston Massachusetts
| | - Pamela Hudak
- Alternative Dispute Resolution Practice, Inc. Toronto Canada
| | - Aileen M Davis
- Krembil Research Institute University Health Network and University of Toronto Toronto Canada
| | - Jeffrey N Katz
- Harvard Medical School and Brigham and Women's Hospital Boston Massachusetts
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19
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Personality changes following heart transplantation: The role of cellular memory. Med Hypotheses 2019; 135:109468. [PMID: 31739081 DOI: 10.1016/j.mehy.2019.109468] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 09/29/2019] [Accepted: 10/28/2019] [Indexed: 02/05/2023]
Abstract
Personality changes following heart transplantation, which have been reported for decades, include accounts of recipients acquiring the personality characteristics of their donor. Four categories of personality changes are discussed in this article: (1) changes in preferences, (2) alterations in emotions/temperament, (3) modifications of identity, and (4) memories from the donor's life. The acquisition of donor personality characteristics by recipients following heart transplantation is hypothesized to occur via the transfer of cellular memory, and four types of cellular memory are presented: (1) epigenetic memory, (2) DNA memory, (3) RNA memory, and (4) protein memory. Other possibilities, such as the transfer of memory via intracardiac neurological memory and energetic memory, are discussed as well. Implications for the future of heart transplantation are explored including the importance of reexamining our current definition of death, studying how the transfer of memories might affect the integration of a donated heart, determining whether memories can be transferred via the transplantation of other organs, and investigating which types of information can be transferred via heart transplantation. Further research is recommended.
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20
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Van Bulck L, Luyckx K, Goossens E, Oris L, Moons P. Illness identity: Capturing the influence of illness on the person’s sense of self. Eur J Cardiovasc Nurs 2018; 18:4-6. [DOI: 10.1177/1474515118811960] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Liesbet Van Bulck
- KU Leuven Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
| | - Koen Luyckx
- KU Leuven School of Psychology and Development in Context, KU Leuven – University of Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Eva Goossens
- KU Leuven Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, Belgium
| | - Leen Oris
- KU Leuven School of Psychology and Development in Context, KU Leuven – University of Leuven, Belgium
- Research Foundation Flanders (FWO), Brussels, Belgium
| | - Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven – University of Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
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21
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The Heart as a Transplanted Organ: Unspoken Struggles of Personal Identity Among Adolescent Recipients. Can J Cardiol 2018; 35:96-99. [PMID: 30595188 DOI: 10.1016/j.cjca.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 11/24/2022] Open
Abstract
In adult heart transplant recipients, a transformation of the self has been observed simultaneous to the "emotional integration" of the heart following transplantation. However, the experiences of adolescents following heart transplantation are virtually unexplored within the current literature. Our qualitative findings address this gap and explore struggles with personal identity in adolescent heart transplant recipients. Twenty-seven heart transplant patients (67% female, age range: 12 to 18 years) from a large teaching hospital participated in 1-on-1 interviews, which were transcribed verbatim and coded, using methods of constant comparison within a grounded- theory approach. Emergent themes were identified and refined through team consensus. Many participants identified emotional and psychological concerns regarding accepting foreign hearts as their own. This manifested in a range of experiences such as sadness or guilt regarding the death of the donor. Adolescent participants also pondered the potential acquisition of personal qualities or characteristics of the donor. Many participants speculated extensively about the donor and "longed for" donor information. Findings point to the meaning-making processes that adolescent heart transplant patients endure as they grapple with the presence of a foreign, life-giving organ within their bodies and the potential impact on their psychosocial well-being. This paper encourages health care professionals to initiate discussions before and following transplantation that address adolescents' concept of self and offers recommendations for clinical care.
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22
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Abstract
The principal focus of this paper is to consider the implications of head and neck transplantation surgery on the issue of personal identity. To this end, it is noted that the immune system has not only been established to impose a level of self-identity on bodily cells, it has also been implicated in mental development and the regulation of mental state. In this it serves as a paradigm for the mind as the product of cephalic and extracephalic systems. The importance of bodily systems in identity is then discussed in relation to phantom tissue syndrome. The data strongly indicate that, even if surgically successful, head and neck transplantation will result in the loss of the continuity of personal identity.
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23
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Pârvan A. The mind electric: Challenges to clinical categories from a person-centred perspective and the possibilities of metaphysics and art for clinician, patient, and treatment. J Eval Clin Pract 2018; 24:1065-1078. [PMID: 29927030 DOI: 10.1111/jep.12964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 05/07/2018] [Accepted: 05/17/2018] [Indexed: 11/27/2022]
Abstract
The paper proposes that frameworks typical to metaphysics and art could be used in clinical treatment in somatic and psychiatric contexts to ensure improved care. The concept of the "body electric" of somatic patients which I introduced in previous work is developed further and paired with the "mind electric" of psychiatric patients. Both are defined as a patient's personally generated metaphysical possibility of being healthy-within-illness which is experientially actualized. Both concepts are used here to explore the alternative and the serious challenges to treatment approaches focused on clinical categories, disease, provision, and promotion of standardized or "black-box" therapies. An argument against the idea implied by the hope for such mass treatments and corresponding overreliance on science, namely, that health comes from fixing and regularizing, is developed based on cultural history and the evidenced fact that personally assumed health, just like art and metaphysics, is transgressive of scientific data, and accommodates the untrue, the impossible or the irregular as actual and normal. Because normality is created only with the help of disorder and from within it for chronic patients, clinicians should offer them the metaphysical care they need to produce and actualize their possibility of irregular normality or their body/mind electric. Better treatments can only be provided when scientific advances will be matched with advances in the humanistic competence of clinicians.
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Affiliation(s)
- Alexandra Pârvan
- Department of Psychology and Communication Sciences, University of Piteşti, Piteşti, Romania
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24
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Palmar-Santos AM, Pedraz-Marcos A, Zarco-Colón J, Ramasco-Gutiérrez M, García-Perea E, Pulido-Fuentes M. The life and death construct in heart transplant patients. Eur J Cardiovasc Nurs 2018; 18:48-56. [PMID: 29923416 DOI: 10.1177/1474515118785088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The technological advances of medicine, and specifically the techniques of organ transplants, have allowed crossing the border of life and death. This is especially relevant in the case of heart transplant, since its symbolism requires a redefinition not only of these traditional concepts, but also of the body or of one's own identity. AIMS To explore the experiences of patients after receiving a heart from a donor. METHODS A phenomenological qualitative approach, through Merleau Ponty and Levinas perspectives, was conducted to capture the subjective experiences of heart transplant patients. We conducted 22 in-depth interviews: 12 with heart transplant patients from two hospitals in Madrid (Spain), and 10 with relatives who lived with them. RESULTS The line between life and death is erased for heart transplant patients. Three main themes arose from the analysis: towards death, the frontier between life and death, and towards life. The need to redefine the concepts of life and death is structured around issues such as the thought of facing one's own death and the concept of gift and resurrection. CONCLUSION Organ transplant techniques open the door to a new definition of death, of the identity of the body and its parts and the limits of life. Considering the cultural, legal, psychological, social and symbolic elements involved in the heart transplant process, a qualitative approach provides new avenues of understanding the clinical process from the patients' perspective.
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Affiliation(s)
- Ana M Palmar-Santos
- 1 Department of Surgery, Universidad Autónoma de Madrid, Qualitative Health Research Group (GIQS-UAM), Spain
| | - Azucena Pedraz-Marcos
- 1 Department of Surgery, Universidad Autónoma de Madrid, Qualitative Health Research Group (GIQS-UAM), Spain
| | - Juan Zarco-Colón
- 2 Department of Sociology, Universidad Autónoma de Madrid, Qualitative Health Research Group (GIQS-UAM), Spain
| | - Milagros Ramasco-Gutiérrez
- 3 Department of Health Promotion, Regional Health Service of Madrid, Qualitative Health Research Group (GIQS-UAM), Spain
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Shildrick M, Carnie A, Wright A, McKeever P, Jan EHC, De Luca E, Bachmann I, Abbey S, Dal Bo D, Poole J, El-Sheikh T, Ross H. Messy entanglements: research assemblages in heart transplantation discourses and practices. MEDICAL HUMANITIES 2018; 44:46-54. [PMID: 28972037 PMCID: PMC5869462 DOI: 10.1136/medhum-2017-011212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 05/30/2023]
Abstract
The paper engages with a variety of data around a supposedly single biomedical event, that of heart transplantation. In conventional discourse, organ transplantation constitutes an unproblematised form of spare part surgery in which failing biological components are replaced by more efficient and enduring ones, but once that simple picture is complicated by employing a radically interdisciplinary approach, any biomedical certainty is profoundly disrupted. Our aim, as a cross-sectorial partnership, has been to explore the complexities of heart transplantation by explicitly entangling research from the arts, biosciences and humanities without privileging any one discourse. It has been no easy enterprise yet it has been highly productive of new insights. We draw on our own ongoing funded research with both heart donor families and recipients to explore our different perceptions of what constitutes data and to demonstrate how the dynamic entangling of multiple data produces a constitutive assemblage of elements in which no one can claim priority. Our claim is that the use of such research assemblages and the collaborations that we bring to our project breaks through disciplinary silos to enable a fuller comprehension of the significance and experience of heart transplantation in both theory and practice.
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Affiliation(s)
- Margrit Shildrick
- Tema Genus, Tema Institute, Linkopings universitet, Linköping, Sweden
| | - Andrew Carnie
- Winchester School of Art, Southampton University, Winchester, UK
| | - Alexa Wright
- Department of English, Linguistics and Cultural Studies, University of Westminster, London, UK
| | - Patricia McKeever
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Ontario, Canada
| | - Emily Huan-Ching Jan
- Department of Studio Arts, Faculty of Fine Arts, Concordia University, Montreal, Quebec, Canada
| | - Enza De Luca
- Department of Cardiology and Transplantation, University Health Network, Toronto, Ontario, Canada
| | - Ingrid Bachmann
- Department of Studio Arts, Faculty of Fine Arts, Concordia University, Montreal, Quebec, Canada
| | - Susan Abbey
- Department of Psychiatry, University Health Network, Toronto, Ontario, Canada
| | - Dana Dal Bo
- Department of Studio Arts, Faculty of Fine Arts, Concordia University, Montreal, Quebec, Canada
| | - Jennifer Poole
- Faculty of Community Services, School of Social Work, Ryerson University, Toronto, Ontario, Canada
| | - Tammer El-Sheikh
- Department of Studio Arts, Faculty of Fine Arts, Concordia University, Montreal, Quebec, Canada
| | - Heather Ross
- Department of Cardiology and Transplantation, University Health Network, Toronto, Ontario, Canada
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Dicks SG, Northam H, van Haren FMP, Boer DP. An exploration of the relationship between families of deceased organ donors and transplant recipients: A systematic review and qualitative synthesis. Health Psychol Open 2018; 5:2055102918782172. [PMID: 30083368 PMCID: PMC6069040 DOI: 10.1177/2055102918782172] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Following deceased organ donation and transplantation, the narratives of families of donors and organ recipients become connected. This is acknowledged when parties receive anonymous information from donation agencies and transplant centres, when they exchange correspondence or when they meet in person. This article reviews literature describing the experience from the points of view of donor families, recipients, and other stakeholders to explore the dynamic system that evolves around this relationship. Findings highlight a link between identity development and ongoing adjustment and will assist those supporting donor families and recipients to make decisions that fit meaningfully.
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Affiliation(s)
| | | | - Frank MP van Haren
- University of Canberra, Australia
- Australian National University,
Australia
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