The Transplant Patient: Biological, Psychiatric, and Ethical Issues in Organ Transplantation

Cover......Page 1
Half-title......Page 3
Title......Page 5
Copyright......Page 6
Contents......Page 7
Contributors......Page 9
Preface......Page 11
The immunologic barrier: the one-way paradigm......Page 15
Graft-versus-host disease......Page 16
With total body irradiation......Page 17
Deficiencies of the one-way paradigm......Page 20
Cell-mediated immunity......Page 21
Whole-organ transplantation......Page 23
Historical enigmas......Page 24
Augmentation of spontaneous chimerism......Page 25
Rejection after drug discontinuance......Page 28
Bone marrow transplantation......Page 29
Acknowledgments......Page 30
References......Page 31
Patient selection – medical issues......Page 35
Rationale for psychosocial screening......Page 37
Selection criteria......Page 39
Refusal rates......Page 43
Instruments for psychosocial screening......Page 44
Standardized psychological tests in transplant patient evaluation......Page 45
Screening and the Americans with Disabilities Act......Page 51
References......Page 53
Introduction......Page 56
Donor motives......Page 57
Donor decision-making......Page 60
Donor ambivalence......Page 63
Postdonation physical and psychosocial issues......Page 66
Kidney donation outcomes......Page 67
Bone marrow donation outcomes......Page 74
Liver donation outcomes......Page 75
Conclusions and future research directions......Page 76
References......Page 77
Introduction......Page 81
Quality of life and its measurement......Page 82
QOL studies included in the present review......Page 84
A general summary of recipient QOL studies......Page 123
Does QOL improve from pre- to post-transplantation?......Page 125
Is QOL in transplant recipients better than QOL in other similarly ill patient comparison samples?......Page 130
Is QOL in transplant recipients similar to or better than QOL in healthy samples?......Page 133
Methodologic issues affecting study results......Page 134
Perceived burdens of the transplantation experience on family members......Page 136
Quality of life in transplant recipients’ family members......Page 138
General summary and conclusions......Page 141
References......Page 143
Introduction......Page 160
Cardiac transplantation......Page 162
Lung transplantation......Page 167
Liver transplantation......Page 168
Renal transplantation......Page 171
Summary and Conclusions......Page 174
References......Page 175
Introduction......Page 178
Standardized battery......Page 180
Modality-specific evaluation......Page 181
Cognition in relation to psychopathology......Page 182
Alcohol and drug abuse effects on cognition......Page 183
Iatrogenic effects on cognition......Page 184
General physical fitness and cognition......Page 185
Functional organization of the cortex......Page 186
Cognitive deficit in patients presenting for organ transplantation......Page 188
Intelligence......Page 189
Attention and concentration......Page 190
Language......Page 191
Perception......Page 192
Academic achievement......Page 193
Computer interactive evaluation......Page 194
Neuropsychologic change associated with organ transplantation......Page 195
Conclusions......Page 196
References......Page 197
General issues in organ insufficiency......Page 201
Absorption......Page 202
Hepatic drug metabolism......Page 203
Hepatic isozymes......Page 206
Cyclosporine......Page 210
FK506......Page 214
OKT3......Page 216
Corticosteroids......Page 217
Cellcept (mycophenolate mofetil)......Page 218
Acyclovir......Page 219
Alpha-interferon......Page 220
Quinolones......Page 221
References......Page 222
Epidemiology......Page 228
Pretransplant survival......Page 230
Ethics and policies......Page 231
Liver transplantation selection criteria and pre-transplantation length of sobriety requirements......Page 232
Candidate selection instruments......Page 234
Liver transplantation – post-OLTX survival......Page 236
Defining relapse in post-OLTX alcoholic cirrhotics......Page 237
Monitoring post-OLTX alcohol use for alcoholic cirrhotics......Page 238
Predictors of post-OLTX alcohol use......Page 240
Post-transplant alcohol-related morbidity and mortality......Page 242
Heart transplant alcohol-related morbidity and mortality......Page 244
References......Page 245
Introduction......Page 253
The justification for transplantation......Page 254
Is the donor really dead?......Page 255
Donors whose life is not-life......Page 256
Living healthy donors......Page 259
The organ market......Page 261
Dangerous donors......Page 263
Xenotransplantation......Page 264
Images and ethical problems......Page 265
The idea of a gift......Page 266
References......Page 267
Introduction......Page 269
Immunity and the mind......Page 270
Psychoneuroimmune communication......Page 272
Stress and immunity......Page 277
Psychiatric disorders and immunity......Page 279
Endocrine regulators of immunity......Page 280
Neuropharmacology and allograft rejection......Page 281
Antidepressants......Page 282
Summary......Page 283
References......Page 284
Epidemiology......Page 289
The family......Page 290
Development......Page 291
Responses of staff......Page 292
Pretransplantation evaluation......Page 293
Waiting......Page 294
Transplantation hospitalization......Page 295
Post-transplant follow-up......Page 296
References......Page 298
Introduction......Page 301
Increased public awareness......Page 302
Use of nonheart beating donors......Page 303
Presumed consent......Page 304
Xenotransplantation......Page 305
New immunosuppressive agents......Page 306
RS-61443......Page 307
Brequinar sodium......Page 308
Intestinal transplantation......Page 309
Pancreas and islet cell transplantation......Page 310
Tolerance induction......Page 311
Chimerism......Page 313
References......Page 314
Index......Page 319