Progress in Transplantation

Transplant assessment of pedophiles and stalkers presents a challenge for clinicians and requires the ability to separate the science from the hysteria. Although rarely seen in organ transplant clinics, the presence of psychosexual disorders can result in both criminal charges and harsh societal reactions. Clinicians must be able to assess and make informed recommendations about the suitability of the candidate and any potential risks for staff, other patients, and society at large. Six patients (5 pedophiles and 1 stalker) were assessed at our major regional multiorgan transplant program; each patient presented with unique and challenging assessment, treatment, and selection issues for the transplant team. The objectives of this article are to raise awareness of the issues associated with pedophiles and stalkers, and to provide the basis for better-informed discussions based on one program's struggles with its candidate selection and follow-up.

Improving employment outcomes for transplant recipients can positively contribute to a patient's identity, self-esteem, and quality of life. Placing a dollar figure on the costs associated with advanced medical procedures is much easier than placing a dollar figure on the benefits resulting from being employed after transplantation. This article outlines the work of the Life Options Rehabilitation Advisory Council and how it has assisted people with kidney disease—those on dialysis and those who received transplants—to achieve life goals and provide long-term access to employer group health plans. A review of current work incentives includes the Ticket to Work and the Work Incentives Improvement Act, Medicaid Buy-in Programs, and other work incentives related to the Social Security system. Effective rehabilitation outcomes can be enhanced in the transplant population through knowledge of work incentives and awareness of obstacles that are perceived by rehabilitation agencies in working with this group.

A longitudinal study of 20 liver transplant recipients was conducted to investigate their posttransplant recovery experience. Data were collected using semistructured interviews at 6 weeks, 6 months, and 1 year after transplantation. Qualitative analysis of data revealed physical, psychological, social, economic, and spiritual dimensions of recovery. Findings reflect ongoing improvement of physical health and functionality for most recipients. Those with continuing health problems often suffered from preexisting health conditions. Psychological adjustment was uneven, with intermittent periods of fear, anxiety, and depression. Some recipients reported short-lived split identities and personality changes. Social support of family was critical in the hospital and at home. Economic issues became primary by the 1-year interview, with all recipients questioning whether they could afford ongoing healthcare and medicines. Spiritual needs were met in secular and nonsecular activities. Findings suggest that healthcare personnel should attend to the lived experience of liver transplant recipients.

Living related liver donations are increasingly used to address the lack of organs available to patients faced with end-stage liver disease. A significant need exists for enhanced psychosocial intervention for donors. We sought to explore donor reactions by assessing psychosocial issues after donation. A descriptive review of donors was undertaken. The overall incidence of psychosocial issues after donation was examined by using a uniform interview questionnaire and by anecdotal case studies. Responses tend to indicate a general positive reaction to donation; yet, findings suggest a need for more preparation in the predonor stage, 100% social work follow-up after donation to provide needed support services, and inclusion of the donor as a critical partner in organ transplant treatment. A more extensive study drawing on the questionnaire may offer a standardized approach to the treatment of organ donors.

In the last half century, informed consent has become a central tenet of all research involving human subjects. However, even after the worldwide adoption of regulations aimed at ensuring the protection of subjects, some abuses continue. The installation of oversight bodies, such as institutional review boards, has prevented the bulk of deliberate mistreatment; however, unintentional coercion is still a problem. Informed consent is not limited to obtaining a signature on a consent form, but a process of decision making designed to protect the rights of patients and subjects. It is a constant, ongoing exchange of information between researcher and subject. Although research is invaluable to the advancement of medicine and transplantation, researchers have the responsibility to protect their subjects' rights and autonomy. This paper provides an overview of informed consent, principles behind the process, and implications of current regulations to assist readers in their endeavor for sound and ethical research.

Quality of life is an important outcome indicator of experiences associated with liver transplantation. Unfortunately, quality of life has been defined in many different ways, causing confusion and misconceptions among practitioners, researchers, policy makers, and patients. This exploratory qualitative study was initiated to gain greater understanding regarding the adult transplant recipients' experiences with liver transplantation in order to direct future studies with this population and to assist in selection of a relevant quality of life survey tool for quantitative investigation. Twelve informants (7 women, 5 men) shared their experiences in face-to-face interviews conducted by the researcher. Analysis of these interviews reveals the importance of physiologic, psychological, social, spiritual, family, and socioeconomic aspects of quality of life for liver transplant recipients.

West Nile virus is a new challenge for transplant programs worldwide. It is a mosquito-borne disease, which has become increasingly prevalent in North America since it was first recognized in New York in 1999. A review of a case study and the literature shows that the morbidity and mortality associated with West Nile virus infection and transplant recipients are alarmingly high. Treatment options are limited because of transplant programs' limited experience in working with this virus. Transplant programs must develop action plans for education on West Nile virus and its prevention to decrease the risk of infection among their transplant recipients.