Sheila Jowsey-Gregoire1, Martin Kumnig. 1. aDepartment of Psychiatry and Psychology Mayo Clinic Rochester, Rochester, Minnesota, USA bDepartment of Medical Psychology, Medical University of Innsbruck, Center for Advanced Psychology in Plastic and Transplant Surgery, Innsbruck, Austria.
Abstract
PURPOSE OF REVIEW: Vascularized composite allotransplantation (VCA) encompasses hand, face, uterus, penile and lower extremity transplantation. Psychosocial factors are recognized as important, but no standard approach to the evaluation, selection or posttransplant care has been described and thus, the development of a standardized approach is needed. RECENT FINDINGS: Various psychosocial assessment tools have been reported. Body image and the functional impact of hand versus face transplantation are notable issues. Patients with psychiatric, chemical dependence histories and suicide attempts have been transplanted. Loss of graft or decreased function because of nonadherence has occurred. Screening for depression, social adaptation, coping styles and quality of life (QOL) is common. SUMMARY: Although VCA is not a lifesaving procedure, as in solid organ transplantation, the following areas require assessment: psychiatric stability, history of chemical dependence, family support, adherence and understanding of transplantation. VCA requires the incorporation of a visible allograft, lengthy rehabilitation, occupational considerations, prosthetic use, possible screening for posttraumatic stress disorder related to injuries and phantom limb pain. Intense media interest may lead to distress. Development of an instrument to address these areas initially and over time to monitor for changes in QOL and training the psychosocial team is a priority.
PURPOSE OF REVIEW: Vascularized composite allotransplantation (VCA) encompasses hand, face, uterus, penile and lower extremity transplantation. Psychosocial factors are recognized as important, but no standard approach to the evaluation, selection or posttransplant care has been described and thus, the development of a standardized approach is needed. RECENT FINDINGS: Various psychosocial assessment tools have been reported. Body image and the functional impact of hand versus face transplantation are notable issues. Patients with psychiatric, chemical dependence histories and suicide attempts have been transplanted. Loss of graft or decreased function because of nonadherence has occurred. Screening for depression, social adaptation, coping styles and quality of life (QOL) is common. SUMMARY: Although VCA is not a lifesaving procedure, as in solid organ transplantation, the following areas require assessment: psychiatric stability, history of chemical dependence, family support, adherence and understanding of transplantation. VCA requires the incorporation of a visible allograft, lengthy rehabilitation, occupational considerations, prosthetic use, possible screening for posttraumatic stress disorder related to injuries and phantom limb pain. Intense media interest may lead to distress. Development of an instrument to address these areas initially and over time to monitor for changes in QOL and training the psychosocial team is a priority.
Authors: Sarah E Van Pilsum Rasmussen; Alexander Ferzola; Carisa M Cooney; Jaime T Shores; Wp Andrew Lee; Emily Goldman; Christina L Kaufman; Gerald Brandacher; Dorry L Segev; Macey L Henderson Journal: SAGE Open Med Date: 2020-07-09
Authors: Dawn Finnie; Joan M Griffin; Cassie C Kennedy; Karen Schaepe; Kasey Boehmer; Ian Hargraves; Hatem Amer; Sheila Jowsey-Gregoire Journal: Front Psychol Date: 2022-09-27