The Impact of Organ Transplantation in Heart, Lung and Liver Recipients. Assessments of positive life changes and transplant representations

Abstract

The most effective treatment for heart, lung and liver failure patients is a solid organ transplant. Transplant outcomes studies have found that survival rates and quality of life improve as a result of the transplant procedure. To date, the majority of the health psychology studies in this area have used generalized assessment tools that are characterised with low specificity and limited content range; examining only the negative psychological effects of organ transplantation. This study aimed to explore how heart, lung and liver recipients conceptualise their transplant through the use of participant generated drawings. In addition, this study aimed to investigate the nature of positive effects the transplant has on recipients’ lives using both qualitative and quantitative methods. The data for this study came from a 2009 cross-sectional transplant adherence project and a 2011 follow up interview. The cross-sectional mixed methods study included 87 heart, 45 lung and 193 liver transplant recipients who were recruited from the Cardiac/Heart and Lung Transplant Services in Greenlane Hospital and Liver Transplant Unit from Auckland City Hospital. All participants completed a postal questionnaire that included an open-ended item about benefit finding, the Transplant Positive Effects Questionnaire (TxPEQ), which was especially constructed for this study and the Transplant Effects Questionnaire (TxEQ) to measure emotional and behavioural responses to transplantation. It also included the Brief Illness Perceptions Questionnaire (BIPQ) and an organ drawing task to measure transplant representations. In addition, six participants from the original study took part in a follow up interview that explored the impact of organ transplantation on their lives. The content of organ drawings revealed that participants conceptualized their transplant as having a positive impact on their physical and emotional well being. The dimension of drawings tapped into participants’ transplant representations; recipients who drew more damage in their old organ drawing possessed more negative transplant representations. With regards to the nature of positive transplant effects, coding of the open ended benefit finding item revealed recipients attribute a range of positive life changes to the transplant experience that reflect post traumatic growth. Principal components analysis of the TxPEQ revealed that this new instrument assesses the degree of positive change in three areas of life as a result of the transplant: 1) life philosophy, 2) gratitude and 3) health. The total TxPEQ exhibited adequate internal consistency and validity, as well as presenting as an appropriate instrument for use among heart, lung and liver recipients. The high prevalence of positive life changes suggests that there are aspects of the transplant experience, which facilitate the process of growth across various life domains. The development of assessment tools provides researchers and clinicians a novel approach to assessing the degree and nature of these life changes.