Family Members, Transplantation Candidates, and Patients Who Underwent Liver Transplantation Had Insufficient Information About the Procedure.

INTRODUCTION: Adherence to treatment is essential for a successful liver transplantation (LT) because LT requires information, abilities, and competencies of patients and family members. OBJECTIVES: This study sought to identify whether the information received about the LT process was enough for either patients or family members who attended a liver transplant center in a school hospital. METHODS: This was a transversal study using questionnaires to verify received information on LT. It included 50 patients on the waiting list for LT, 50 transplanted patients, and 50 family members. RESULTS: There was a prevalence of men (82%) among patients, age range from 19 to 67 years (average: 46.87 ± 10.99), and of women (74%) among family members, age range from 18 to 80 years (average: 43.5 ± 11.77). The majority of subjects (88%) had a low education level. The most frequent etiology of hepatic cirrhosis was viral hepatitis associated with alcohol. A significant number of the listed and transplanted patients as well as all family members reported insufficient information about the process of the transplantation. The kind of insufficient information varied according to the period of treatment. The best way to obtain information, as reported by patients and family members, was a combination of oral and written information. CONCLUSIONS: Our data show the need for improvement in the means of delivering information to patients and family members, and an explanatory manual was created from this study.

Families who previously refused organ donation would agree to donate in a new situation: a cross-sectional study.

BACKGROUND: The limited supply of organs restricts the number of transplantations. Studying the families who refuse donation may help to increase the number of transplantations. METHODS: This descriptive cross-sectional study used a questionnaire to obtain information from 61 family members who had refused to donate organs from January 1997 to December 2004. The exclusion criterion was donor death less than 1 year from the study. The mean age of subjects was 41 ± 12.7 years (range, 18 to 79 years) with 66% women. RESULTS: More than half (36 of 69; 52%) of the families who refused donation would agree to donate in a new situation. The primary reasons for refusing donation were: disagreement among family members (25 of 128; 19%), lack of knowledge regarding the deceased's wishes (22 of 128; 17%), and previous request from the deceased not to be a donor (17 of 128; 13%). The most frequent suggestions to increase organ donation were to provide families with more information (43 of 149; 29%), initiate contact among the families (36 of 149; 24%), and involve a trusted physician (30 of 149; 20%). CONCLUSION: Most family members who refused organ donation changed their minds and would agree to donate in a few situation. Most of the reasons for refusing to donate reflected a lack of information and discussion on the topic.

Quality of life, depression, and psychosocial characteristics of patients awaiting liver transplants.

BACKGROUND: The identification of the psychological issues that impair the quality of life and the adherence to treatment in transplant candidates are important. OBJECTIVE: This study evaluated the presence of symptoms of depression and the quality of life of liver transplant candidates. METHODS: One hundred liver transplant candidates underwent a psychological analysis using the following instruments: the short form-36 (SF-36) quality of life questionnaire, the Beck depression inventory (BDI), and Structured Interviews for liver transplant candidates. RESULTS: Seventy-three (73%) of the patients were males. Interestingly, 63% of the patients were in a domestic partnership. At the time of the evaluation, 55 patients were not working due to illness, 27 patients were actively working, and 11 patients were retired. Importantly, fears related to the transplant (e.g., fear the surgery and of death) were identified in 38% of the patients. The data from this study demonstrated a significant negative correlation between depressive scores (BDI) and seven of the eight areas of quality of life (SF-36), such as functional capacity (r = .317, P = .0013), social aspects (r = -.469, P < .0001), economic aspects (r = -.319, P = .0012), and mental health (r = -.3832, P < .0001). CONCLUSION: The data indicated that the psychological aspects related to transplants require psychological intervention because they can affect the recuperation process, the quality of life, and the adherence to treatment for potential transplant patients.

Report of initial experience in small bowel transplantation at São José do Rio Preto Medical School Hospital.

Intestinal failure is the patient's inability to maintain hydroelectric and nutritional support by the digestive route, arising from massive enterectomy or diseases in which the bowel is incapable of adequately absorbing fluids and nutrients. Patients with intestinal failure associated with short bowel syndrome (SBS) and with other functional diseases with malabsorption or with total parenteral nutrition-related complications (recurrent sepsis and thrombosis of one or more deep venous accesses) are candidates for small bowel transplantation (SBT), which can be an isolated small bowel, a combined liver and small bowel, or a multivisceral graft. At our institution, three isolated SBTs were performed as our initial experience with this transplant.