Mr. F. is a fifty-year-old father of two school-aged daughters. Six years ago, he received a double lung transplant because he was suffering from interstitial lung disease, a fatal illness that causes suffocation by progressive scarring of the lungs. He is now experiencing chronic rejection of the transplant and is being considered to receive another. Without it, he is expected to survive only a year and a half. With it, his prognosis will improve, but the numbers are still not good.
Three years after his lung transplant, Mr. F. stopped attending his office visits. For a period of sixteen months he went without the studies and attention essential to posttransplant care. He stopped performing the required daily self-monitoring of his lung function about eight months after his transplant, but he has maintained a regular exercise regimen. While lost to follow-up, he continued to take his immunosuppressant medications, but he stopped taking medicine to control his high blood pressure because of its expense.