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Biopsychosocial Perspectives in Transplantation. J. R. Rodrigue (Ed.) . New York : Kluwer Academic/Plenum Publishers , 2001 : 188 pp.

Department of Physical Medicine and Rehabilitation, University of Minnesota, Box 390 Mayo Memorial Building, 420 Delaware Street, Minneapolis, MN 55455, USA

Psychosocial factors have a major impact on transplant outcomes and will continue to play an important role in developing ethical and legal guidelines for this dynamic field. Familiarity with these complex issues is essential for anyone working in this area. Biopsychosocial Perspectives in Transplantation provides a good overview of all of the major issues. The nine chapters are concisely written and well referenced.

The first two chapters serve as a general introduction to transplantation. Chapter One provides background information on solid organ transplantation (kidney, pancreas, liver, heart, and lung). The various diseases treated with solid organ transplantation, major medical developments, and survival statistics are summarized. Chapter Two covers blood and marrow transplantation. A somewhat more detailed summary of the procedures is provided, including indications, bone marrow transplant (BMT) types, risks, and outcomes. Four phases of BMT are described along with the psychological ordeals encountered at each phase. The need for patient and family education and ongoing support at each phase is emphasized.

The next two chapters review some of the more controversial topics. Chapter Three deals with social, ethical and legal issues in transplantation. U.S. legislation pertaining to transplantation is reviewed, including the 1968 Uniform Anatomical Gift Act and 1987 revision, the National Organ Transplant Act, and the 1986 Budget Reconciliation Act. Ethical dilemmas stemming from the scarcity of organs are addressed in this chapter, including: determining the legal criteria for death in potential organ donors, the most appropriate way to approach surviving family members about donation, and means of inferring consent. Additional controversies covered include: the pros and cons of offering financial incentives for organs, use of organs taken from executed criminals, and methods used to guard against potential donor coercion.

Psychological considerations of living organ donation are the topic of Chapter Four. Guidelines recommended by the Live Organ Donor Consensus Group (a multidisciplinary group founded in 2000 and published a consensus statement) are reviewed. The chapter also addresses donor motivations, outcomes of donation for the donor, and the role of psychologists in evaluating and assisting donors pre- and postdonation.

Some of the unique problems in evaluating pediatric transplant patients are discussed in Chapter Five. The major developmental phases of childhood and adolescence are reviewed, and the impact of serious medical illness and transplant on psychosocial and cognitive development are briefly summarized. The authors advocate the use of standardized rating scales and the development of larger normative databases to better determine the long-range consequences of transplant.

Chapter Six deals with the broad issue of medical compliance. This is one of the more substantive chapters, perhaps because this topic has received more research attention. There has been no consensus among centers about how compliance should be assessed, or its relative importance in selecting transplant candidates. Descriptive data on the incidence of various forms of pre- and post-transplant noncompliance is provided. Smoking in heart or lung transplant patients and alcohol use in liver transplant patients are by far the most studied areas and hence receive the most attention in this chapter.

Chapter Seven reviews the literature on smoking and substance abuse. Several summary tables provide good reference sources. Much of the data pertains to alcohol use among liver transplant patients. The literature is limited by a heavy reliance on patient self-reports. The authors urge further study on the rates of substance abuse pre- and post-transplant, improved and more consistent assessment methods, and the development and validation of substance abuse treatment tailored to transplant patients.

Chapter Eight addresses mental health issues and psychopharmacology. Depression and anxiety are common problems among all transplant groups, and delirium is common in liver transplant populations. The chapter reviews some of the cognitive and psychiatric side-effects of transplant medications and discusses some of the unique challenges in pharmacologically managing patients with severe medical problems and complex transplant medication regimens.

Lastly, Chapter Nine briefly explores the role of coping, religion, and spirituality. Data is presented to suggest that coping skills may predict transplant outcomes and quality of life. Religion may improve survival and facilitate effective coping.

This book provides a pithy introduction to transplantation in general and the most relevant psychosocial issues. The material is free of technical jargon and should be understandable for the average reader. It will be most valuable to mental health professionals new to the field. As the chapters are brief by design, the text will be of less interest to professionals who already have a solid background in this field or to those looking for a more in-depth treatise on these issues. However, seasoned transplant professionals will find the discussions of current controversies thought provoking, and the summary data a useful reference guide.

Deborah D. Roman